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    4. New York broadens nurse protocol authority to include physician assistant orders

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    Alert / Healthcare

    New York broadens nurse protocol authority to include physician assistant orders

    July 1, 2025

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    By Michele Masucci, Jéna Grady, Jennifer Greco and Justin PfeifferLindsay Ing (Marketing Intern—Healthcare practice) assisted with the preparation of this alert.

    What’s the impact?

    • The rule aims to improve healthcare access and flexibility, especially in high-need settings.
    • Healthcare organizations should review and update internal protocols and delegation policies to reflect PAs’ new authority to issue non-specific orders to RNs.

    DOWNLOAD

    NY broadens nurse protocol authority (PDF)

    As of June 25, 2025, New York State Education Department finalized a rule permitting registered professional nurses (RNs) to follow non-patient specific orders issued by licensed physician assistants (PAs). This change was originally implemented through an emergency rule on February 22, 2025, to meet the regulatory implementation deadline established in Senate Bill 9038, which required amendments within three months of the bill’s enactment on November 22, 2024. The rule was made permanent following the required public comment and review period, which ended April 27, 2025. The agency received no public comments during the comment and review period.

    The rule implements Chapter 520 of the Laws of 2024, which amends the state law to authorize RNs to perform designated medical services—such as immunizations, overdose treatment, and infectious disease screening—under non-patient specific orders issued by a PA. In enacting the statute that enabled this regulatory change, the Legislature found that “New Yorkers face significant barriers to health care that largely stem from a shortage of health care professionals able to serve the needs” of New York communities. Prior to the emergency rule, only physicians and nurse practitioners were permitted to issue non-patient specific orders and protocols to nurses. By expanding this authority to PAs, the law aims to increase care access and flexibility, particularly in high-need settings like schools, shelters, community clinics, and mobile health programs.

    What has changed?

    RNs may now administer the following services under standardized, non-patient specific orders and protocols issued by a PA:

    • Immunizations
    • Emergency treatment of anaphylaxis
    • Tuberculosis screening (e.g., PPD tests)
    • HIV and Hepatitis C testing
    • Opioid overdose treatment (e.g., naloxone)
    • STI screening (syphilis, gonorrhea, chlamydia)
    • Electrocardiograms for suspected acute coronary syndrome
    • Point-of-care glucose testing for suspected hypoglycemia
    • IV access and diagnostic testing for suspected sepsis
    • Pregnancy testing
    • COVID-19 and influenza testing

    The final rule also includes technical revisions to clarify language and improve consistency across the nurse practice framework.

    Key takeaways for healthcare providers

    Healthcare organizations should ensure internal protocols and delegation policies reflect the updated authority of PAs to issue non-specific orders and protocols to RNs. This change supports greater flexibility in staffing and can streamline service delivery for time-sensitive interventions such as immunizations, overdose reversal, and infectious disease screening.

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