Sample Paper on New York State: Registered Nurse Project

New York State Scope of Practice for Registered Nurse Project

Standing orders are orders for treatment as well as medication that have been designed and endorsed by the local medical society and which could be used by the attending nurse until a physician can be secured, or in case the attending physician did not leave orders to the nurse in charge (D’Antonio, 2005). Standing orders in this context waive the usual requirement that there should be a relationship between the patient and the attending medical personnel before a RN can execute a medical order. Such standing orders in NYS which are comparable with the Texas standing orders include the nurse administration of immunization, purified protein tests, HIV tests, and anaphylactic agents (D’Antonio, 2005). These orders are genuine and legitimizes the process and performance of the RNs without the need for any patient specific order. Under the order, the responsibility of the patient in the assessment of any danger or obstacle that might occur lies with the nurse. This overlap of medical and nursing protocols in nursing may also occur in ICU, CCU and in IV team practice (Follin & Springhouse Corporation., 2004)

Roles of nurses order in the EHR

There are various orders that a nurse can put in the EHR. These include though not limited to prescribing the patients details for the purpose of safe custody and follow-up. Under this, the nurse is able to input all relevant details reading the patient such that other authorized personnel within the setting of the healthcare can also access the data for easy follow-up. This would reduce duplication of roles and duties that other people would do thereby creating efficiency. Actually, the nurse can transcribe the necessary medication to the patient. This would help nurses to fast-track quickly the medicine being given to a particular patient. At the same time, nurses may put on the EHR, the details of drugs and the time of drug dispensation to patients especially to patients admitted at the facility. This would be important as it would reduce paperwork and ease documentation. At the same time, details of drug administration would be put in the EHR thereby making it easier for any person to access patient’s administration details. This implies that the use of the computer technology would help in capturing and in retrieving healthcare information by providing medical orders, interventions and recording patients’ responses, leading to improved facility’s/systems workflow that would in turn lead to quality and effective undertakings (Walker-Czyz, 2014)

What are the implications when designing workflows in the Electronic Health Record using Computerized Order Entry?

Health care providers design their workflows in the EHR using CPOE (computerized physician order entry) to place various orders including medications, lab tests and other services. The use of CPOE has led to reduction of medical ordering errors, has promoted standardization, reduced the general healthcare costs as well as decreased redundant test ordering. Despite this fact, many institutions fail to embrace and implement it because of the various implications including high costs involved in the implementation, resistance of the technology by the staff involved, the fear associated with technological failures as well as the inability of the technology to integrate with the existing healthcare platforms. The impact of implementing therefore has implications as it affects the way in which clinicians coordinate their work.

One of the implication of designing EHR using the COE entails the fact that its introduction creates conflict between the system and the persons working on them. For example, when the workstations are in short supply, and there are increased workloads, the contention for computers can be high leading to slowed morning rounds for clinicians.

At the same time, the computerized order entry may affect the pace, the sequence as well as the dynamics since some patent information not integrated in the system may be hard to get or access. The computerized system forces the persons working on them to accommodate them thereby creating confusion and rigid systems that forces activities.

The computerized order entry reduces situation awareness and does not recognize the holistic work activities involved in the system. This means that all work and activities of all the staff is not supported by the system.

Physicians order in the EHR

In the electronic health records, the physician may undertake electronic ordering by typing prescription orders for patients. At the same time, the physician may print out prescription and respond to medications that affects patients including the allergic medicines. The physician at the same time on the same platform may order laboratory tests, order referrals and order other tests that may seems appropriate to a given patient.

The physician may also use the EHR to message with outsiders with the aim of improving care coordination and with the patient to improve their satisfaction through the sense of patient-centered care. The physician can perform an analysis and report the findings through the EHR thereby improving quality through performance monitoring and feedback. It is also a fact that through the system, a physician is able to order patient directed functionality including patient reminders, schedule patients return visits, order medication and other function directed to the patients.

Mid-level providers and EHR

Middle level providers are practitioners, nurse practitioners, dentists, certified midwives, psychologists, physician assistants among others (Walker et al., 2005). Some middle level practitioners like psychologists are not allowed to make order for medication, though in some fields, they function like the physicians. The psychologists function independently in regard to therapy of their patients though the supervision by a physician is mandatory.



D’Antonio, P. (Ed.). (2005). Nursing History Review, Volume 14, 2006: Official Journal of the American Association for the History of Nursing. Springer Publishing Company.

Follin, S. A., & Springhouse Corporation. (2004). Nurse’s legal handbook. Philadelphia, Pa: Lippincott Williams & Wilkins.

Walker, J. M., Walker, J. M., Bieber, E. J., & Richards, F. (2005). Implementing an electronic health record system. London: Springer.

Walker-Czyz, A. (2014). The Impact of an Integrated Electronic Health Record Adoption on the Quality of Nursing Care Delivered.