Clinical Practice > Is it appropriate for a licensed nurse to follow written guidelines when providing patient care?

Definition

Guidelines have been defined as "systematically developed statements that include recommendations, strategies or information to assist health care practitioners" make decisions about appropriate health care based on an established standard of care. Process protocols are flexible and easily adapted to all levels of practice settings. Nurses may implement physician/APRN issued protocols and standing/routine orders, including the administration of medications, following nursing assessment. Protocols/orders should be written to reflect treatment of signs and symptoms, and should include parameters for the nurse to consult the physician/APRN. In addition, protocols and standing/routine orders should be officially approved by the facility medical and/or nursing staff, or approved by the prescriber of the individual patient."

Content

Guidelines may include both independent nursing activities (e.g. obtain orthostatic blood pressure readings) and nursing activities requiring a health care provider order and collaboration (e.g. administer sublingual nitroglycerin, immunizations).

The development of guidelines directing nursing care should include the following content:

• Title
• Definition or Purpose
• Specific population to whom the guideline applies
• Assessment data to be obtained
• Collaboration parameters when appropriate
• Interventions to be implemented
• Anticipated outcome
• Signature of Health Care Provider (MD, APRN, DO, Dentist) who authorized implementation of the guideline.

(Note that each facility should have a policy stating the time frame or manner in which the authorization occurs)

Documentation

The nurse is responsible for documenting the implementation of the guideline and the nursing care provided under the guideline.

Reference: Agency for Health Care Policy and Research (AHCPR)