Practice Information

Standing Orders or Protocols


To: Interested Parties

From: Barbara Zittel, RN, Ph.D., Executive Secretary to the State Board for Nursing

Subject: Standing Orders or Protocols

Date: August 2006

The purpose of this memorandum is to provide guidance in clarifying the scope of practice of registered professional nurses (RNs) in relation to a variety of circumstances where non-patient specific medical orders, culturally known as standing orders, are being used to dictate nursing care. There appears to be a heightened interest among medical providers to rely on non-patient specific orders for patient care. The State Education Department, however, has historically interpreted that standing orders are not appropriate because without the existence of a relationship between the patient and an authorized provider, given the complexities of patient co-morbidities, considerable allergies and multiple medications, it is difficult and potentially dangerous to design a medical treatment plan in which "one size fits all."

In 2000, the New York State Legislature created the non-patient specific standing order as a legal entity. The legislation's intent was to legitimize the administration of immunizations and anti-anaphylactic agents by RNs without the need for a patient specific order. More recently, purified protein derivative (PPD) tests and human immunodeficiency virus (HIV) tests were added to the law by the legislature.

Within the limited context of this legislation, non-patient specific orders waive the usual requirement that there exist a treatment relationship between the patient and the authorized medical provider prior to execution of a medical order by an RN. In the absence of such a treatment relationship, the responsibility for assessing each patient for any obstacle or danger that the order might create, falls to the RN. Since assessment is not within the scope of practice of Licensed Practical Nurses (LPNs), they may not independently execute a non-patient specific order. However, depending upon the outcome of the patient assessment, the RN may lawfully delegate the actual administration of the immunization or test to an LPN.

Non-patient specific standing orders for the administration of immunization, anaphylactic agents, purified protein derivative tests and human immunodeficiency virus tests are the only legal circumstance in which orders can be provided for a given patient population with whom an authorized provider has no treatment relationship. The use of non-patient specific standing orders or non-patient specific standing protocols for clients in camps, college infirmaries, jails, hospitals, nursing homes, and occupational health facilities, for example, has no legal standing, and may result in a charge of unprofessional conduct against the RNs executing such orders.

The State Education Department has stated that in certain limited situations the development of a standardized list of orders designed for a given patient population may be lawful if each list of orders is signed by the patient's primary care provider and customized to the particular needs of a specific patient. Such orders are to be administered on an as needed (PRN) basis and executed in the same manner as any other PRN order.

We hope this clarification is helpful. If you have questions or need additional information, please contact the New York State Board for Nursing at the letterhead address above, by phone 518-474-3817 ext. 120, or by e-mail nursebd@nysed.gov.

Last Updated: January 31, 2013