If you're a nurse practitioner (NP) considering adding lab testing to your practice, you might be wondering about your lab ordering rights - what you can and can't do when it comes to lab testing. The ability to order and interpret laboratory tests is a crucial component of comprehensive patient care, but the extent of this authority can vary significantly.

Lab testing can be confusing. Who can order what, and in what states are you allowed to order? In this article, we’ll work to unravel the complexities surrounding the lab test ordering rights of nurse practitioners. We will navigate through the maze of regulations and guidelines that dictate these rights, both at the federal and state levels, and examine how they impact your practice.

[signup]

What Labs Can Nurse Practitioners Order?

If you’re a nurse practitioner considering ordering lab tests for your patients, I have good news! NPs are generally authorized to order lab tests, including functional medicine lab tests. The scope of practice for nurse practitioners can vary by region and country, but in many places, including the United States, NPs are trained and licensed to perform a variety of tasks that include diagnosing and treating illnesses, prescribing medications, and ordering diagnostic tests such as lab work.

This capability is a key component of their role in providing comprehensive healthcare services, particularly in primary care settings. The specific lab tests that a nurse practitioner can order will depend on their specialty and the healthcare setting in which they work.

Can Nurse Practitioners Order Bloodwork?

Like lab ordering, nurse practitioners are able to order bloodwork as part of their scope of practice. In many regions, including the United States, NPs are licensed and trained healthcare professionals who have the authority to diagnose and treat medical conditions. This includes ordering diagnostic tests such as blood tests.

The ability to order bloodwork is an important aspect of their role, especially in primary care and specialty settings, enabling them to manage patient care effectively. The types of blood tests they can order will depend on the patient's symptoms, medical history, and specific healthcare needs.

Can Registered Nurses Order Labs?

Registered nurses are a bit of a different story when it comes to lab ordering. RNs typically do not have the authority to independently order labs or bloodwork. The ability to order diagnostic tests, including laboratory work and imaging, generally falls within the scope of practice of advanced practice nurses, such as nurse practitioners (NPs), rather than RNs.

Here's a breakdown of the differences:

1. Nurse Practitioners (NPs): 

As advanced practice registered nurses, NPs have expanded roles that include diagnosing conditions, prescribing medications, and ordering diagnostic tests, including lab work and bloodwork. Their advanced education and training (usually a Master's or Doctoral degree in nursing) equip them with these extended capabilities.

2. Registered Nurses (RNs): 

RNs typically focus on patient care and implementing healthcare plans. They may collect samples for lab tests and assist in the diagnostic process, but they usually do not have the authority to order these tests themselves. Their role often includes communicating findings to the healthcare team, including NPs and doctors, who can then order appropriate tests.

However, there can be exceptions based on specific institutional policies or in certain healthcare settings. For example, in some clinical environments, RNs may have delegated authority under specific protocols or standing orders to initiate certain lab tests. These protocols are usually set by physicians or healthcare institutions and are specific to particular situations, like emergency or critical care settings.

Overall, the ability of nurses to order labs and bloodwork is largely dependent on their level of education, licensure, and the regulations of the state or country they practice in.

How Does Lab Ordering For Nurse Practitioners Vary By State?

The ability of Nurse Practitioners (NPs) to order laboratory tests varies significantly across different states in the United States, reflecting the diverse scope of practice regulations that govern their profession. In states with Full Practice authority, such as Washington and New Mexico, NPs can independently order and interpret laboratory tests as part of their practice. This level of autonomy allows them to manage patient care without the need for physician oversight, including the ordering of necessary diagnostic tests.

Conversely, in Reduced Practice states, such as Ohio and Pennsylvania, NPs have more limited lab ordering rights. In these states, NPs may require a collaborative agreement with a physician to order certain types of laboratory tests, or they may face restrictions on the range of tests they can order independently. This collaborative agreement often outlines the extent and conditions under which NPs can order lab tests.

In Restricted Practice states, like Texas and Oklahoma, NPs face the most significant limitations. In these environments, NPs must work under the supervision or delegation of a physician, and their rights to order laboratory tests are closely regulated. This often means that a physician must authorize or approve lab orders, limiting the NP's ability to independently manage patient diagnostics.

For detailed, state-specific information regarding lab ordering rights for Nurse Practitioners, the American Association of Nurse Practitioners (AANP) provides a comprehensive resource. Their State Practice Environment map offers an up-to-date and detailed overview of the regulations affecting NPs in each state, including their lab ordering rights. You can access this information at AANP State Practice Environment, which is an invaluable reference for understanding the varied landscape of NP practice authority across the United States.

*Note: NJ, NY, and RI tend to have strict lab ordering rights in general for all healthcare practitioners. However, some labs are available even in these states through Rupa Health.

Most Popular Lab Tests Ordered by Nurse Practitioners

Nurse Practitioners (NPs) frequently order a variety of lab tests to diagnose, monitor, and manage patient conditions. The types of tests most commonly ordered by NPs often depend on their specialty and practice setting, but some of the general categories include:

Complete Blood Count (CBC)

A CBC is one of the most frequently ordered blood tests and provides valuable information about the health of a patient's blood cells. It measures components such as red blood cells (which carry oxygen), white blood cells (which fight infection), hemoglobin (the oxygen-carrying protein in red blood cells), hematocrit (the proportion of blood volume that is made up of red blood cells), and platelets (important for blood clotting). NPs order this test to screen for conditions like anemia, infection, inflammation, bleeding disorders, or leukemia, among others. Order CBC Labs on Rupa.

Basic Metabolic Panel (BMP) or Comprehensive Metabolic Panel (CMP)

These tests are critical for assessing metabolic functions and organ health. A BMP includes tests for blood glucose, calcium, electrolytes like sodium, potassium, chloride, and bicarbonate, and measures of kidney function like blood urea nitrogen (BUN) and creatinine. A CMP includes all of the BMP tests plus additional tests for liver function, such as ALP, ALT, AST, and bilirubin. NPs order these panels to monitor organ function, check for conditions like kidney disease, liver disease, hypertension, and diabetes, and to monitor medication effects. Order BMP Lab Tests on Rupa Health.

Lipid Panel

This panel measures levels of various types of fat in the blood, an important indicator of cardiovascular health. It typically includes total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides. An imbalance in these levels can indicate an increased risk of heart disease, stroke, and other cardiovascular problems. NPs order lipid panels to assess cardiovascular risk, guide therapy, and monitor treatment effectiveness. Order Cardiovascular Lab Tests on Rupa Health.

Thyroid Function Tests

These tests are vital in assessing the functioning of the thyroid gland, which regulates metabolism. The most common tests include Thyroid Stimulating Hormone (TSH), Free Thyroxine (Free T4), and Free Triiodothyronine (Free T3). NPs order these tests to diagnose thyroid disorders such as hypothyroidism or hyperthyroidism and to monitor the effectiveness of thyroid medications. Order Thyroid Lab Tests on Rupa Health.

Hemoglobin A1C

This test provides an average blood glucose level over the past two to three months and is essential in the management of diabetes. It helps NPs to understand how well a patient’s blood sugar levels are being controlled over time, which is crucial in adjusting medications, dietary recommendations, and other treatments for diabetes. Order Hemoglobin A1C Lab Tests on Rupa Health.

Urinalysis

This is a simple test that examines the content of urine. It is used to detect and manage a wide range of disorders, such as urinary tract infections, kidney disease, and diabetes. Urinalysis can evaluate the presence of substances like proteins, glucose, ketones, and blood and detect urinary tract infections based on the presence of white blood cells or bacteria. Order Urinalysis Lab Tests on Rupa Health.

Food Sensitivities & Allergies

Tests for food sensitivities and allergies can help diagnose adverse reactions to specific foods. These tests can measure specific IgE antibodies to common allergens or evaluate reactions to various foods. NPs may order these tests when patients exhibit symptoms like digestive issues, skin rashes, or respiratory problems that suggest a food sensitivity or allergy. Order Food Sensitivity & Allergy Lab Tests on Rupa Health.

These tests are integral to the holistic approach NPs take in patient care, encompassing prevention, diagnosis, and management of a wide range of health conditions. It's important to note that the specific tests an NP orders will be tailored to each patient's individual health needs and medical history.