Ben White, Rachel Feeney, Amanda Ward, Lindy Willmott
Nurse practitioners and nurses involved in voluntary assisted dying in Queensland play a range of roles in its delivery, assuming responsibilities that extend beyond administering to include patient and family support, education, and cultural leadership. These roles, which draw on nurses' emotional intelligence, relational skills, and clinical expertise, reflect an expanded scope of practice. Despite challenges such as uneven implementation across Hospital and Health Services and resource constraints, nurses' fulfilment of these roles has been essential to the establishment and early delivery of voluntary assisted dying services in Queensland.
BACKGROUND: Voluntary assisted dying commenced in Queensland in January 2023, making it the fourth of seven Australian jurisdictions to provide voluntary assisted dying as a lawful option in specified circumstances. Under Queensland legislation, nurse practitioners and registered nurses are eligible to act as administering practitioners for voluntary assisted dying.
OBJECTIVE: This study explored the roles of nurse practitioners and nurses in voluntary assisted dying delivery in Queensland.
METHODS: This qualitative study collected data through individual, in-depth, semi-structured interviews. The data were analysed using thematic analysis. Interviews were conducted with 20 nurses involved in voluntary assisted dying delivery across 12 of Queensland's 16 Hospital and Health Services. Nursing participants included Hospital and Health Services voluntary assisted dying coordinators, nurse practitioners and nurses who acted as administering practitioners, and staff from the Queensland Voluntary Assisted Dying Support and Pharmacy Service. The Queensland University of Technology Human Research Ethics Committee approved the study. Participants were informed that their participation was voluntary.
RESULTS: Five themes were identified through the interviews: (1) the unique clinical and relational value of nursing in voluntary assisted dying practice; (2) practice settings vary for nurse participation in voluntary assisted dying; (3) nurses undertake diverse (and unanticipated) roles across the entire voluntary assisted dying process; (4) statewide and local structural factors are pivotal in shaping nursing roles in voluntary assisted dying; and (5) perspectives on and comfort with nurse practitioners assessing voluntary assisted dying eligibility. Six main nursing roles were identified: practitioner administration, supporting other practitioners, supporting self-administration, providing patient and family navigation, delivering education and driving cultural change, and undertaking other clinical and administrative tasks. Nurse-led local models of care strongly influenced service delivery, resulting in variation in nursing participation. Most participants supported extending nurse practitioners' scope to assessing voluntary assisted dying eligibility.
CONCLUSIONS: Nurse practitioners and nurses involved in voluntary assisted dying in Queensland play a range of roles in its delivery, assuming responsibilities that extend beyond administering to include patient and family support, education, and cultural leadership. These roles, which draw on nurses' emotional intelligence, relational skills, and clinical expertise, reflect an expanded scope of practice. Despite challenges such as uneven implementation across Hospital and Health Services and resource constraints, nurses' fulfilment of these roles has been essential to the establishment and early delivery of voluntary assisted dying services in Queensland.