The 4 types of New York nursing professions are:
*In New York, midwifery is not considered a nursing profession. Midwifery is a separately licensed profession.
* Nurse Aides and Home Health Aides are certified by the Department of Health.
2. The scopes of practice for the registered professional nurse, licensed practical nurse, clinical nurse specialist and nurse practitioner professions are defined in New York Law. Does that mean that I can do everything that falls within the legal scope of the practice of my nursing profession?
Icon for the answerA nurse may provide nursing services allowed by New York Law only if the nurse is personally competent to provide the services. You are not legally allowed to provide nursing services that you are not personally competent to perform, even if New York Law generally allows a nurse to provide the service. As a licensed professional, it is your responsibility to provide care competently, and as authorized by New York Law. If you do not, you could be charged with unprofessional conduct.
3. Can an unlicensed person, such as a medical technologist, use the title "nurse" or be referred to as "the nurse" in New York?
Icon for the answerNo. New York Law restricts the use of the title “nurse” to persons who are licensed by the New York State Education Department as an RN, LPN, CNS or NP. Graduates of certain RN or LPN education programs may also use the title of “graduate nurse” or graduate practical nurse” if they have applied to the New York State Education Department (SED) for a New York RN or LPN license and a limited permit.
4. Do I have to be registered and licensed as a nurse with the SED to practice as a nurse in New York?
Icon for the answerYes. You must be licensed and registered by SED as an LPN to practice as an LPN. You must be licensed and registered by SED as a RN to practice as an RN. To practice as a nurse practitioner, you must be licensed and registered by SED as a RN and certified and registered by SED as a nurse practitioner. To practice as a clinical nurse specialist, you must be licensed and registered by SED as a RN and certified and registered by SED as a clinical nurse specialist.
5. Must I wear an identification badge while I provide nursing care in a healthcare setting? Icon for the answerYes. You are legally required to wear an identification badge indicating your first and last name and your professional title while you are practicing at a hospital, clinic, medical practice or other establishment offering health services to the public.
6. Can a business venture that is not licensed to provide medical or nursing care hire a registered professional nurse, licensed practical nurse, clinical nurse specialist or nurse practitioner to provide nursing services?
Icon for the answerNo. If a business ventures is not specifically authorized by New York Law to provide medical or nursing care (i.e., salons or nutritional supplement stores) it is not legally allowed to hire licensed nurses to provide professional nursing services in New York.
7. Can a licensed practical nurse (LPN), registered professional nurse (RN) or clinical nurse specialist (CNS) perform services that constitute the practice of medicine (i.e., spinal taps) if delegated by a physician?
Icon for the answerNo. LPNs, RNs and CNSs are not legally allowed to practice medicine.
8. What options are available to a nurse if a co-worker is suspected of diverting controlled substances or appears to be impaired while providing care to patients?
Icon for the answerSeveral options are available. The nurse could share their concerns with a supervisor or report their observations to the New York State Department of Health’s Bureau of Controlled Substances at 866-811-7957. If the co-worker is a nurse, the co-worker should be encouraged to contact; (1) the New York State Nurses Association's Statewide Peer Assistance for Nurses (SPAN) program by phone 518-782-9400 ext. 304, or electronically through their website at https://www.nysna.org/nursing-practice/statewide-peer-assistance-nurses; or, (2) the New York State Education Department's Professional Assistance Program (PAP) at 518-485-9353.
9. If an insurance company or managed care organization refuses to pay for a nursing service, does it mean that it is not within my legal scope of practice to perform the service?
Icon for the answerInsurance companies, managed care organizations and other health care payors do not define the legal scope of practice of nurses. However, they may determine which nursing services they will pay for and how much they will pay. The State Board for Nursing does not have the authority to resolve fee disputes between nurses and managed care organizations, insurance companies or other payors.
10. If I am unsure about whether something falls within my legal scope of practice, how can I find out?
Icon for the answerPlease review the practice information on this website. If you cannot find the information that you seek, you may contact the Nursing Board Office by EMAIL at: nursebd@nysed.gov, or by telephone at 518-474-3817 ext. 120. You may also send a letter with your question to: New York State Education Department, 89 Washington Avenue-Education Building, State Board for Nursing, Second Floor, West Wing, Albany, New York, 12234.
New York's Nurse Practice Act allows LPNs to provide nursing services under the direction of a registered professional nurse (RN), clinical nurse specialist, physician, nurse practitioner, licensed midwife, physician assistant, specialist assistant, dentist, or podiatrist ("directing practitioner"). An LPN typically provides the following services under the direction of an RN or other directing practitioner (assuming that the LPN is appropriately trained and competent to provide the service or services):
An LPN is not legally allowed to determine nursing diagnoses, develop or change nursing care plans, perform triage, or perform any service that the LPN is not personally competent to perform. There are many services not listed here that LPNs may or may not be allowed to perform. There are many New York laws and regulations that impact the practice of LPNs. To view some of these laws and regulations, click on "Laws, Rules & Regulations" in the left navigation menu.
2. Can a licensed practical nurse (LPN) practice independently? Can an LPN supervise other staff? Icon for the answerAnswer: LPNs do not practice nursing independently. LPNs are legally required to practice under the direction of an RN, clinical nurse specialist, nurse practitioner, physician, dentist, physician assistant, specialist assistant, podiatrist, or midwife (“directing practitioner”). The directing practitioner must provide an appropriate degree of direction to the LPN, which is determined by the care needs of the patients and the skill and ability of the LPN. In most cases, the directing practitioner must be on premises when LPNs provide nursing care. The directing practitioner does not necessarily have to be on premises to direct an LPN where: (1) the LPN has demonstrated competence to meet the nursing care needs of the LPN’s patients; (2) the LPN’s patients are highly unlikely to require personal intervention by the directing practitioner; and, (3) the directing practitioner is available to direct the LPN by telephone or video conferencing and can personally intervene within 15 minutes to ensure timely and appropriate care. The directing practitioner remains ultimately responsible for providing appropriate direction via telephone, videoconferencing, or in person to ensure patient safety. No other licensed professionals or individuals are legally allowed to supervise or direct the professional practice of an LPN. They could, however, supervise non-clinical matters such as attendance or use of paid leave.
An LPN who is issued an "Independent Medicaid Provider Number" is not allowed to practice independently. An "Independent Medicaid Provider Number" merely qualifies the LPN to be paid for services covered by New York’s Medicaid Program.
An LPN may supervise another LPN if: (1) the nursing services to be provided are within both LPNs’ legal scope of practice and personal competency; and (2) both LPNs practice under the continuous direction of a RN, clinical nurse specialist, nurse practitioner or physician. An LPN cannot legally “direct” the practice of another LPN in lieu of an RN or other qualified directing practitioner. LPNs are not legally allowed to supervise professional services provided by RNs or other licensed health care professionals. In some cases, an LPN may supervise patient care staff, such as Certified Nurse Aides in nursing homes.
3. What services can a registered professional nurse (RN) provide? Icon for the answerNew York's Nurse Practice Act allows RNs to diagnose and treat human responses to actual or potential health problems through such services as case finding, health teaching, health counseling and providing care supportive to or restorative of life and well-being. RNs perform nursing assessments, determine nursing diagnoses, and plan, implement and evaluate nursing care. A nursing regimen must be consistent with any existing medical regimen.
New York's Nurse Practice Act also allows RNs to execute medical regimens prescribed by a physician, dentist, nurse practitioner, physician assistant, specialist assistant, midwife or podiatrist for a specific patient. In addition, RNs execute non-patient specific orders and protocols issued by a physician or nurse practitioner for administering certain: (1) immunizations; (2) emergency anaphylaxis treatment; (3) TB, HCV, HIV, COVID-19, Influenza, pregnancy and other lab tests; (4) opioid related overdose treatment; (5) medical screenings of persons at increased risk of having gonorrhea, syphilis or chlamydia, (6) medical services to newborn patients in hospitals, and, (7) emergency services for three life threatening medical conditions.
RNs may practice independently, in collaboration with other health care practitioners, or under the supervision of a physician, nurse practitioner, midwife, dentist, podiatrist, clinical nurse specialist or another RN. An RN typically provides the following types of services (assuming that the RN is appropriately trained and competent to provide the service or services):
An RN is not legally allowed to determine medical diagnoses, prescribe medical treatments, or perform any nursing services that the RN is not competent to perform. There are many New York laws and regulations that impact the practice of RNs. To view some of these laws and regulations, click on "Laws, Rules & Regulations" in the left navigation menu.
4. Who is allowed to supervise an RN? Icon for the answerAnswer: Only a licensed physician, nurse practitioner, midwife, podiatrist, dentist, clinical nurse specialist or an RN may supervise the nursing practice of an RN.
5. Can an RN or LPN administer drugs, performed medical laboratory tests, or provide medical treatments or therapeutic diets ordered by a nutritionist, pharmacist, or a patient?
Icon for the answerAnswer: RNs and LPNs execute medical regimes prescribed by a physician, medical resident, dentist, nurse practitioner, physician assistant, midwife or podiatrist. They are not legally allowed to execute medical orders issued by nutritionists, pharmacists, or other licensed healthcare professionals or individuals.
6. Can a registered professional nurse (RN) or licensed practical nurse (LPN) work in a position that is below their level of licensure?
Icon for the answerYes. A licensed nurse may work in a position that they have the training to do and that is within their scope of practice. RNs may perform LPN duties. RNS and LPNs may perform Certified Nurses Aid and Home Care Aid functions. However, the RN or LPN would still be required to act prudently based on their educational preparation and would be held to that standard. In addition, nurses cannot refer to themself as an "LPN" or "Certified Nurse Aid" unless it is, in fact, true.
7. Can a registered professional nurse (RN) be supervised by an unlicensed person or another licensed health care practitioner?
Icon for the answerOnly a licensed physician, nurse practitioner, midwife, podiatrist, dentist, clinical nurse specialist or an RN may supervise the nursing practice of an RN. All other licensed professionals (including licensed practical nurses) are not legally allowed to supervise the professional nursing practice of an RN. They could, however, supervise non-clinical matters such as attendance, dress code, etc.
8. Can a graduate of a nursing school practice nursing before being licensed and registered to practice nursing in New York?
Icon for the answerAnswer: In some cases, yes. The New York State Education Department (SED) issues limited permits to RN or LPN license applicants who have met all legal requirements to be licensed and registered to practice nursing except for taking the National Council Licensure Examinations (NCLEX–RN or NCLEX–PN). An LPN license applicant with a limited permit is a graduate practical nurse (GPN). An RN license applicant with a limited permit is graduate nurse (GN). This title must be displayed on the GPN’s or GN’s identification badge and must also be used when signing patient records.
9. What practice restrictions apply to graduate practical nurses (GPNs) and graduate nurses (GNs)? Icon for the answerAnswer: GPNs and GNs must practice at all times under the supervision of a registered professional nurse (RN) in a hospital or residential healthcare facility (nursing home). The supervising RN must be on the patient care unit at all times when professional services are being performed by the GPN or GN. The supervising RN must provide an appropriate degree of supervision, which is determined by the care needs of the patients and the skill and experience of the GPN or GN and other relevant factors.
In New York State, a clinical nurse specialist is a registered professional nurse who has completed advanced education (usually a master’s or doctorate degree) in a nursing clinical practice specialty and is certified by the New York State Education Department (SED) as a "Clinical Nurse Specialist" or "CNS". SED issues CNS certificates in the following specialty practice areas: Adult Health; Pediatrics; Psychiatric/Mental Health; and Oncology.
Clinical nurse specialists provide expert, highly skilled nursing services to benefit patients with complex health care needs. They coordinate and supervise care, evaluate the quality and effectiveness of patient care, and provide clinical consultation. Clinical nurse specialists may be involved in clinical research and health policy development.
Clinical nurse specialists do not determine medical diagnoses and do not prescribe or order medical treatments or diagnostic tests. For example, a clinical nurse specialist does not prescribe medications or order CT scans. There are many laws that govern clinical nurse specialist practice. To view some of these laws and regulations, click on "Laws, Rules & Regulations" in the left navigation menu.
2. Please describe the specialty areas in which the SED issues clinical nurse specialist certifications.
Icon for the answerSED issues clinical nurse specialist certifications in the following specialty areas: Adult Health; Pediatrics; Psychiatric/Mental Health; and Oncology.
Answer: In New York State, a nurse practitioner is a registered professional nurse who has completed advanced nursing education (usually a master's or doctorate degree) in a nurse practitioner specialty area and is certified by the New York State Education Department ("SED") as a "Nurse Practitioner" or "NP". SED certifies nurse practitioners to practice in the following specialty practice areas: Acute Care; Adult Health; Community Health; College Health; Family Health; Gerontology; Holistic Care; Neonatology; Obstetrics; Oncology; Palliative Care; Pediatrics; Perinatology; Psychiatry; School Health; and Women's Health. Nurse Practitioners manage the medical and nursing care of their patients. A nurse practitioner diagnoses illnesses and physical conditions and performs therapeutic and corrective measures within a specialty area of practice in which the nurse practitioner is certified by SED. In addition, nurse practitioners may issue non-patient specific orders and protocols to authorize and RN to administer certain: (1) immunizations; (2) emergency anaphylaxis treatment; (3) TB, HCV, HIV, COVID-19, Influenza, pregnancy and other lab tests; (4) opioid related overdose treatment; (5) medical screenings of persons at increased risk of having gonorrhea, syphilis or chlamydia, (6) medical services to newborn patients in hospitals, and, (7) emergency services for life threatening medical conditions. Certain medical services, including certain immunizations, and emergency treatments. Nurse practitioners also issue non-patient specific orders and protocols to authorize a licensed pharmacist to administer certain immunizations and dispense certain medications and medical devices.
There are many New York Laws and regulations that impact the practice of RNs. To view some of these laws and regulations, click on “Laws, Rules & Regulations” in the left navigation menu.
2. Please describe the "specialty practice areas" in which the SED issues nurse practitioner certifications.
Icon for the answerSED issues nurse practitioner certificates in the following specialty practice areas:
Nurse Practitioner (Acute Care): diagnoses, treats, and manages the care of acutely ill patients in a variety of hospital and ambulatory care settings.
Nurse Practitioner (Adult Health): diagnoses, treats, and manages the care of adults (young adults from about age 18 to the very elderly). Adult nurse practitioners may provide primary care or acute care; they may address acute or chronic health problems or provide preventive or supportive care.
Nurse Practitioner (College Health): addresses the physical and mental health needs of adolescent and adult populations in college settings.
Nurse Practitioner (Community Health): provides primary care services in community settings and engages in population-based health planning for communities.
Nurse Practitioner (Family Health): diagnoses, treats and manages the care of families and individuals across the life span. Family nurse practitioners usually provide primary care but they may also provide acute care, address acute or chronic health problems, and provide preventive and supportive care. Family Nurse Practitioners practice in a variety of settings, including schools, homes, workplaces, hospitals, clinics and primary care health practices.
Nurse Practitioner (Gerontology): diagnoses, treats and manages the care of older adults. This includes primary care and acute care, adressing acute or chronic health problems and providing preventive or supportive care.
Nurse Practitioner (Holistic Care): provides care that encompasses the body, emotion, mind and spirit, focusing on personal development and self-healing.
Nurse Practitioner (Neonatology): diagnoses, treats and manages the care of newborns and infants up to 1 year of age and provides support services to new parents.
Nurse Practitioner (Obstetrics and Gynecology): provides obstetrical and gynecological care to adults and adolescents. Obstetrics and Gynecology nurse practitioners may provide primary care or acute care; they may address acute or chronic health problems and provide preventive or supportive care. Some Obstetrics and Gynecology nurse practitioners sub-specialize in fields such as Labor & Delivery.
Nurse Practitioner (Oncology): diagnoses and treats and manages oncology related care for patients with cancer, and counsels, educates and provides support to their families.
Nurse Practitioner (Palliative Care): provides care to improve the quality of life of individuals with chronic, debilitating and life limiting illnesses and their families. Palliative care nurse practitioners typically treat pain and other distressing symptoms as well as address other physical, psychosocial and spiritual needs of patients and families.
Nurse Practitioner (Pediatrics): diagnoses, treats, and manages the care of infants, children, adolescents and young adults (up to about age 21). Pediatric nurse practitioners provide primary care and acute care; they address acute or chronic health problems and provide preventive and supportive care.
Nurse Practitioner (Perinatology): promotes quality care across the spectrum of birth experiences, ranging from a physiologic approach to birth that minimizes unnecessary intervention to coordinating treatment plans for conditions typically associated with high-risk pregnancies. They also work with new parents to provide guidance on breast feeding and parenting.
Nurse Practitioner (Psychiatry): diagnoses and treats psychiatric disorders and manages other acute and chronic mental health problems of adults and children. They may provide primary mental health care services or acute mental health services (i.e., triage, crisis intervention services).
Nurse Practitioner (School Health): addresses the health care needs of students in school settings. School health nurse practitioners may develop care plans to be implemented in school settings, train school staff to help students with health issues, and provide counseling and health education to students and their families.
Nurse Practitioner (Women’s Health): diagnoses, treats and manages the care of women and female adolescents, with a focus on primary care and gynecological care. They diagnose and treat sexually transmitted diseases in adults and adolescents, regardless of sex or gender identity.
3. Can a nurse practitioner medically diagnose or prescribe medical treatments for patients outside of the specialty area of practice in which they are certified by SED?
Answer: No. A nurse practitioner may only diagnose and prescribe medical treatments within the specialty area of practice for which they are certified by SED.
4. Does New York State Education Law require physicians to supervise nurse practitioners (NPs) or co-sign their charts or records?
Icon for the answerAnswer: No. New York State Education Law holds nurse practitioners independently responsible for the care of their patients and does not require a physician to supervise the nurse practitioner or co-sign any of the nurse practitioner’s records or charts.
5. Are nurse practitioners required to “collaborate” with a physician in order to practice? Icon for the answerAnswer: New York State Education Law requires all nurse practitioners to practice in accordance with written practice protocols and a written practice agreement with a collaborating physician, unless or until the nurse practitioner has completed more than 3600 hours of qualifying nurse practitioner experience. This experience must consist of practicing as a licensed or certified NP as follows:
Nurse practitioners with more than 3,600 hours of qualifying practice experience are authorized to practice independently. This allows experienced nurse practitioners to provide the full scope of services they are educated and clinically trained to provide.
6. Can a nurse practitioner (NP) who has a written practice agreement with a collaborating physician continue to work while the collaborating physician is not available for prolonged periods or after the collaborating physician dies?
Icon for the answerAnswer: During an extended absence, the collaborating physician can designate a resource person to be available to the NP, as needed, during the physician's absence. For prolonged absences, it is preferred if the resource person is identified in the written practice agreement. However, if the collaborating physician dies, the written practice agreement signed by the nurse practitioner and physician is no longer valid. To continue practicing, a nurse practitioner with 3,600 or fewer hours of qualifying nurse practitioner practice must enter into a written practice agreement with another collaborating physician.
7. Is there a limitation on the medications that a nurse practitioner (NP) may prescribe under a DEA number?
Icon for the answerAnswer: New York State Education Law authorizes each NP to prescribe controlled substances (from Schedules II through V) for patients only within the specialty area of practice for which the NP is certified by SED. Federal and New York laws permit some NPs to prescribing Suboxone for treating drug dependence.