The Executive Secretary of the NYS Board of Nursing sends the following communication. I
wanted to share with you that it has been brought to my attention that Emergency Departments,
in some acute care facilities, are using practice protocols in an inappropriate and ultimately
unlawful manner.
As background, non-patient specific protocols that are initiated by an RN are limited to certain
immunizations, and to HIV testing/counseling. [See our web site for a description of non-patient
specific orders and protocols: www.op.nysed.gov/prof/nurse/nurse-rnlpnissues.htm ] All other
patient orders are required, by the Nurse Practice Act, to be patient specific and ordered by an
authorized prescriber, such as a nurse practitioner or physician.
It is however, acceptable for ERs to develop best practice protocols. For example, based on the
chief complaint of chest pain, a protocol could be developed that includes starting an IV,
administering pain medications, drawing blood samples and performing an EEG, etc. That
protocol would need to be approved by the facility's highest clinical governing body, generally
the Medical Board. It can then be pre-printed or made available electronically. However, the
protocol must be made patient-specific by the ER nurse by including it in the patient's chart.
Most importantly, an authorized prescriber must invoke the protocol. This can be accomplished
by a verbal order from a nurse practitioner or a physician in the patient's name, followed by a
signature when time permits.
In an ER situation, patients have not previously been seen by an authorized prescriber and no
medical diagnosis is present. Since RNs do not have medical diagnostic or prescriptive
privileges, performing such functions is outside of their scope of practice and can result in a
disciplinary charge.
I ask your assistance in assuring that nurses in your facility are not practicing beyond their legal
scope of practice.
Please feel free to contact me by e-mail or telephone should you have any questions about this
request.
My contact information follows.
Respectfully,
Barbara
Barbara Zittel, RN, Ph.D.
Executive Secretary,
NY State Board for Nursing Education Building
89 Washington Ave.
2nd Floor, West Wing
Albany, NY 12234