Authorizes hospitals to establish standing orders for the care of newborns in the hospital until the discharge of the newborn from the hospital following the birth, which may authorize an attending nurse to provide services and care to healthy newborns.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A9950B
SPONSOR: Gottfried TITLE OF BILL: An act to amend the public health law and the educa-
tion law, in relation to hospital standing orders for the care of
newborns
PURPOSE OR GENERAL IDEA OF BILL:
To allow hospitals to establish non-patient specific orders for the care
of healthy newborns by an attending registered nurse.
SUMMARY OF PROVISIONS:
Section 1 creates a new section 2803-v in the public health law, author-
izing hospitals to create standing orders for newborn care.
Subdivision 1 authorizes a hospital to establish standing orders for the
care of newborns. Subdivision 2 defines terms.
Subdivision 3 provides that a standing order may be implemented either
when directed by the attending practitioner, or when the attending nurse
determines that implementing the standing order is clinically appropri-
ate and consistent with the order, the hospital's policies, and applica-
ble regulations.
Subdivision 4 requires that a standing order provide for the circum-
stances in which departure from the order is required, and that an
attending nurse shall advise the attending practitioner if the nurse
becomes aware of circumstances that reasonably indicate a need to depart
from the standing order. The order must also provide that the attending
practitioner shall review and acknowledge in writing the care provided
under the standing order.
Subdivision 5 allows a standing order to provide for circumstances in
which it shall not be implemented or shall only be implemented at the
order of an attending practitioner. A standing order shall also be
dated, timed, and authenticated promptly in the patient's medical record
by the attending practitioner.
Subdivision 6 requires that in order to implement a standing order, a
hospital must: establish that the order has been reviewed and approved
by the hospital's medical staff and nursing and pharmacy leadership, and
signed by a physician or midwife affiliated with the hospital; demon-
strate that the order is consistent with nationally recognized
evidence-based guidelines; and ensure that the hospital's medical staff
and nursing and pharmacy leadership conduct periodic and regular reviews
of the order to determine its continuing usefulness and safety.
Subdivision 7 provides that a standing order is a medical regimen and
shall be consistent with the lawful scope of practice of a registered
nurse.
Subdivision 8 allows the commissioner to make regulations governing the
terms, procedures, and implementation of standing orders.
Section 2 adds a new subdivision 9 to section 6909 of the education law
to provide that a registered professional nurse may execute a standing
order for newborn care in a hospital established under section 2803-v of
the public health law.
Section 3 is the effective date.
JUSTIFICATION:
Until recently, it was common for hospitals to establish non-patient
specific orders for the care of infants delivered within their facili-
ties. These orders enabled registered nurses (RNs) to carry out standard
procedures following deliveries of healthy babies, without a specific
order from the attending obstetric or pediatric practitioner. They were
initiated by the RN, were evidence-based, and included state-mandated
treatments that must be performed within specified time limits for all
healthy newborns, such as antibiotic eye prophylaxis, administration of
vitamin K, and HIV and metabolic disorder testing. Such treatments and
services are well within the scope of practice of a registered nurse.
Since births often occur when the attending physician, nurse practition-
er, physician assistant, or midwife is unavailable, an RN's ability to
initiate the routine care of a healthy newborn is an important part of
ensuring timely care.
New York law authorizes "non-patient specific regimens" to allow RNs to
do such things as administer certain treatments and tests, including
immunizations and HIV tests, to patients without a patient-specific
order from a physician for each individual. Since the law does not
explicitly include standing orders for the care of healthy newborns,
some authorities interpret hospital standing orders for newborn care to
be illegal.
The bill maintains the authority of the attending practitioner, the
hospital, and Health Department regulations, and protects the role and
scope of practice of RNs.
This bill will allow hospitals to establish non-patient specific stand-
ing orders for RNs to initiate upon the birth of a healthy newborn in
their facility. Each hospital will establish the circumstances in which
its order will and will not be implemented without a patient-specific
order from the attending practitioner, and all orders will comply with
an RN's scope of practice and all applicable regulations.
PRIOR LEGISLATIVE HISTORY:
New bill.
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
None.
EFFECTIVE DATE:
This act shall take effect one hundred twenty days after it shall become
a law. Effective immediately, the commissioner may make regulations and
take other actions reasonably necessary to implement this act on that
date.
STATE OF NEW YORK
________________________________________________________________________
9950--B
IN ASSEMBLY
February 27, 2018
___________
Introduced by M. of A. GOTTFRIED, BRAUNSTEIN, ENGLEBRIGHT, CAHILL, McDO-
NALD, D'URSO, CROUCH, THIELE, SEAWRIGHT, BUCHWALD, LIFTON, DICKENS,
TAYLOR, JAFFEE, NIOU, LUPARDO, BARRON, ZEBROWSKI, NORRIS, LAWRENCE,
ERRIGO, MONTESANO, BLAKE, ORTIZ, COOK, MOSLEY, LAVINE, GLICK, CRESPO,
BICHOTTE, DE LA ROSA, GOODELL, RIVERA, FAHY -- Multi-Sponsored by --
M. of A. DAVILA, GIGLIO, HYNDMAN -- read once and referred to the
Committee on Health -- reported and referred to the Committee on Codes
-- committee discharged, bill amended, ordered reprinted as amended
and recommitted to said committee -- reported and referred to the
Committee on Rules -- Rules Committee discharged, bill amended,
ordered reprinted as amended and recommitted to the Committee on Rules
AN ACT to amend the public health law and the education law, in relation
to hospital standing orders for the care of newborns
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The public health law is amended by adding a new section
2 2803-v to read as follows:
3 § 2803-v. Standing orders for newborn care in a hospital. 1. A hospi-
4 tal may establish standing orders for the care of newborns in the hospi-
5 tal until the discharge of the newborn from the hospital following the
6 birth, which may authorize an attending nurse to provide services and
7 care to healthy newborns.
8 2. As used in this section, unless the context clearly requires other-
9 wise:
10 (a) "Hospital" means a hospital that routinely provides perinatal care
11 to newborns.
12 (b) "Attending practitioner" means the physician, nurse practitioner,
13 physician assistant or midwife, acting within his or her lawful scope
14 and terms of practice, attending the birth or postnatal care of a
15 newborn in a hospital.
16 (c) "Attending nurse" means a registered nurse attending the postnatal
17 care of a newborn, acting within his or her lawful scope of practice.
18 (d) "Standing order" means a non-patient specific order for the care
19 of healthy newborns in the hospital, established under this section.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD14792-04-8
A. 9950--B 2
1 3. A standing order may be implemented in the case of any newborn when
2 (a) directed by the attending practitioner, or (b) in the absence of a
3 specific direction by the attending practitioner, the attending nurse
4 determines, in his or her professional judgment, that implementing the
5 standing order for the newborn is clinically appropriate and consistent
6 with the standing order, the hospital's policies and applicable regu-
7 lations. The standing order shall not be implemented in a specific situ-
8 ation where the hospital's policies, the standing order, or applicable
9 regulations provide otherwise.
10 4. (a) A standing order shall provide for the circumstances in which
11 the condition or change in condition of the newborn or the newborn's
12 mother, or other circumstances relating to providing services and care
13 to the newborn, require departure from the terms of the standing order.
14 (b) Where an attending nurse implementing a standing order becomes
15 aware of circumstances that, in his or her professional judgment,
16 reasonably indicate a need to depart from the terms of the standing
17 order, he or she shall so advise the attending practitioner. In such
18 circumstances, if the attending nurse determines, in his or her profes-
19 sional judgment, that the health of the newborn requires departing from
20 the standing order prior to receiving direction from the attending prac-
21 titioner, the attending nurse may do so, consistent with his or her
22 lawful scope of practice, the hospital's policies and applicable regu-
23 lations.
24 (c) The standing order shall provide, including the times and manner,
25 that an attending practitioner shall review and acknowledge in writing
26 the services and care provided to the newborn under the standing order
27 and the condition of the newborn.
28 5. (a) A standing order may provide for circumstances in which it
29 shall not be implemented, or implemented only at the order of an attend-
30 ing practitioner, which may include but not be limited to:
31 (i) lack of or inadequate prenatal care;
32 (ii) a birth not attended by an attending practitioner;
33 (iii) a birth not occurring in a hospital; or
34 (iv) a premature or low birth weight birth.
35 (b) A standing order shall be dated, timed, and authenticated promptly
36 in the patient's medical record by the attending practitioner acting in
37 accordance with law, including scope-of-practice laws, hospital poli-
38 cies, and medical staff bylaws, rules and regulations.
39 6. A standing order may be implemented only if the implementing hospi-
40 tal:
41 (a) establishes that the order has been reviewed and approved by the
42 hospital's medical staff and nursing and pharmacy leadership, and signed
43 by a physician affiliated with the hospital or, in the case of a midwif-
44 ery birth center, by a midwife affiliated with the hospital;
45 (b) demonstrates that the order is consistent with nationally recog-
46 nized evidence-based guidelines; and
47 (c) ensures that the periodic and regular review of the order is
48 conducted by the hospital's medical staff and nursing and pharmacy lead-
49 ership to determine the continuing usefulness and safety of the order.
50 7. A standing order is a medical regimen; it shall be consistent with
51 the lawful scope of practice of a registered nurse.
52 8. The commissioner may make regulations governing the terms, proce-
53 dures and implementation of standing orders.
54 § 2. Section 6909 of the education law is amended by adding a new
55 subdivision 9 to read as follows:
A. 9950--B 3
1 9. A registered professional nurse may execute a standing order for
2 newborn care in a hospital established under section twenty-eight
3 hundred three-v of the public health law, as provided in that section.
4 The commissioner may make regulations relating to implementation of this
5 subdivision.
6 § 3. This act shall take effect on the one hundred twentieth day after
7 it shall have become a law. Effective immediately, the commissioner of
8 health and the commissioner of education may make regulations and take
9 other actions reasonably necessary to implement this act on that date.
