Can a Registered Nurse Pronounce Death? The Rules in Every State

In most states a registered nurse can pronounce death, but only under conditions the state sets. 25 jurisdictions (24 states and DC) say so in a statute or rule, and 5 more say so through the board of nursing or the health department. The usual conditions are an expected death, a patient of a hospice, home health agency or facility, and a physician who has agreed in writing or is told right away. States differ on the setting, on who has to sign off first, and on LPNs. Four states leave pronouncement to a physician or coroner, and in almost every state the cause of death is certified by someone else.

This article goes through every state for RNs, and LPNs where the state says, with the rule quoted and linked. The rule is often not in the nurse practice act. It sits in a vital records law, a public health statute or a board position statement, so I've labelled each source. I'm an occupational therapist, not a nurse, so I've stuck to what the rules say.

This isn't legal advice. I checked every rule on November 9, 2026, on the state's own legislature, code or board site. Your board's current rule is the one that counts.

The Short Answer

• Yes, by statute or rule: 25. Alaska, Arkansas, Connecticut, Delaware, DC, Georgia, Hawaii, Iowa, Kentucky, Massachusetts, Michigan, Montana, Nevada, New Hampshire, New Jersey, New Mexico, Ohio, Pennsylvania, Tennessee, Texas, Utah, Virginia, Washington, West Virginia and Wisconsin.
• Yes, by board or health department guidance: 5. Arizona, Mississippi, North Carolina, Rhode Island and Wyoming. North Carolina's board says yes while a statute says a physician determines death.
• The state says the law doesn't stop it, or leaves it to the facility: 4. Minnesota, New York, North Dakota and Vermont.
• No, or physician only: 4. Alabama, Kansas, Louisiana and South Carolina.
• No specific rule: 12. Colorado, Florida, Idaho, Illinois, Indiana, Maine, Maryland, Missouri, Nebraska, Oklahoma, Oregon and South Dakota. Couldn't verify: 1, California.
• At home: of the 25 with a statute or rule, 20 reach a death at home, three of them only for hospice or palliative care. New Mexico and West Virginia limit it to facilities. In Arkansas, Kentucky and Tennessee it turns on wording about the employer or setting that I couldn't fully confirm.
• LPNs: Iowa, Pennsylvania and Virginia allow it by statute, North Carolina and Washington through board guidance. Six states say no.
• The cause of death: an RN doesn't certify it, with narrow exceptions in Arkansas and Connecticut.

Medicare's conditions of participation for hospices and home health agencies don't say who may pronounce death. That's left to state law.

Pronouncing Death Is Not Certifying It

These are two different acts, and most of the confusion starts here.

Pronouncing death means determining that the person has died and recording when. Nevada's vital records law defines it:

“Pronouncement of death” means a declaration of the time and date when the cessation of the cardiovascular and respiratory functions of a patient occurs as recorded in the patient’s medical record by the attending provider of health care in accordance with the provisions of this chapter.

(NRS 440.415(7)(e) (opens in a new tab))

Rhode Island's health department puts it in three words: a registered nurse "may pronounce death (i.e., determine biological death)." (RIDOH, Death and Dying Information for Healthcare Professionals (opens in a new tab)) Wisconsin's hospice nurse may "pronounce the date, time, and place of the patient’s death." (Wis. Stat. § 69.18(1)(cm) (opens in a new tab))

Certifying death means completing the medical certification on the death certificate: the cause of death and how it happened. That's a medical diagnosis, and states keep it with the physician, usually the APRN or PA, or the medical examiner or coroner. Several states draw the line in the same rule that lets a nurse pronounce:

• Pennsylvania: the section "in no way authorizes a nurse to determine the cause of death. The responsibility for determining the cause of death remains with the physician, certified registered nurse practitioner or the coroner as provided under this act." (35 P.S. § 450.507(d) (opens in a new tab))
• Virginia: the subsection "shall not authorize a nurse, licensed practical nurse, physician assistant, or advanced practice registered nurse who is not an autonomous nurse practitioner to determine the cause of death." (Va. Code § 54.1-2972(C) (opens in a new tab))
• Wisconsin: the hospice nurse rule "may not be construed to authorize a hospice nurse to certify under sub. (2) (b) the cause of the patient’s death." (Wis. Stat. § 69.18(1)(cm) (opens in a new tab))
• Washington: "A registered nurse may determine and pronounce death, but shall not certify death as defined in RCW 70.58.160 unless the registered nurse is a licensed ARNP" (WAC 246-840-830 (opens in a new tab))
• North Carolina's board: "Certification of death is not within the scope of RN and LPN practice." (NCBON Death and Resuscitation Position Statement (opens in a new tab))

South Carolina's board reads the two together the other way. Its view is that "pronouncing or declaring death has consistently been viewed as meaning a function of the person who certifies death," which is why it says RNs don't pronounce. (SC Board of Nursing Advisory Opinion #3 (opens in a new tab))

A few states let the RN put a signature on the certificate without certifying the cause. In Alaska "The registered nurse shall sign the death certificate," which must show the name, any known contagious disease, and the date and time of death, and a physician, APRN or PA certifies within 24 hours. (Alaska Stat. § 08.68.700(b), (c) (opens in a new tab)) In New Jersey the RN attests by "signing in the space designated for this signature on the certificate of death" (N.J.S.A. 26:6-8.1 (opens in a new tab)). Ohio goes the other way: "The nurse shall not complete any portion of the individual's death certificate." (R.C. 4723.36(B)(2)(a) (opens in a new tab))

Every State at a Glance

Statute and rule mean the law itself. Board statement and health department guidance mean the agency's reading of the law, which isn't binding in the same way. Each citation links to the official source I read. Where I checked who certifies the cause of death, it's at the end of the conditions.

States That Wrote It Into Law

Most of these rules share a shape: an expected death, a patient of an agency or facility that employs the nurse, a physician who has agreed or will be told, and a hand-off of the cause of death to someone else. The details are where they differ.

Written agreement or order first

• Alaska. An RN "may make a determination and pronouncement of death of a person" when "an attending physician, an attending advanced practice registered nurse, or an attending physician assistant has documented in the person's medical or clinical record that the person's death is anticipated due to illness, infirmity, or disease; this prognosis is valid for purposes of this section for not more than 120 days from the date of the documentation," and that clinician "authorized in writing a specific registered nurse or nurses to make a determination and pronouncement of the person's death." In a facility with written policies, the authorization can cover all its nurses. (Alaska Stat. § 08.68.700(a), (d) (opens in a new tab))
• Nevada. "A physician who anticipates the death of a patient because of an illness, infirmity or disease may authorize a specific registered nurse or physician assistant or the registered nurses or physician assistants employed by a medical facility or program for hospice care to make a pronouncement of death if they attend the death of the patient." An APRN can authorize RNs the same way. The authorization must "Be a written order entered on the chart of the patient," and a "medical facility" includes "An agency to provide nursing in the home." (NRS 440.415 (opens in a new tab))
• Utah. A registered nurse may determine death if "an attending physician has: (i) documented in the individual's medical or clinical record that the individual's death is anticipated due to illness, infirmity, or disease no later than 180 days after the day on which the physician makes the documentation; and (ii) established clear assessment procedures for determining death." A facility can use a general authorization only if it "shall adopt written policies and procedures." (Utah Code § 26B-8-132(3), (6) (opens in a new tab))
• Delaware. The authority applies "to attending nurses caring for terminally ill patients or patients who have “do not resuscitate” orders in the home or place of residence of the deceased as a part of a hospice program or a certified home health-care agency program," and "provided that the attending physician of record has agreed in writing to permit the attending registered nurse to make a pronouncement of death in that case." (24 Del. C. § 1902(b) (opens in a new tab))
• Tennessee. The Board of Nursing's rule says "Pursuant to the restrictions and guidelines found in T.C.A. § 68-3-511, a Registered Nurse may make an actual determination and pronouncement of death." (Tenn. Comp. R. & Regs. 1000-03-.02(5) (opens in a new tab)) In 2025 the legislature rewrote the condition in that section to read "The attending physician has agreed in writing to sign the death certificate. The agreement by the attending physician must be present with the deceased at the place of death" (2025 Tenn. Pub. Acts ch. 116 (opens in a new tab)). The full current section is published only on the state's commercial code site, so I quote the amendment.

The physician can't get there

• Virginia. An RN may pronounce death if "(i) the nurse is employed by or the physician assistant or advanced practice registered nurse who is not an autonomous nurse practitioner works at (a) a home care organization as defined in § 32.1-162.7 , (b) a hospice as defined in § 32.1-162.1 , (c) a hospital or nursing home" and so on, and "(ii) the nurse ... is directly involved in the care of the patient; (iii) the patient's death has occurred; (iv) the patient is under the care of a physician or autonomous nurse practitioner when his death occurs; (v) the patient's death has been anticipated; and (vi) the physician or autonomous nurse practitioner is unable to be present within a reasonable period of time to determine death." If the death wasn't anticipated or needs investigation, the nurse "shall notify the Office of the Chief Medical Examiner of the death and the body shall not be released to the funeral director." (Va. Code § 54.1-2972(C) (opens in a new tab))
• Pennsylvania. Professional nurses "who are involved in direct care of a patient shall have the authority to pronounce death as determined under the act of December 17, 1982 (P.L.1401, No.323), known as the "Uniform Determination of Death Act," in the case of death from natural causes of a patient who is under the care of a physician or certified registered nurse practitioner when the physician or certified registered nurse practitioner is unable to be present within a reasonable period of time to certify the cause of death." (35 P.S. § 450.507(a) (opens in a new tab))
• Massachusetts. For a patient "suffering from a terminal illness or whose death is anticipated and who is receiving the services of a home health agency," a licensed hospice, a certified nursing home or a PACE program, the employed RN "may declare such person dead; provided, however, that said nurse first makes a reasonable effort to contact the attending physician or medical examiner before making such determination or pronouncement" and uses a state form. (M.G.L. c. 46, § 9 (opens in a new tab))

The setting decides

• Connecticut. "a registered nurse employed by a home health care agency licensed by the state of Connecticut, in a home or residence may make the actual determination and pronouncement of death of a patient provided that the following conditions are satisfied: (1) The death is an anticipated death; (2) the registered nurse attests to such pronouncement on the certificate of death; and (3) the registered nurse, an advanced practice registered nurse licensed under this chapter, or a physician licensed under chapter 370 certifies the death and signs the certificate of death not later than twenty-four hours after the pronouncement." (Conn. Gen. Stat. § 20-101a (opens in a new tab))
• New Hampshire. "If an anticipated death occurs in a hospital, a nursing home, a private home served by a home health care provider licensed under RSA 151, an assisted living residence as defined in RSA 161-J:2, II, or a hospice, the registered nurse attending at the last sickness may pronounce the person dead and release the body to the funeral director, next-of-kin as defined in RSA 290:16, IV, or designated agent after certifying the fact of death and completing the death record by hand or other approved electronic process." (RSA 290:1-b (opens in a new tab))
• Iowa. The RN may "Make the pronouncement of death for a patient whose death is anticipated if the death occurs in a licensed hospital, a licensed health care facility, a correctional institution listed in section 904.102, a Medicare-certified home health agency, a Medicare-certified hospice program or facility, an assisted living facility, or a residential care facility, with notice of the death to a physician, advanced registered nurse practitioner, or physician assistant." (Iowa Code § 152.1(6)(e) (opens in a new tab))
• Georgia. When a hospice patient "who is terminally ill or whose death is anticipated" dies, an RN employed by the hospice may make the determination and pronouncement "in the absence of an attending physician." In a nursing home, the nursing home's RN may do it "in the absence of a physician," but if the death appears to be from other than natural causes, "only a physician may make the determination" or pronouncement. Either way it's recorded on a state form. (O.C.G.A. §§ 31-7-176.1, 31-7-16, as amended by 2017 Act 236 (opens in a new tab))
• Ohio. An RN "may determine and pronounce an individual's death, but only if the individual's respiratory and circulatory functions are not being artificially sustained and, at the time the determination and pronouncement of death is made, the registered nurse is providing or supervising the individual's care through a hospice care program licensed under Chapter 3712. of the Revised Code or any other entity that provides palliative care." The nurse must notify the attending clinician "not later than twenty-four hours following the determination and pronouncement of the individual's death." (R.C. 4723.36(B) (opens in a new tab))
• New Mexico. Unless there's reason to believe "that the death is not due to natural causes," the RN may pronounce in two places only: "nurse employed by a nursing home or a hospice agency may" pronounce for "a resident of the nursing home," and a hospital RN for "a patient of the hospital." A hospice RN at a patient's home isn't covered. (NMSA 1978, § 24-14-20(D) (opens in a new tab))

Facility or agency policy decides

• Texas. "A registered nurse, including an advanced practice registered nurse, or physician assistant may determine and pronounce a person dead in situations other than those described by Subsection (b) if permitted by written policies of a licensed health care facility, institution, or entity providing services to that person." Where there's an organized nursing and medical staff, they "shall jointly develop and approve those policies." (Tex. Health & Safety Code § 671.001(d) (opens in a new tab))
• Michigan. "A physician or registered nurse may pronounce the death of a person in accordance with this act. This subsection does not prohibit a health facility or agency licensed under article 17 of the public health code ... from determining which of its medical personnel may pronounce the death of a person in that health facility or agency." (MCL 333.1033(3) (opens in a new tab))
• Washington. The RN may do it "only if there are written policies and procedures relating to the determination and pronouncement of death in the organization with which the registered nurse is associated as an employee or by contract," the decedent "was under the care of a health care practitioner qualified to certify cause of death," and was a patient of that organization. (WAC 246-840-830(1) (opens in a new tab))
• Kentucky. "A registered nurse who is employed by a health facility as defined in KRS 216B.015 may determine whether or not a patient is dead in accordance with the requirements of KRS 446.400. The nurse shall notify the patient's attending physician or other appropriate practitioner of the death in accordance with the facility's policy. The registered nurse is authorized to sign the provisional report of death as furnished by the state registrar of vital statistics." (KRS 314.181 (opens in a new tab))
• Wisconsin. A hospice nurse "may pronounce the date, time, and place of the patient’s death if all of the following apply": "The patient was generally under the care of a physician at the time of death," and the death was anticipated. (Wis. Stat. § 69.18(1)(cm) (opens in a new tab))

Any setting, few conditions

• New Jersey. "Where there has been an apparent death that is not governed by the provisions of section 4 of P.L.1991, c.90 (C.26:6A-4), a registered professional nurse licensed by the New Jersey Board of Nursing ... may make the actual determination and pronouncement of death." The excluded section covers death declared on neurological criteria. (N.J.S.A. 26:6-8.1(a), as amended by P.L.2015, c.224 (opens in a new tab))
• Hawaii. "a person shall be considered dead if, in the announced opinion of a physician or osteopathic physician licensed under part I of chapter 453, physician or osteopathic physician excepted from licensure by section 453-2(b)(3), physician assistant licensed under chapter 453, or registered nurse licensed under chapter 457, based on ordinary standards of current medical practice, the person has experienced irreversible cessation of spontaneous respiratory and circulatory functions." Brain death stays with physicians. (HRS § 327C-1(a) (opens in a new tab))
• District of Columbia. A body may be released "In the case of an expected death at a decedent's place of residence, at the time of death upon the consent of a treating physician or a registered nurse working in general collaboration with the treating physician who signs the pronouncement of death section of the report of death." (D.C. Code § 7-231.17(c)(2) (opens in a new tab))
• Montana. The vital records rule says "For the purpose of the death certificate, any professional registered nurse licensed by the state of Montana may provide pronouncement of death information." (Admin. R. Mont. 37.8.801(6) (opens in a new tab))

Facilities only

• West Virginia. "When death occurs in an institution and the person responsible for the completion of the medical certification is not available to pronounce death, another physician may pronounce death. If there is no physician available to pronounce death, then a designated licensed health professional who views the body may pronounce death." The section says nothing about a death at home. (W. Va. Code § 16-5-19(e) (opens in a new tab))
• Arkansas. "A registered nurse employed by the attending hospice may" "complete and sign the medical certification of death and pronounce death" for a terminally ill hospice patient whose death is anticipated and who dies in a "hospice inpatient program or as a hospice patient in a nursing home" or hospital. (Ark. Code § 20-18-601(c)(3)(A), as printed in Act 862 of 2025 (opens in a new tab)) That's the one place I found where an RN may sign the medical certification itself. The Arkansas Code is published officially only on a commercial site, so I couldn't read the rest of the section; check with your hospice about deaths at home.

Where the Board or Health Department Answers

In these states no statute settles it, so the answer comes from an agency. The agencies say their statements aren't law, but they're how the board reads the law it enforces.

• Arizona. "It is within the Scope of Practice of the Registered Nurse (RN) to assess a patient/client death." The board ties this to the definition of registered nursing: "By this statute an RN has the authority to make an assessment and therefore, a determination of death. An RN’s assessment or determinant of death does not include the medical certification of death." (AZBN Advisory Opinion, Determination of Death: Role of RN/LPN, revised 9/24 (opens in a new tab)) The statute it rests on defines registered nursing as including "Diagnosing and treating human responses to actual or potential health problems." (A.R.S. § 32-1601(24)(a) (opens in a new tab))
• Mississippi. "It is within the scope of practice of the appropriately prepared registered nurse to pronounce death provided: There is documentation that the registered nurse has the knowledge and skills to perform this procedure; The patient is not connected to or dependent upon a life support device; There has been contact with the medical provider regarding the patient’s care within the preceding thirty days; The registered nurse is the most qualified person available; and The facility has policies and procedures in place addressing all aspects of this issue." (MSBN FAQ (opens in a new tab)) The practice act defines RN practice to include "the achievement of a dignified death." (Miss. Code § 73-15-5(2) (opens in a new tab))
• Rhode Island. "Rhode Island law requires physicians, as defined by the Rules and Regulations Governing Vital Records, to sign death certificates, but it is silent on the issue of pronouncement of death. Therefore, it is the policy of the Department of Health that, with respect to the expected death of a person who is receiving nursing services in the home and for whom the attending physician has included documentation of such expected death in the patient’s medical record, a registered nurse may pronounce death (i.e., determine biological death), but must then notify the attending physician forthwith." (RIDOH, Death and Dying Information for Healthcare Professionals (opens in a new tab))
• Wyoming. "A Registered Nurse (RN) may make the clinical determination and pronouncement of the death of a person under the following circumstances when subsections a, b, c, and d are met: (a) A licensed provider has documented in the individual’s medical or clinical record that the individual’s death is anticipated due to illness, infirmity, or disease." The death must occur in a licensed facility or while "Receiving services from a Wyoming licensed hospice or home care organization," with "an established DNR or a certification of a terminal illness," written assessment procedures, and an RN employed by the organization. The board issues its opinions under W.S. § 33-21-122(c)(iii). (WSBN Advisory Opinion, Determination, Pronouncement, and Certification of Death (opens in a new tab))
• North Carolina, where the board and a statute disagree. The board says "Determination and pronouncement of death is within the legal scope of Registered Nurse (RN) and Licensed Practical Nurse (LPN) practice. This is based upon nursing assessment, provided the nurse has the requisite knowledge and competencies needed to assess the presumptive and conclusive signs of death and the agency has policy/procedure that allows this activity." With a written DNR order, death is determined when "ALL five presumptive signs of death are present." The statement adds that it "does not carry the force and effect of law and rules." (NCBON Death and Resuscitation Position Statement (opens in a new tab)) The General Statutes say "The determination that a person is dead shall be made by a physician licensed to practice medicine applying ordinary and accepted standards of medical practice." (G.S. 90-323 (opens in a new tab)) If you work in North Carolina, ask your agency which one its policy follows.

Four more states say, in effect, that the law doesn't stop a nurse:

• Minnesota. "Minnesota statues limit who can report the cause of death, but do not limit who can report a death." The page is written for APRNs and points them to "their facility or employer policies or protocols regarding who may pronounce death in that specific setting." (Minnesota Board of Nursing, APRNs and Authority to Pronounce Death (opens in a new tab))
• New York. "New York State Public Health Law does not require that death be pronounced by a physician. Unless there is a local law that requires otherwise, anyone may make the pronouncement of death." (NYS DOH, Vital Statistics Technical Notes (opens in a new tab)) New York City and other localities can have their own rules.
• Vermont. "There is no Vermont law requiring a licensed physician to make an official pronouncement of death." (VDH, OCME Death Certification Tutorial (opens in a new tab))
• North Dakota. "In July 2023, the Board reaffirmed their previous position adopted in 1995 related to pronouncing death and the nurses’ scope of practice." That position leaves standing orders on pronouncement to the facility. (NDBON Board Opinion, Death Pronouncement (opens in a new tab))

Where the Answer Is No

• Alabama. "(1) The licensed nurse may receive pronouncement of a patient’s death from a physician via telecommunication without a physical examination of the patient by that physician. (2) The facility policy shall specify the permissible patient conditions for which the licensed nurse in a specific health care facility or agency may receive the pronouncement of a patient’s death by telecommunication." So the physician pronounces, often by phone, and the nurse receives it. (Ala. Admin. Code r. 610-X-6-.15 (opens in a new tab))
• Kansas. The Attorney General's 1990 opinion, which the Board of Nursing still posts, says "In some instances, a medical diagnosis of death could be made based upon the statements of a nurse attending the patient. However, the recognition that the patient is dead in-fact must come from the physician" and concludes "This diagnosis must be made by a physician in accordance with accepted medical standards." (Kan. Att'y Gen. Op. No. 90-81 (opens in a new tab)) The statute it reads says "A determination of death must be made in accordance with accepted medical standards." (K.S.A. 77-205 (opens in a new tab)) The board's current practice act and regulations have nothing on pronouncement.
• Louisiana. "A person will be considered dead if in the announced opinion of a physician, duly licensed in the state of Louisiana based on ordinary standards of approved medical practice, the person has experienced an irreversible cessation of spontaneous respiratory and circulatory functions." A coroner's pronouncement "may also be based on personal observation, information, or statements obtained from coroner investigators, registered nurses, licensed practical nurses, physician assistants, or emergency medical technicians at the scene who are reporting from firsthand observation of the physical condition of the deceased." (La. R.S. 9:111 (opens in a new tab))
• South Carolina. "The State Board of Nursing for South Carolina acknowledges that it is NOT within the role and scope of responsibilities of the RN or LPN to make pronouncements of death under state law." It points to the health department's vital records regulation, which requires a physician, medical examiner or coroner to certify death, and adds: "However, it is within the role and scope of the RN to make an assessment of death utilizing guidelines established by a healthcare institution, home or hospice agency. The RN may assess that a person has died and notify the appropriate persons, including the physician, supervisory personnel, family, and funeral home staff." (SC Board of Nursing Advisory Opinion #3, revised July 2024 (opens in a new tab))

LPNs

Most states don't mention LPNs at all. The ones that do:

• Yes, by statute: Iowa lets an LPN "Make the pronouncement of death for a patient whose death is anticipated" in the same settings as an RN, except correctional institutions (Iowa Code § 152.1(5)(c) (opens in a new tab)). Virginia: "A licensed practical nurse may pronounce death for a patient in hospice pursuant to a valid Do Not Resuscitate Order" (Va. Code § 54.1-2972(C) (opens in a new tab)). Pennsylvania requires "(1) The patient is in the care of a licensed hospice. (2) The patient has a valid Do Not Resuscitate Order issued in accordance with the laws of this Commonwealth," a focused assessment, and training of "a minimum of three hours in vital signs training, postmortem care, grief training and circumstances requiring a coroner's investigation." (35 P.S. § 450.508 (opens in a new tab))
• Yes, by board guidance: North Carolina's board (quoted above), and Washington's commission, which says it is "within the scope of practice of the appropriately prepared and competent licensed practical nurse (LPN), registered nurse (RN), and advanced registered nurse practitioner (ARNP)" to determine and pronounce death, while noting "The opinion is not legally binding" (NCAO 23.01 (opens in a new tab)).
• No: Kentucky's board says "It is NOT within the scope of licensed practical nursing to declare death or sign the provisional report of death or death certificate." (KBN AOS #36 (opens in a new tab)). Texas: "Licensed vocational nurses (LVNs) do not have the authority to legally determine death, diagnose death, or otherwise pronounce death in the State of Texas." (BON Position Statement 15.2 (opens in a new tab)) Mississippi, South Carolina and Wyoming say the same in the statements quoted above, and Arizona limits the LPN to gathering data and reporting it.

If you're an LPN, our LPN and LVN home health scope guide covers the rest of what you can and can't do on a visit.

If You're the Nurse at the Bedside

None of this is legal advice. It's what the rules above have in common, put as steps.

1. Know your state's answer before the visit. Check the table, then your agency's written policy. Several states only allow it if the agency has one.
2. Check the chart for the paperwork the rule needs. That might be a physician's note that the death is expected, a written authorization naming you, a DNR or POLST, or a hospice election.
3. Assess and document. Record the signs you found and the time. North Carolina's board lists five presumptive signs to confirm with a DNR in place, and Washington requires a physical assessment and documentation.
4. Notify. The physician or APRN who will certify the cause, the family, and the funeral home, in the time your state sets: within 24 hours in Ohio, and right away in Rhode Island and Virginia.
5. Call the coroner or medical examiner if the death wasn't expected or looks unnatural. Virginia, Pennsylvania and Georgia all take the decision away from the nurse in that case.
6. Leave the cause of death to the certifier, unless you're in one of the narrow Arkansas or Connecticut cases.
7. Working in another state? If you work on a multistate license, the rule of the state where the patient is applies. Our Nurse Licensure Compact tool lists the member states.

Key Takeaways

• Most states let an RN pronounce death under conditions: 25 in a statute or rule, 5 more through a board or health department.
• The common conditions are an expected death, a patient of the agency or facility that employs you, and a physician who agreed or will be told.
• Four states keep pronouncement with a physician or coroner: Alabama, Kansas, Louisiana and South Carolina.
• Pronouncing death isn't certifying it. The cause of death goes to the physician, APRN or PA, or the medical examiner or coroner.
• LPNs can pronounce in only a handful of states, usually just for hospice patients with a DNR.
• Medicare doesn't decide this. State law does.
• This isn't legal advice. I checked these rules on November 9, 2026, and your board's current rule is the one that counts.

Frequently asked questions

Can a registered nurse pronounce death?

In most states, yes, under conditions. 25 jurisdictions, 24 states plus DC, say so in a statute or rule, and 5 more say so through the board of nursing or the health department. The usual conditions are an expected death, a patient of a hospice, home health agency or facility, and a physician who has agreed or been told. Alabama, Kansas, Louisiana and South Carolina leave pronouncement to a physician or coroner, and 12 states have no specific rule.

Can a hospice or home health nurse pronounce death at home?

In 20 of the 25 jurisdictions with a statute or rule, the rule reaches a death at home, though Georgia and Wisconsin limit it to hospice, and Ohio to hospice or palliative care. Arizona, Mississippi, Rhode Island and Wyoming allow it through board or health department guidance. New Mexico and West Virginia allow RN pronouncement only in facilities, and in states with no rule your agency's policy and the coroner decide.

Can an LPN pronounce death?

Only in a few states. Iowa allows it in the same settings as RNs. Pennsylvania and Virginia allow it for a hospice patient with a valid DNR order, and North Carolina's board and Washington's commission say it is within LPN scope. Arizona, Kentucky, Mississippi, South Carolina, Texas and Wyoming say an LPN may not pronounce death. Elsewhere the rules are silent.

Can a nurse sign the death certificate?

Not the cause of death, in almost every state. The physician, and in most states the APRN or PA, who treated the patient certifies the cause, or the medical examiner or coroner does. Some states let the RN sign the pronouncement part: Alaska, Connecticut, DC, New Hampshire and New Jersey, for example. Arkansas lets a hospice RN sign the medical certification for some hospice deaths, and Connecticut lets an RN complete it when the physician or APRN is absent.

What is the difference between pronouncing death and certifying it?

Pronouncing death means determining that the person has died and recording the date and time. Certifying death means completing the medical certification on the death certificate, which states the cause of death. Nevada defines pronouncement as a declaration of the time and date the heart and breathing stopped, and Pennsylvania, Virginia and Wisconsin say outright that a nurse who pronounces may not determine or certify the cause.

Sources

Every state's rule is linked in the table, to the state's legislature, its official code publisher, its board of nursing or its health department. All were read on November 9, 2026.

• Connecticut's rule letting an RN complete the medical certification when the physician or APRN is absent: Conn. Gen. Stat. § 7-62b(c) (opens in a new tab), which allows "a registered nurse as provided in section 20-101a" to complete and sign it.
• Virginia's medical certification rule, including deaths under hospice care: Va. Code § 32.1-263 (opens in a new tab).
• New Jersey's death certification rule: R.S. 26:6-8, as amended by P.L.2015, c.38 (opens in a new tab).
• Medicare: the hospice and home health conditions of participation on eCFR (opens in a new tab), which I searched for any rule on pronouncing death and found none.