1. Olson, DaiWai M.
  2. McNett, Molly M.

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Nurses are educated and required by state laws to maintain competence on patient assessment. We all remember in nursing school that we had to write individualized nursing care plans for each assigned patient. We were tasked to determine the parameters would we assess, identify the frequency of assessment (e.g., hourly), and justify our decisions. Patient assessment is clearly within the domain of nursing and remains a central tenet of the nursing process governed by our licensing boards. So, why and how did we get to the point where a physician tells us what, when, and how to document neurological examinations and vital signs?

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Within the United States, state nurse practice acts are the legislative component that outlines an administrative structure that includes state boards of nursing and regulatory components for nursing practice.1 Although there may be slight variation from state to state, each board establishes rules and regulations for the nursing process. The process includes independent nurse assessment of the health status of their patient, the analysis and reporting of assessment findings, and the planning, implementation, and evaluation of interventions to determine ongoing intervals and frequency of reassessments. This nursing process is guided by clinical expertise and nursing judgment and is a central tenet of nursing scope of practice that is governed by state boards of nursing.


Independent nursing assessment based on clinical judgment is not only a licensing requirement but also a professional requirement for optimal and truly collaborative interdisciplinary teamwork in our practice settings. Every member of the healthcare team plays an important role across all practice settings. Every member of the team has received specialized training in their chosen discipline, resulting in clinical expertise unique to their discipline and area of practice. Furthermore, every member of the team has distinct levels of autonomy and a professional obligation to contribute his/her expertise when delivering care. Yet, it is becoming increasingly common to hear nurses state, "I cannot do that without an order." This trend has exacerbated in the age of electronic medical records.


The historical practice of a physician writing "assessments, vital signs, diet, and activity per unit routine" was intended to communicate that the physician did not have any special requests. The physician delegated the determination of assessment to nurses. Computerization and order sets seem to have altered the paradigm such that nurses are abandoning their professional obligation. This paradigm shift is due in part to increased regulatory and accreditation requirements, whereby creation of electronic order sets promotes alignment with required components. Nurses have a professional obligation to be active participants in the development of these order sets, which are collaboratively developed to provide a prompt for the healthcare team to align practices with regulatory requirements and not solely "because a doctor said so."


This editorial is not the first to declare that the term doctor's order is outdated and should be abandoned.2Order derives from the Latin word for rank and has evolved to imply command as in "I order/command you to assess the heart rate." Physicians and advanced practice providers are empowered to prescribe, to suggest, and, in collaboration with other disciplines, to plan patient care. Nurses have an obligation to the patient (not to the physician) to be a collaborative member of the healthcare team. In 2021, it is not uncommon to see the request for "Physical Therapy assess and treat." This is an example of collaborative practice. Imagine the uproar if, instead, the physician ordered the physical therapist to walk a patient 27 m using a 2-wheeled rolling walker at a pace of 1.25 km per hour at exactly 10:15 AM.


Nursing deserves, and must demand, the respect afforded to the other disciplines. Nursing owns the science of nursing assessment. We should collaborate with our colleagues and provide meaningful input. Our colleagues should request and receive our help. Nurses should not need be ordered to assess, plan, implement, and evaluate nursing care.


As neuroscience nurses, we need to build upon current evidence and refine the science that supports our profession. The JNN welcomes articles that provide evidence to support the science of nursing assessment of patients with neurological illness and injury. Share your success at designing a collaborative practice environment in which nursing owns nursing care. Publish evidence that patient outcomes are improved by professional nursing care. Join the conversation and contribute by submitting your manuscript or letter to the editor.




1. Ohio Administrative Code. Rule 4723-4-07: standards for applying the nursing process as a registered nurse. Available at: Accessed April 8, 2021. [Context Link]


2. Reuter C, Fitzsimons V. Physician orders. Am J Nurs. 2013;113(8):11. [Context Link]