NYS Scope of Practice for Registered Nurses Research Paper

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Standing Orders, Computerized Order Entry, & Admission Pressure Ulcers

Standing orders are non-patient specific orders written by a physician or a nurse practitioner (Primer on standing orders for immunizations and emergency treatment of anaphylaxis, n.d.). New York RNs can administer certain immunizations with a standing order and protocols. Implications have come from designing workflows in the computerized order entry systems if not properly fitted with the existing information systems. Physicians are now responsible to assess, document, and treat present on admission pressure ulcers.

In the state of New York, RNs must be CPR certified with American Red Cross, American Heart Association, or other equivalent organization to administer immunization agents with a standing order and protocol. For adults, 18 or older, authorized agents include Hepatitis A, Hepatitis B, Influenza, Pneumococcus, Meningococcus, Diphtheria, Tetanus, Measles, Mumps, Rubella, Varicella, Inactivated Polio, and any additional approved by the Board of Regents. For children, under 18 years, authorizing immunization agents include Diphtheria, Tetanus, Acellular Pertussis, Measles, Mumps, Rubella, Varicella, Haemphilus Influenza Type b (HIB), Inactivated Polio, Hepatitis B, and any additional approved by the Board of Regents. RNs are also authorized when the immunization program is instituted as an epidemic declared by a health official.

The RNs must follow all non-patient specific standing orders and protocols and must maintain a copy of the standing order and protocols that authorizes them to administer the immunizations. The standing orders must be written in language that the RNs to administer the immunizations and contain names and license number of the RNs or the entity that is legally authorized to employ or contract RNs and contain a statement that RNs not named individually cannot administer immunizations outside of employment or contract.

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The standing order must also contain specific immunization agents allowed, the period of time the order is effective, protocol in accordance with the standing order, and the name, license number, and signature of the prescribing physician or CNP.

The authorization of administration of immunizations by RNs is state specific. RNs in California may administer immunizations without a standing order (the BRN Report, 14(1), 2001). The RNs must possess knowledge, skills, and abilities to do so competently using CDC guidelines. Agency policies and procedures may require a physician order, but it is not required by state law.

"Computerization of ordering can dramatically affect the care delivery process as patterns of communication, cooperation, and collaborative work must shift to accommodate technology" (Campbell, 2009). Computerized Provider Order Entry (CPOE) can cause contentions for computers in busy workstations, software design issues cause some work processes to be awkward, and there is often not enough space for free text entry. The CPOE often does not smoothly handle transactions in level or location, causes rigid scheduling of tests and medications (schedules from time of order entry instead of time….....

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