Registered Nurse Scope of Practice and ED Complaint-Specific Protocols

Castner, Jessica; Grinslade, Susan; Guay, Jennifer; Hettinger, A. Zachary; Seo, Jin Young; Boris, Lenore

doi:10.1016/j.jen.2013.02.009

Cited by 14 publications

(23 citation statements)

References 18 publications

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“…Another comment mentioned "our state Board of Nursing is silent on this [the topic of nurse initiated protocols]." Silence by state boards of nursing on the issue is common (Castner et al, 2013).…”

Section: Approvalmentioning

confidence: 99%

State Laws and Regulations Addressing Nurse-Initiated Protocols and Use of Nurse-Initiated Protocols in Emergency Departments: A Mixed-methods Cross-sectional Survey Study

Castner¹,

Boris

2020

Preprint

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Introduction: State regulations may impede the use of nurse-initiated protocols to begin life-saving treatments when patients arrive to the emergency department. In crowding and small-scale disaster events, this could translate to life and death practice differences. Nevertheless, research demonstrates nurses do utilize nurse-initiated protocols despite legal prohibitions. The purpose of this study was to explore the relationship of the state regulatory environment as expressed in nurse practice acts and interpretive statements prohibiting the use of nurse-initiated protocols with hospital use of nurse- initiated protocols in emergency departments. Methods: A mixed-methods approach was used with a cross-sectional nationwide survey. The independent variable categorized the location of the hospital in states that have a protocol prohibition. Outcomes included protocols for blood laboratory tests, x-rays, over the counter medication, and electrocardiograms. A second analysis was completed with New York State alone because this state has the strongest language prohibiting nurse-initiated protocols. Results: 350 surveys from 48 states and the District of Columbia were received. A hospital was more likely to have policies supporting nurse-initiated protocols if they were not in a state with scope of practice prohibitions. Four qualitative categories emerged: advantages, approval, prohibition, and conditions under which protocols can be used. Prohibitive language was associated with less protocol use for emergency care. Conclusion: State scope of practice inconsistencies create misalignment with emergency nurse education and training, which may impede timely care and contribute to inequalities and inefficiencies in emergency care. In addition, prohibitive language places practicing nurses responding to emergencies in crowded work environments at risk. keywords: emergency nursing, emergency department, scope of practice, protocol, nurse practice act

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Section: Approvalmentioning

confidence: 99%

State Laws and Regulations Addressing Nurse-Initiated Protocols and Use of Nurse-Initiated Protocols in Emergency Departments: A Mixed-methods Cross-sectional Survey Study

Castner¹,

Boris

2020

Preprint

Self Cite

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“…The language of state scope of practice acts was analyzed in a previous study (Castner et al, 2013). Three major themes were identified that applied to nurseinitiated protocols in the ED setting such as cautiously within scope, intentionally vague/silent, and outside scope of practice (seven states of CT, KS, NY, OK, IL, LA, and NJ).…”

Section: Introductionmentioning

confidence: 99%

“…These generically termed, "nurse practice acts" broadly outline the legal limits of RNs' professional activities. Nurse practice acts vary by state; however, in many states, regulatory and policy barriers constrain nursing practice (Castner et al, 2013). These regulatory and policy barriers and inconsistencies often lead nurses to question whether certain activities are within their scope of practice.…”

mentioning

confidence: 99%

“…Emergency care is a crucial health care area where barriers to nursing practice scope and autonomy is particularly poignant, as demand for nursing care often outstrips resources and timeliness of care is essential to patient outcomes (Pines et al, 2011). In the ED, RNs are typically the first to assess a patient's condition and are thus in ideal positions to initiate timely care based on preestablished facility protocols (Castner et al, 2013;Douma et al, 2016). This practice is often referred to as nurse-initiated protocols, complaint-specific protocols, advanced triage orders, medical directives, and standing triage protocols.…”

mentioning

confidence: 99%

“…In these instances, RNs may initiate treatment and diagnostic testing based on patients' presentations only when both the state scope of practice regulation and hospital policy allow nurseinitiated protocols. However, there are many inconsistencies among states in how the RN scope of practice is regulated that prohibit RNs from applying these protocols to a patient without a patient-specific written or verbal prescription (Castner et al, 2013).…”

mentioning

confidence: 99%

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State Laws and Regulations Addressing Nurse-Initiated Protocols and Use of Nurse-Initiated Protocols in Emergency Departments: A Cross-Sectional Survey Study

Castner

Boris

2020

Policy, Politics, & Nursing Practice

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Introduction State regulations may impede the use of nurse-initiated protocols to begin life-saving treatments when patients arrive to the emergency department. In crowding and small-scale disaster events, this could translate to life and death practice differences. Nevertheless, research demonstrates nurses do utilize nurse-initiated protocols despite legal prohibitions. The purpose of this study was to explore the relationship of the state regulatory environment as expressed in nurse practice acts and interpretive statements prohibiting the use of nurse-initiated protocols with hospital use of nurse-initiated protocols in emergency departments. Methods A cross-sectional approach was used with a nationwide survey. The independent variable categorized the location of the hospital in states that have a protocol prohibition. Outcomes included protocols for blood laboratory tests, X-rays, over-the-counter medication, and electrocardiograms. A second analysis was completed with New York State alone because this state has the strongest language prohibiting nurse-initiated protocols. Results A total of 350 participants returned surveys from 48 states and the District of Columbia. A hospital was more likely to have policies supporting nurse-initiated protocols if they were not in a state with the scope of practice prohibitions. Four categories emerged such as advantages, approval, prohibition, and conditions under which the protocols can be used. Prohibitive language was associated with less protocol use for emergency care. Conclusion State scope of practice inconsistencies create misalignment with emergency nurse education and training, which may impede timely care and contribute to inequalities and inefficiencies in emergency care. In addition, prohibitive language places practicing nurses responding to emergencies in crowded work environments at risk.

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