REPORT: March 2005

Ask the Experts

Can RNs implement “standing orders?”

Q.: My new employer asks nurses to implement standing orders. I don’t think this is acceptable. Am I correct?

A.: You are correct. The implementation of a “standing order” by a nurse, without a signed review by an authorized prescriber, places the nurse in the position of making a “medical” diagnosis and prescribing. This is outside the scope of practice of the RN, unless she or he is also a certified nurse practitioner (NP). This applies to standing orders for over-the-counter medications (such as Tylenol®) as well.

There are three legal exceptions, under which an RN may implement non-patient-specific orders. Once the orders have been reviewed and authorized by an NP or physician and following an assessment by an RN, the nurse may implement non-patient-specific orders for: 1) administration of certain immunizations, 2) treatment of anaphylaxis, and 3) administration of Purified Protein Derivative (PPD), or a tuberculin skin test. Remember, an RN must first evaluate all patients receiving immunizations or PPD tests under a non-patient-specific order. Once this occurs, the RN may assign an LPN to administer the immunization or PPD.

If your employer has “standing orders” specific to specialty units or patient populations, they may only be implemented after the prescriber has reviewed them for appropriateness for that patient and signed them, thus making the medical order patient-specific.