Yes, a nurse practitioner can sign a Do Not Resuscitate Order (DNRO) in Florida, but only if they hold a specific designation: they must be an advanced practice registered nurse (APRN) registered for autonomous practice. This requirement was established through Florida laws passed in 2020 and 2021 that expanded which practitioners could sign the state’s official DNRO form.
Who Can Sign a DNRO in Florida
Florida law authorizes four types of licensed practitioners to sign a DNRO:
- Physicians (MD)
- Osteopathic physicians (DO)
- Advanced practice registered nurses registered for autonomous practice
- Physician assistants
The practitioner’s signature alone isn’t enough. The form also requires a signature from either the competent patient themselves or an authorized representative, such as a healthcare surrogate, proxy, or guardian with explicit authority to make healthcare decisions.
The Autonomous Practice Requirement
Not every nurse practitioner in Florida qualifies. The key distinction is autonomous practice registration. Florida created this designation to allow experienced APRNs to practice without a formal physician supervision agreement. To qualify, an APRN generally needs a certain number of supervised clinical practice hours and must register with the state as autonomous.
If an NP has not obtained autonomous practice status, they cannot legally sign a DNRO in Florida, even if they are the patient’s primary care provider. In that case, a supervising or collaborating physician would need to sign the order instead.
How the DNRO Form Works
Florida uses a standardized form known as DH Form 1896. The form must be printed on yellow paper or have a full-page yellow background to be recognized by emergency medical services personnel. This is sometimes called the “yellow form,” and it’s the only prehospital DNRO format that EMS providers in Florida are required to honor.
The completed DNRO becomes part of the patient’s prescribed medical treatment plan. It applies across clinical settings, whether the patient is at home, in a hospital, in a long-term care facility, or receiving hospice services. The same signature rules apply regardless of the setting.
A Recent Change in Florida Law
Autonomous APRNs and physician assistants were not always eligible to sign the DNRO. This authority was added through legislation passed in 2020 and 2021 (Chapters 2020-9 and 2021-204, Laws of Florida), which prompted the Florida Department of Health to update Administrative Code Rule 64J-2.018 and revise the printed DNRO form to reflect the expanded list of eligible signers. Before these changes, only physicians and osteopathic physicians could sign.
The Florida Nurse Practitioner Network noted that the updated form was a long-awaited change for the profession, formally recognizing autonomous APRNs alongside other licensed professionals on the document itself.
What This Means in Practice
If you or a family member is working with a nurse practitioner on end-of-life planning in Florida, the first thing to confirm is whether that NP holds autonomous practice registration. You can verify this through the Florida Department of Health’s license verification tool. An NP with autonomous status can discuss your wishes, complete the yellow DNRO form, and sign it as the authorizing practitioner.
If your NP does not have autonomous status, they can still be involved in the conversation and help coordinate care, but you will need a physician, osteopathic physician, or physician assistant to provide the required practitioner signature on the form. The patient or their legal representative must also sign, so the process always involves at least two signatures.