March 26, 2025

Advocating for those in need and working to transform how Florida addresses end-of-life care have become passions for Meredith Fischer, a University of Florida College of Nursing student.

Due in part to her tenacity, two bills on Patient-Directed Medical Orders have been introduced to the Florida Legislature this session: House Bill 353, sponsored by state Rep. Susan Plasencia, R-Orlando, and co-sponsored by state Rep. Michelle Salzman, R-Escambia County; and the companion Senate Bill 566, sponsored by state Sen. Ana Maria Rodriguez, R-Miami, and co-sponsored by Florida nurse practitioner and state Sen. Barbara Sharief, D-Miramar.

The bills address the shortcomings of Florida’s advance directive orders — legal documents that specify how people’s medical care should be handled if they are unable to make decisions.

During her 15 years as a nurse in the intensive care unit, Fischer saw how advance directive and do-not-resuscitate orders often failed to ensure that patients’ end-of-life wishes were respected. Many people ended up unable to have their wishes followed because the proper documents could not be found or accessed in time. So, Fischer acted.

“We are building a grassroots movement to mobilize others to contact their legislators to support this crucial health care policy,” Fischer said.

Fischer’s drive to effect legislative change began in the fall of 2023 for an assignment in a health policy and finance class, part of her Doctor of Nursing Practice coursework, when she was encouraged to write letters to state representatives about health policy issues.

Just hours after sending a letter to State Rep. Kelly Skidmore, D-Boca Raton, about advance directive orders, Fischer received a response and a request to meet.

“I was shocked,” Fischer said. “I had no idea that a simple letter would get this kind of response.”

A legislative proposal was already in the works when Fischer wrote her letter. And she quickly joined the effort backed by Dr. Leonard Hock Jr., a geriatric physician and longtime advocate of hospice and palliative care issues; and Hattie Bryant, an author, lecturer and advocate of advance care planning.

The proposal aimed to create a formalized, legally recognized document — one that would translate a patient’s end-of-life wishes into actionable medical orders. The bill also proposed an electronic registry to ensure that emergency medical service workers could access these orders, even before arriving at a scene.

The proposal, however, failed to advance during the 2024 legislative session. It lacked widespread support from the health care community, including the powerful Florida Nurses Association, which withheld its endorsement — partly because of its formal approval process before supporting legislation and the exclusion of independently operating nurse practitioners from executing advance directives.

Fischer undertook the formal process of securing the Florida Nurses Association’s endorsement and ensured that the proposal’s backers understood the necessity of inclusive language to gain full support.

The 2025 proposal advanced with revised language, aligning with updated Florida laws, allowing nurse practitioners with full practice authority and physician assistants to be included among those authorized to execute the orders. She played a direct role in bringing the discussion to the attention of the Florida Nurses Association and the Florida Nurse Practitioner Network, ultimately securing their endorsements.

“Timing is everything,” Fischer said. “I happened to be there at just the right moment.”

Fischer’s efforts to improve patient rights are gaining momentum. The Florida Nurses Association tapped her to speak to more than 150 nurses during the organization’s Advocacy Days in Tallahassee, and she discussed the proposed bills before the nurses met with their legislators. Fischer also serves as the policy advocacy leader for the Graduate Nursing Student Academy and plans to attend the American Association of Colleges of Nursing Student Policy Summit in Washington, D.C., this spring.

Fischer credits the UF faculty and nursing program with inspiring her recent successes.

“Meredith Fischer’s advocacy is a powerful example of how education and determination can drive meaningful change,” said Marcia Johansson, D.N.P., interim associate dean for academic affairs – graduate clinical education. “At the UF College of Nursing, we are proud to support students like Meredith who not only excel in their studies but work tirelessly to improve health care policy. Her commitment to ensuring that patients’ end-of-life wishes are honored is a true reflection of the transformative impact nursing leadership can have on our communities.”

And Fischer won’t stop until the advance directive policy is adopted.

“Patients deserve to have their wishes honored,” Fischer said. “I’m doing everything I can to make sure that happens.”