Advanced Directives in Nursing: What do you need to know?

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It is the nurse’s job and part of the law (Client Self-Determination Act) to assess for existing advanced directives and integrate them into the patient’s care, and inform and educate about them if the patient is unfamiliar with advanced directives

Wikipedia | Mayo Clinic

  • Check the EHR for any advanced directives
  • Ask the patient: “Mr. Smith, do you have any advanced directives already set up? Do you have a living will or healthcare power of attorney?
  • If the patient says yes, ask for copies so that they can be added to the chart

Educate the patient

about them if they don’t have any or know what they are


  • A living will is a document that says what you want to be done, or not done, in the event that you become incapacitated
  • A durable power of attorney is someone who makes medical decisions for you when you are incapacitated
  • Assess for existing advanced directives
  • If the patient becomes incapacitated, integrate them into their care

A health care proxy is the document that outlines who is the durable power of attorney.

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Podcast Transcription

Welcome to the unofficial NCLEX Prep podcast by 00:00:07] where our goal is to give you the tools and the confidence that you need to succeed in nursing school, on the NCLEX, and in your life as a nurse.


To get the massive PDF guide that goes along with this podcast, head over to That’s Thank you so much for joining us today. We want you to succeed. We’re here to help you along in the process. Now let’s roll into the show.


All right, guys. Welcome to episode 1, what do nurses need to know about advanced directives? First, let’s go ahead and define what advanced directives are. I’m going to define a couple very important terms that you need to know.


First one, living will. A living will is a document that says what you want done, or not done in the event that you become incapacitated. Examples of this would be, “I want CPR, I want a breathing tube placed.” or I don’t want those things, or maybe I want CPR and a breathing tube, but if there’s no chance at me having a normal life and I’m going to be bed-ridden in a nursing home the rest of my life, I don’t want artificial nutrition. I want to be allowed to pass naturally. This is how I want that to look. That’s what that, a living will is.


It can look very different for many people. It’s an actual document that outlines these things in much more professional, fancy language than what I just described.


The next definition, a durable power of attorney, sometimes called a healthcare power of attorney. It’s someone who makes medical decisions for you when you become incapacitated. The key there, though is when you become incapacitated, when, or if you become incapacitated. If you are of sound mind, this doesn’t apply. I’ll give you an example.


Had a patient once. He had surgery. He was a little bit of a different kind of guy, whatever. I see everything. I don’t really …. I didn’t even think anything about it. I let his family back in after surgery. He’s fine. I think he had some mild pain, but that was about it.


I’m at the desk and his daughter comes up to me. This was after I had introduced myself as a nurse, “Hey, I answered some questions and I left. Hey, I’ll be back in a little bit.” She comes to me at the nurses’ station. “He’s driving me nuts. He’s going to be asking about this. He’s going to keep me up all night. I need to stay here with him, but he’s going to keep me up all night, can you just knock him out? It’s okay. I’m his healthcare power of attorney. It’s okay. Just give him whatever.”


I actually had to say, “I understand you’re his healthcare power of attorney, but he is of sound mind right now. He is totally with it. If he doesn’t want, or require those medications, I can’t just give those to him. He’s having mild pain. I’ve given him pain medication to address that, which should kick in.”


It was very mild pain medication, so it wasn’t like it was going to knock the guy out. She wanted him to go to sleep, so she could sleep and didn’t want to talk to him all night apparently. “Hey, I’m his healthcare power of attorney, it’s okay.” No, that’s not how it works.


This is when the person is totally incapacitated. They can’t speak. They can’t tell you, “I want this, I don’t want this.” That’s when this healthcare power of attorney comes into play. There’s the legal next of kin and all that stuff where, if you don’t have these documents set up, it falls to your spouse. That’s a whole other podcast. This is a document that’s says for sure, “This is the person that I designate.” They’re very important to have.


The last definition is a healthcare proxy. It’s a document that outlines exactly who that healthcare power of attorney, durable power of attorney is. The documents, they are legal documents. Most states have very specific rules you have to follow for them to be recognized.


It’s really important to know, within your state, what those rules look like, not for the NCLEX. The NCLEX isn’t going to ask you as a California nurse, what is the North Carolina process of getting that. No, it’s not going to be that specific. It’s important you know what they are.


I’m just speaking from a practical, at the bedside. I actually had a situation once where I had a patient. I’m in North Carolina. The patient had just moved from the Midwest, I think. They had a lot of healthcare stuff going on where they had a very specific living will, a specific durable power of attorney, legal guardian, a whole bunch of stuff.


The laws in the other state were different from what North Carolina was. We really had to sit down with case management and our legal team and what is …? “Wait, hold on. This is what this state says. It’s a different process. Just because it’s in this state, doesn’t mean it works in this state.” There’s a new process they have to go through.


It looks different. I won’t exactly go over what that means. A lot of times, it’s a document that’s notarized and signed with some witnesses and whatnot.


You as the bedside nurse, you get a patient admitted when you’re checking them out, you want to check in the chart to see if they already have advanced directives. Most hospitals now have those electronic healthcare records where you check and see if some are already scanned in. If they are, wonderful. You’d still want to ask, “Hey, do you have anything new to add to it? Has anything changed?”


If you don’t see anything there, you want to ask the patient, “Hey, Mr. Smith, do you have any advanced directives already set up? Do you have a living will, healthcare power of attorney, or any paperwork?” If they say, “Yes” we want to make sure we ask for copies, so they can be added to the chart.


If the patient does become incapacitated, then we start to integrate them into their care. A lot of times we have these on the chart and thankfully, hopefully we never have to use them, but it’s something we want to make sure we have just in case.


If the patient says, “Hey, I don’t know what an advanced directive is and I don’t know. I don’t know what that is.” Educate them and their loved ones about what they are, the process for creating them, resources. A lot of hospitals actually have people on staff that can help set up these while they’re still in the hospital. The key is is they have to be of sound mind.


If you have someone that has come with a stroke, if they’ve come in with something where they’re not of sound mind, or they’re getting these potent medications, you won’t be able to do that at that point. It’s important that they know what they are and when they want to set them up, what steps they need to take. That is episode 1, what do nurses need to know about advanced directives.


This has been another episode of the unofficial NCLEX prep podcast, by To get the massive cheat sheet, PDF guide that goes along with this podcast, head over to That’s Thank you so much for joining us today. Thank you for being part of the NRSNG family. We appreciate you guys. We love you guys and we’re here to hold your hand and help you reach that goal of becoming an RN.


Our goal is to create a generation of nurses that is focused, that is dedicated, and that really understands what’s going on. Thank you for being here. Thank you for being part of the NRSNG family. You guys know what time it is now. It’s time to go out and be your best self today. Happy nursing.


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