NY Scope of Practice for Nurses
The scope of nursing for nurses is largely similar but differs across states because of different practice environments. The variance is nursing scope of practice across states is also attributable to the differences in nurse practice laws and regulations. Actually, each state has established specific laws and regulations that govern practice within the state. These laws incorporate different licensure and regulatory requirements as well as details regarding nursing practice environment. Some examples of states with different scope of practice for nurses are New York and California. The differences in the scope of practices in these states are evident in definition of some aspects of nursing such as definition of standing orders, developing workflows in electronic health records, and what nurses can order in the EHR.
Definition of Standing Orders
One of the major ways in which nursing practice differs between New York and California is definition of standing orders. Standing orders are generally defined as prewritten medication orders and specific directions provided by the licensed independent practitioner to administer medication to a patient/individual whose condition has been clearly identified (Buppert, 2012). Generally, nurses work in collaboration with physicians to create a series of standing orders to help provide safe and efficient care. Therefore, standing orders are created and approved by physicians since they are responsible for care delivery covered by the orders.
Based on New York State's scope of practice for registered nurses, standing orders are defined as non-patient specific medical orders that are used to direct nursing care (New York State Education Department, 2009). However, according to the State Education Department, standing orders are considered inappropriate since creating a medical treatment plan is difficult and potentially dangerous without a relationship between the patient and an authorized care provider. This is primarily because of the complexities of individual's co-morbidities, significant allergies, several medications, and challenges in creating a one-size-fits-all treatment plan. Nonetheless, the New York State Legislature established certain criteria for the non-patient specific standing order as a legitimate entity in 2000.
In contrast, the California scope of practice for registered nurses define standing orders as written orders that are utilized when a specific order for a specific patient offered by a licensed health care provider within his/her professional scope of licensure or practice. In this state, physicians can utilize standing orders to authorize nurse practitioners or medical assistants to offer certain services. However, the use of these orders by medical assistants and licensed practical nurses is restricted and based on specific nursing rules and settings.
In light of these differences in definitions, there are variances in what a registered nurse may order on his/her own behalf in New York and California. In New York, a nurse may order for the administration of immunization, provision and administration of antianaphylactic agents, and delivery of purified protein derivative (PPD) tests and HIV tests (Buppert, 2012). On the contrary, nurses in California may use standing orders to order for administration of medication/drugs and initiation of clearly described clinical processes to a specific patient.
Designing Workflows in Electronic Health Record
The other aspect in which nursing practice differs between New York and California is the implications when designing workflows in the electronic health record using computerized order entry. Computerized order entry is generally described as direct entry of clinical orders into the electronic health record of a healthcare system by licensed independent practitioners or medical staff with certain ordering privileges. The entries are not made by clinical or administrative support staff because they do not have ordering privileges.
In California, the implications of designing workflows in electronic health record using computerized order entry include issues that have traditionally been regarded as barriers to the adoption of these applications in healthcare practice. These barriers include poor planning and implementation, lack of adequate participation by clinicians, lack of standardized medical terminology, and insufficient financial commitment (Doolan & Bates, 2002, p.183). Nonetheless, the implications of designing workflows in electronic health record using computerized order entry include enhanced accuracy and completeness, reduced transcription, and capability to enter orders in several locations.
New York nurses also have similar implications when designing workflows in the electronic health record using computerized order entry. These implications emerge from the fact that computerized order entry has numerous advantages over paper-based techniques. Moreover, the use of these entries in designing workflows helps in enabling physicians to have decision support at the point of care. Decision support in turn lessens the rate of medication error and increases the suitability and cost-effectiveness of ordering medications and tests.
EHR Orders by Nurses, Physicians, and Mid-level Providers
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