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Method: This is a single-center, retrospective, and prospective, observational convenience-sample study. ED registered nurses (ED RNs) received standardized GOC conversation training. Their selection criteria included a selection interview, a minimum of 3 years of ED clinical experience, and current employment in the ED. ED RNs used a standardized GOC questionnaire. Patient inclusion criteria included age \u226518 years and one or more of the following: chronic kidney disease \u2265 stage III, congestive heart failure with an ejection fraction \u2264 40%, chronic obstructive pulmonary disease with home oxygen use, and\/or malignancy with metastasis. GOC conversations were recorded in the electronic medical record (EMR). Physician Orders for Life-Sustaining Treatment (POLST) forms were completed as appropriate. Select individual patient data for the 12 months prior to the conversation were compared with the following 12 months. Results: Over 6 months, 94 of 133 patients who were approached consented to the GOC discussion with the RN. All 94 enrolled patients had their GOC recorded into the EMR. One-third already had a completed POLST form prior to ED arrival. 50% without a POLST on ED arrival left with a completed POLST. Eighty-four patients survived the index visit and 46 patients survived to study completion. Patient satisfaction with the interaction was high: In the cohort who survived past the index visit, 95% rated their experience at 4\/5 or 5\/5 (Likert scale, 5: strongly agree, 1: strongly disagree). In the survival-to-study completion cohort, 100% rated their experience as 4\/5 or 5\/5. Subsequent median ED visits decreased by 15% (1.0-4.0 interquartile range). There were no statistically significant changes in hospitalizations (both decreased by 25%, 0-3.0) or intensive care unit admissions (0%, 0-0). Conclusions: An ED RN-led GOC conversation had high patient satisfaction and 100% GOC documentation in the EMR. There was a significant increase in ED POLST form completion. There were no significant changes noted in subsequent hospitalizations, length of hospitalization, or intensive care unit utilization.<\/jats:p>","DOI":"10.1177\/08258597221149402","type":"journal-article","created":{"date-parts":[[2023,1,3]],"date-time":"2023-01-03T02:57:43Z","timestamp":1672714663000},"page":"3-12","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":16,"title":["Difficult Conversations: Outcomes of Emergency Department Nurse-Directed Goals-of-Care Discussions"],"prefix":"10.1177","volume":"39","author":[{"given":"Suzanne","family":"Bigelow","sequence":"first","affiliation":[{"name":"Emergency Medicine, Providence Regional Medical Center Everett, Everett, WA, USA"},{"name":"Elson School of Medicine, Washington State University, Spokane, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron","family":"Medzon","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Boston University School of Medicine, Boston, Massachusetts, USA"},{"name":"Solomont Center for Clinical Simulation and Nursing Education, Boston Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari","family":"Siegel","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Palliative Medicine, Temple University Hospital, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruyun","family":"Jin","sequence":"additional","affiliation":[{"name":"Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence Research Network, Portland, OR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,1,2]]},"reference":[{"key":"bibr1-08258597221149402","unstructured":"United States Government. 2017. www.consus.gov\/data\/tables\/2017\/demo\/popproj\/2017-summary-tables.html. 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