NY vs. California Nursing Scope of Practice Compared
This paper compares the scope of nursing practice in New York and California, focusing on three key areas where state laws and regulations produce meaningful differences. It examines how each state defines standing orders and what registered nurses may independently order under them, the implications of designing workflows in electronic health records using computerized order entry, and what nurses, physicians, and mid-level providers are authorized to order within EHR systems. A comparative table summarizes the distinctions between the two states, illustrating how variation in state nurse practice laws shapes everyday clinical and administrative responsibilities for registered nurses.
- Introduction: State-Level Variation in Nursing Practice: Why nursing scope of practice varies by state
- Definition of Standing Orders: How NY and CA define standing orders differently
- Designing Workflows in Electronic Health Records: EHR workflow implications in each state
- EHR Orders by Nurses, Physicians, and Mid-Level Providers: What each provider type can order in EHRs
- Comparative Summary Table: Side-by-side table of NY vs. CA differences
- Conclusion: Key regulatory differences and their causes
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What makes this paper effective
- Uses a clear parallel structure throughout, consistently comparing New York and California across the same three dimensions, which makes differences easy to follow.
- Grounds abstract regulatory concepts in concrete clinical examples, such as specifying that New York nurses may independently order PPD tests and antianaphylactic agents under standing orders.
- The comparative table at the end functions as an effective visual synthesis, consolidating the paper's findings for quick reference without replacing the analytical prose.
Key academic technique demonstrated
The paper demonstrates systematic comparative analysis: each section introduces a general concept, then applies it to both states in sequence, using transitional phrases like "In contrast" and "On the contrary" to signal differences. This point-by-point structure, rather than a state-by-state block approach, keeps the comparison tight and prevents repetition.
Structure breakdown
The paper opens with a brief framing introduction explaining why scope of practice varies by state. It then addresses three substantive topics in separate sections — standing orders, EHR workflow design, and EHR ordering privileges — each following the same NY-then-CA comparison pattern. A visual table recaps all findings, and a short conclusion restates the key differences and their regulatory causes. This is a well-organized short analytical paper appropriate for an undergraduate health policy or nursing foundations course.
Introduction: State-Level Variation in Nursing Practice
The scope of practice for nurses is largely similar across the country but differs from state to state because of variations in practice environments, nurse practice laws, and regulations. Each state has established specific laws and regulations that govern nursing practice within its borders, incorporating different licensure and regulatory requirements as well as details regarding the nursing practice environment. New York and California offer instructive examples of these differences. The distinctions between the two states are evident in how they define standing orders, how they approach the design of workflows in electronic health records (EHRs), and what nurses, physicians, and mid-level providers are authorized to order within EHR systems.
Definition of Standing Orders
One of the major ways in which nursing practice differs between New York and California is in the definition of standing orders. Standing orders are generally defined as prewritten medication orders and specific directions provided by a licensed independent practitioner to administer medication to a patient whose condition has been clearly identified (Buppert, 2012). Nurses typically work in collaboration with physicians to create a series of standing orders that help provide safe and efficient care. Standing orders are created and approved by physicians, who bear responsibility for the care covered by those orders.
Based on New York State's scope of practice for registered nurses, standing orders are defined as non-patient-specific medical orders used to direct nursing care (New York State Education Department, 2009). However, according to the State Education Department, standing orders are considered potentially inappropriate because creating a medical treatment plan without a relationship between the patient and an authorized care provider is difficult and potentially dangerous. This concern stems from the complexities of individual patients' co-morbidities, significant allergies, multiple medications, and the challenges of creating a one-size-fits-all treatment plan. Nonetheless, the New York State Legislature established certain criteria recognizing the non-patient-specific standing order as a legitimate entity in 2000.
In contrast, California's scope of practice for registered nurses defines standing orders as written orders utilized when a specific order for a specific patient is offered by a licensed healthcare provider within his or her professional scope of licensure or practice. In California, physicians may use standing orders to authorize nurse practitioners or medical assistants to provide certain services. However, the use of these orders by medical assistants and licensed practical nurses is restricted and governed by specific nursing rules and practice settings.
These definitional differences produce variances in what a registered nurse may order independently in each state. In New York, a nurse may order the administration of immunizations, the provision and administration of antianaphylactic agents, and the delivery of purified protein derivative (PPD) tests and HIV tests (Buppert, 2012). In California, nurses may use standing orders to order the administration of medication or drugs and the initiation of clearly described clinical processes for a specific patient.
Designing Workflows in Electronic Health Records
Another area in which nursing practice differs between New York and California involves the implications of designing workflows in the electronic health record using computerized order entry. Computerized order entry is generally described as the direct entry of clinical orders into the electronic health record of a healthcare system by licensed independent practitioners or medical staff with established ordering privileges. Clinical or administrative support staff do not make these entries, as they do not hold ordering privileges.
In California, the implications of designing EHR workflows using computerized order entry include issues that have traditionally been regarded as barriers to adoption of these applications in healthcare practice. These barriers include poor planning and implementation, lack of adequate clinician participation, lack of standardized medical terminology, and insufficient financial commitment (Doolan & Bates, 2002, p. 183). Nonetheless, the benefits of computerized order entry in designing workflows include enhanced accuracy and completeness, reduced transcription errors, and the capability to enter orders from multiple locations.
New York nurses face similar implications when designing EHR workflows using computerized order entry. These implications arise because computerized order entry offers numerous advantages over paper-based techniques. In particular, the use of these systems helps enable physicians to access clinical decision support at the point of care, which in turn reduces medication errors and improves the appropriateness and cost-effectiveness of ordering medications and tests.
Conclusion
New York and California have significant differences in scope of practice for registered nurses. The differences are attributable to the variances in state laws and regulations on nursing practice as well as differences in nurse practice settings and environments. Some of the major areas in which these states differ include the definition and use of standing orders as well as the use of electronic health records by physicians, nurses, and mid-level providers. Understanding these state-level distinctions is essential for nurses who practice across state lines or transition between healthcare systems governed by different regulatory frameworks.
References
Buppert, C. (2012, December 7). Are standing orders legal? Retrieved April 8, 2016, from http://www.medscape.com/viewarticle/775617
Coffman, J. M. (2012, June 14). California physicians unprepared for electronic health record regulations, according to UCSF report. Retrieved from University of California San Francisco website: https://www.ucsf.edu/news/2012/06/12174/california-physicians-unprepared-electronic-health-record-regulations-according
Doolan, D. F., & Bates, D. W. (2002, July/August). Computerized physician order entry systems in hospitals: Mandates and incentives. Health Affairs, 21(4), 180–188.
New York State Education Department. (2009, April). Nursing guide to practice. Retrieved from Office of the Professions — The State Education Department website:
The New York City Department of Health and Mental Hygiene. (2007, January). Electronic health records for the primary care provider. City Health Information, 26(1), 1–6. Retrieved from
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