Open Forum

Good Morning,

I am in search of some guidance on whether it is within the scope of practice for a Registered Professional Nurse to order a drug screen panel for medical clearance within the clinical setting.  I realize that each state will have its own practice guidelines.  I am waiting on feedback from NYS.

Thank you,
Claudia 

 

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Claudia Gardner-Benn, MSN, RN
Director of Nursing and Quality Management
Columbia University Irving Medical Center
New York, NY
cg3371@cumc.columbia.edu
------------------------------

I think it will depend on the healthcare setting. For example, some ER nurses are drawing blood, doing EKG’s, and ordering Covid test, as soon as the patient walks in the door.

We do finger sticks if our patient is fainting. In outpatient clinic we order pre-clinic routine fasting labs, screening fit test, and screening mammograms for our providers. I sometimes order labs or X-ray on walk-in patients with my providers permission as not to delay patient care sometimes.

The issue comes when a test result are abnormal. Most likely the provider will need to know why the test was ordered so that they can treat the patient appropriately.

If you are ordering a screening uds that comes back positive, then will the provider take responsibility? Will the patient need a referral to rehab etc.?

I think an organization protocol in the specific care setting can address these issues so that abnormal test results are not missed, and the provider agrees to take responsibility for testing initiated by nurses. Otherwise providers can order there own test for their patients.

Sent from my iPad


Original Message:
Sent: 9/23/2022 9:38:00 AM
From: Claudia Gardner-Benn
Subject: Scope of Practice

Good Morning,

I am in search of some guidance on whether it is within the scope of practice for a Registered Professional Nurse to order a drug screen panel for medical clearance within the clinical setting.  I realize that each state will have its own practice guidelines.  I am waiting on feedback from NYS.

Thank you,
Claudia 

 

------------------------------
Claudia Gardner-Benn, MSN, RN
Director of Nursing and Quality Management
Columbia University Irving Medical Center
New York, NY
cg3371@cumc.columbia.edu
------------------------------

Hi Myra,

Thank you for your response.  Yes, depending on the setting, verbal orders are appropriate (i.e. the ER and OR).  But I think the important thing to note is that an order (of some kind) is still needed.

I did receive a response from my State Board of Nursing.  Specifically, with regard to my question, their response was:

RNs may execute non-patient specific orders and protocols prescribed by a physician or NP for: (1) administering immunizations; (2) emergency anaphylaxis treatment; (3) TB, HIV, or HCV testing (3) opioid-related overdose treatment (4) screening at-risk persons for syphilis, gonorrhea or chlamydia infections.    ** Visit, http://www.op.nysed.gov/nurse. Click or tap if you trust this link." data-linkindex="8">www.op.nysed.gov/nurse  Practice Information - Non-Patient Specific Orders. 

RNs may not order drug screens for medical clearance, and drug screens are not included in the laws regarding non-patient-specific orders.  Drug screens require patient-specific orders from a provider.

Again, thanks for your input.

Regards,
Claudia

------------------------------
Claudia Gardner-Benn, MSN, RN
Director of Nursing and Quality Management
Columbia University Irving Medical Center
New York, NY
cg3371@cumc.columbia.edu
------------------------------

Original Message:
Sent: 09-24-2022 01:11
From: Myra Thomas
Subject: Scope of Practice

I think it will depend on the healthcare setting. For example, some ER nurses are drawing blood, doing EKG's, and ordering Covid test, as soon as the patient walks in the door.

We do finger sticks if our patient is fainting. In outpatient clinic we order pre-clinic routine fasting labs, screening fit test, and screening mammograms for our providers. I sometimes order labs or X-ray on walk-in patients with my providers permission as not to delay patient care sometimes.

The issue comes when a test result are abnormal. Most likely the provider will need to know why the test was ordered so that they can treat the patient appropriately.

If you are ordering a screening uds that comes back positive, then will the provider take responsibility? Will the patient need a referral to rehab etc.?

I think an organization protocol in the specific care setting can address these issues so that abnormal test results are not missed, and the provider agrees to take responsibility for testing initiated by nurses. Otherwise providers can order there own test for their patients.

Sent from my iPad


Original Message:
Sent: 9/23/2022 9:38:00 AM
From: Claudia Gardner-Benn
Subject: Scope of Practice

Good Morning,

I am in search of some guidance on whether it is within the scope of practice for a Registered Professional Nurse to order a drug screen panel for medical clearance within the clinical setting.  I realize that each state will have its own practice guidelines.  I am waiting on feedback from NYS.

Thank you,
Claudia 

 

------------------------------
Claudia Gardner-Benn, MSN, RN
Director of Nursing and Quality Management
Columbia University Irving Medical Center
New York, NY
cg3371@cumc.columbia.edu
------------------------------