Provider orders for life-sustaining treatment (POLST) are a set of portable medical orders that allow seriously ill or frail people to communicate their end-of-life care wishes to health care facilities and providers.
POLST terminology varies from state to state and may be referred to as POST, MOLST, COLST or MOST, among others.
POLST forms and advance directives are similar in that they are both advance care planning tools, and different in many ways. A POSLT form is a complement to advance directives by allowing patients to specify what care, treatments or interventions they wish to receive (or not receive) in an emergency situation. A patient’s choice to fill out a POLST form is voluntary but is becoming more common as part of end-of-life planning as it bolsters shared decision making between a provider and patient.
Historically, POLST orders could only be authorized or signed by a physician. In recent years, more states have expanded authority for physician assistants and advanced practice nurses, including nurse practitioners, to fill out and sign POLST forms. At least 37 states authorize nurse practitioners to fill out and sign POLST forms.
Expanding authority for nurse practitioners, among others, may allow for timelier completion of forms as more providers on the care team are authorized to sign. This authority gives patients the option to have end-of-life conversations with their established provider when that provider is a non-physician. Lastly, it ensures that patients in rural or underserved areas still have access to these medical orders when a nurse practitioner may be the only provider in the area.
NCSL’s Scope of Practice (SOP) Policy website now features nurse practitioners’ authority to sign POLST forms. More information about this topic can be found on the nurse practitioner page on the SOP website.
Legend
■ NPs are not explicitly authorized to sign POLST forms
■ NPs are authorized to sign POLST forms
■ Information is not currently available
Sarah Jaromin is a policy analyst in NCSL's Health Program.
This resource is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $767,749 with 100% funded by HRSA/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. government.