Advance directives and the Patient Self-Determination Act: what is a nurse to do?

Since the Patient Self-Determination Act was enacted in 1991, asking patients whether they have advance directives (eg, a Living Will and a Durable Power of Attorney for Health Care Decisions) has become part of the admission procedures at health care facilities. However, questions may still remain about what exactly is the role of the health care provider in this part of the admission process. In many health care settings, the nurse has the responsibility to ask the patient about advance directives. If this occurs during preparation for surgery or other medical procedures, it adds responsibility for the nurse in an already hectic time. This article defines advance directives and examines their place in the admission process. The article further addresses to what extent health care providers are responsible for discussing patients' rights and advance directives and suggests methods that may facilitate the nurse's role in this responsibility.