In Florida, a nurse practitioner can sign a Do Not Resuscitate order only if she or he is registered for autonomous practice under state law. A standard nurse practitioner working under physician supervision cannot. The authority is real but narrow, and it comes from the intersection of two statutes and an administrative rule rather than a single provision.
Which Nurse Practitioners Qualify
The nurse practitioner must hold autonomous practice registration under Florida Statute § 464.0123. That registration is limited to primary care fields: family medicine, general pediatrics, and general internal medicine.1Online Sunshine. Florida Statutes 464.0123 – Autonomous Practice by an Advanced Practice Registered Nurse A nurse practitioner who practices under a supervising physician’s protocol, or one who works in a specialty outside primary care, does not have signing authority for a DNR, no matter how experienced.
If you’re a patient trying to arrange a DNR, the practical question to ask your provider is direct: are you a registered autonomous APRN? If the answer is no, the order will need a physician, osteopathic physician, or physician assistant instead.
Where the Authority Comes From
Florida Statute § 401.45 is the governing law on DNR orders. On its face, it authorizes only “the patient’s physician or physician assistant” to sign one.2Florida Senate. Florida Code 401.45 – Denial of Emergency Treatment Advanced practice registered nurses are not named.
The gap is closed by § 464.0123, which permits an autonomous APRN to “provide a signature, certification, stamp, verification, affidavit, or endorsement that is otherwise required by law to be provided by a physician.”1Online Sunshine. Florida Statutes 464.0123 – Autonomous Practice by an Advanced Practice Registered Nurse Because § 401.45 requires a physician signature on a DNR, the autonomous practice provision extends that authority to qualifying APRNs by operation of law.
Florida’s administrative code confirms the reading. Rule 64J-2.018 provides that a DNR order “must be signed by the patient’s physician, osteopathic physician, autonomous advanced practice registered nurse, or physician assistant.”3Legal Information Institute. Florida Administrative Code R. 64J-2.018 – Do Not Resuscitate Order Form and Device The official state DNR form, DH Form 1896, includes a checkbox for “autonomous practice registered nurse” alongside the boxes for physician and physician assistant.4Florida Department of Health. Form DH 1896 – Do Not Resuscitate Order
What Else the Order Needs to Be Valid
A qualifying signature is only one piece. If any of the following are wrong, EMS personnel are not required to honor the DNR, and they will perform CPR by default.
The Right Form
The order must be on DH Form 1896, the official state DNR form incorporated by Rule 64J-2.018.5Florida Department of Health. Do Not Resuscitate Order A handwritten note, a hospital chart entry, or any other document will not substitute. The form is available from the Florida Department of Health.
Yellow Paper
The form must be printed on yellow paper. Any shade of yellow qualifies, but EMS is only obligated to honor the order if it appears on yellow paper, the content has not been altered, and the printed text is legible. Photocopies and electronic reproductions of the completed original are valid as long as they accurately reproduce the original on yellow paper, including handwriting and signatures.3Legal Information Institute. Florida Administrative Code R. 64J-2.018 – Do Not Resuscitate Order Form and Device
Two Signatures
Both the healthcare provider and the patient must sign. If the patient has capacity to make the decision, that patient signature is required.4Florida Department of Health. Form DH 1896 – Do Not Resuscitate Order Florida does not require notarization or witnesses, and the form has no fields for either.
When the Patient Cannot Sign
If the patient lacks capacity, someone legally authorized to act on their behalf can sign in their place. Florida recognizes four categories:
- A healthcare surrogate the patient previously designated in writing.
- A healthcare proxy selected by the patient’s attending physician under Chapter 765 when no surrogate has been named.
- A court-appointed guardian under Chapter 744 with delegated authority to make healthcare decisions.
- An agent under a durable power of attorney under Chapter 709 expressly authorized to make healthcare decisions.
A guardian or attorney-in-fact whose authority is limited to financial matters cannot sign a DNR. The healthcare authority must be specifically delegated.2Florida Senate. Florida Code 401.45 – Denial of Emergency Treatment
A DNR Is Not an Advance Directive
One boundary worth flagging, because patients and families often assume otherwise. A DNR order is not the same as an advance directive or living will, and one does not substitute for the other. Rule 64J-2.018 says so directly: a DNR order “is not a substitute for an advance directive, living will, or declaration.”3Legal Information Institute. Florida Administrative Code R. 64J-2.018 – Do Not Resuscitate Order Form and Device
An advance directive under Florida Statute § 765.101 is any written or oral statement expressing wishes about healthcare or designating someone to make healthcare decisions on the patient’s behalf.6Online Sunshine. Florida Statutes 765.101 – Definitions A living will covers a range of treatments in scenarios of terminal illness or persistent vegetative state and speaks to the treating physician. A DNR order is much narrower. It is a medical order that addresses one question, whether CPR should be attempted during cardiac or respiratory arrest, and it is written primarily for EMS. A patient who wants comprehensive control over end-of-life decisions typically needs both documents, and both should be signed by someone with authority to sign them.