Nurses sometimes hear a practice described as “against the law” when the restriction actually comes from an employer policy. In another setting, a unit procedure may be described as “the standard of care” even though other organizations approach the same practice differently.
Law, regulation, Board of Nursing guidance, employer policy, professional standards, clinical guidelines, and the legal standard of care can all influence the same clinical question, but they do not carry the same authority. Identifying the source of a requirement is often the first step toward determining what it actually requires and who has authority to change it.
A Quick Comparison
| Source | What it does | Type of authority |
|---|---|---|
| State law | Establishes legal authority and the framework for nursing regulation | Legally binding |
| Rules and regulations | Add enforceable detail under statutory authority | Legally binding when properly adopted |
| Board guidance | Helps explain how laws and rules may apply to practice questions | Regulatory guidance; legal status differs from statutes and formal rules |
| Employer policy | Establishes how a particular organization expects practice to occur | Organizational requirement, subject to applicable law |
| Professional standards | Describe expectations for competent professional practice | Inform practice, regulation, credentialing, and professional accountability |
| Clinical guidelines | Provide evidence-based recommendations for care | Inform clinical decisions and policy; strength and applicability vary |
| Legal standard of care | Provides the benchmark used to evaluate professional conduct in negligence litigation | Determined within the applicable legal and factual context |
These sources frequently reinforce one another, but their authority and function are not interchangeable. Understanding the distinction becomes especially important when a practice question involves more than one of them.
State Law and Regulation Establish the Legal Foundation
Every U.S. nursing jurisdiction has a Nurse Practice Act establishing the statutory framework for nursing regulation. Nurse Practice Acts commonly address licensure, protected titles, scope of practice, disciplinary authority, delegation, and other elements of professional regulation. Boards of Nursing or other authorized regulatory bodies may adopt administrative rules that provide additional detail.
NCSBN explains that safe, competent nursing practice is grounded in the Nurse Practice Act and its related rules and regulations. Properly adopted rules carry legal force and must remain consistent with the statute they implement (National Council of State Boards of Nursing [NCSBN], n.d.-a, n.d.-b). The Nurse Practice Act is only part of the legal environment affecting healthcare, however. Controlled substances, privacy, emergency treatment, mandatory reporting, public health, prescribing, telehealth, and other areas may be governed by additional state or federal law.
This becomes particularly important in advanced practice. The American Nurses Association notes that APRN practice is typically defined through the Nurse Practice Act and governed by the appropriate regulatory body, while other statutes and regulations may also affect practice (American Nurses Association [ANA], n.d.). A legal scope question may therefore require examining the Nurse Practice Act, administrative rules, role and population focus, prescribing law, and other applicable requirements.
Board Guidance Has a Different Legal Status
Boards of Nursing may publish advisory opinions, position statements, decision-making resources, frequently asked questions, and other guidance explaining how regulatory requirements apply to practice questions. These resources can be valuable when statutory language is broad or a newer clinical activity is not addressed explicitly because they provide insight into how the nursing regulator interprets the law it administers.
Their authority still needs to be identified accurately. A statute enacted by a legislature and a regulation adopted through formal rulemaking do not have the same legal status as an educational FAQ or advisory opinion. When a Board resource is cited as “the law,” an important distinction can be lost. The relevant questions are what type of document it is, what authority supports it, and how the jurisdiction treats that form of guidance.
Employer Policy Operates Within the Legal Boundary
Healthcare organizations establish policies and procedures governing how care is delivered within their settings. These policies may address medications, documentation, IV therapy, restraints, infection prevention, emergency response, procedural requirements, and many other aspects of clinical practice. Organizations operating under the same Nurse Practice Act can establish different requirements. One may permit an activity after documented competency, while another requires additional education, supervision, certification, or approval.
State law establishes the legal boundary, while employer policy determines which legally permissible activities the organization authorizes and under what conditions. An employer cannot create legal authority that the clinician does not possess. At the same time, an activity may be legally within a nurse’s general scope while remaining unavailable to an individual clinician because of organizational policy, education, competence requirements, credentialing, privileging, available resources, or clinical circumstances.
NCSBN’s Scope of Practice Decision-Making Framework reflects this layered approach. It directs nurses and employers to consider law and regulation, professional standards, organizational policy, education, competence, evidence, and the circumstances of practice when evaluating whether an activity is appropriate (NCSBN, n.d.-c). For nurse practitioners, this distinction becomes especially important because state law may authorize diagnosis, prescribing, and treatment management within an appropriate role and population focus, while credentialing and privileging determine which services an individual NP may provide within a particular organization.
Professional Standards and the Legal Standard of Care Are Different Concepts
Professional standards describe expectations for competent practice across the profession. ANA’s Nursing: Scope and Standards of Practice, for example, describes national expectations for nursing practice across roles and settings (ANA, 2021). These standards can influence education, credentialing, organizational policy, regulatory review, and evaluation of professional conduct, but publication by a professional organization does not convert a professional standard into state law.
The phrase “standard of care” creates additional confusion because clinicians use it in several ways. In ordinary clinical conversation, it may refer to a widely accepted intervention or evidence-based recommendation. In negligence litigation, however, the applicable standard of care becomes part of the legal analysis. Minnesota law, for example, requires expert review in covered malpractice actions when expert testimony is necessary to establish a prima facie case, including an expert opinion that a defendant deviated from the applicable standard of care and that the deviation caused injury (Minn. Stat. § 145.682, 2025).
The precise legal analysis depends on the jurisdiction, type of claim, facts, and evidence presented. Professional standards, clinical guidelines, organizational policies, and other professional evidence may be relevant to that analysis, but they should not be treated as interchangeable with the legal standard itself. A single guideline, professional standard, or hospital policy should therefore not be described as automatically establishing the entire legal standard of care in every case.
Clinical Guidelines Inform Practice and Policy
The National Academies defines clinical practice guidelines as recommendations intended to optimize patient care that are informed by systematic review of evidence and assessment of the benefits and harms of alternative care options (Institute of Medicine [IOM], 2011). Trustworthy guidelines should also make the relationship between evidence and recommendations transparent and identify the quality of evidence and strength of recommendations (IOM, 2011).
Publication of a clinical guideline does not by itself create a legal mandate. Recommendations differ in evidentiary strength and applicability, and individual patient circumstances remain relevant. Guidelines can nevertheless influence clinical decision-making, professional expectations, education, and organizational policy.
The opposite problem occurs when longstanding custom is treated as sufficient justification for continuing a practice. Repetition alone does not establish that a process remains evidence-based or professionally appropriate. New evidence can justify reviewing an existing policy, but changing an established organizational process generally requires evaluation through appropriate channels, including consideration of evidence, regulatory requirements, patient safety, workflow, education, staffing, resources, and implementation needs. Evidence-based practice therefore includes both critical appraisal and responsible implementation.
Policy, Scope, and Competence Have to Align
A written organizational policy carries real professional consequences. Policies describe how the employer expects care to be delivered and may reflect regulatory obligations, accreditation requirements, risk-management decisions, equipment, staffing, and local safety processes. When a clinical event is reviewed, compliance with an applicable organizational policy may become relevant, but policy compliance does not replace the nurse’s broader responsibility to practice within legal scope, maintain competence, exercise appropriate clinical judgment, and escalate safety concerns when necessary.
Scope questions therefore require more than asking whether an activity is “legal.” A complete analysis considers legal authority, professional standards, organizational authorization, education and competence, available resources, and the clinical circumstances (NCSBN, n.d.-c). This also explains why policies can legitimately differ among organizations. One hospital may require additional competency validation for an activity that another allows after standard orientation, while another may assign a procedure to a specialty team because of staffing, equipment, patient population, accreditation requirements, or local risk analysis.
Different policies do not automatically indicate that one organization is violating the law. The relevant question is whether the local requirement is legally permissible, professionally supportable, and appropriate for the setting.
Unit Tradition Has Less Authority Than a Written Requirement
Some clinical practices persist without a clearly identified policy, regulation, or professional standard. A process may be described as mandatory because “we have always done it that way” or because it has been passed from one staff member to another for years. The routine may be sensible, but familiarity does not establish legal authority or make it a formal organizational requirement.
Locating the actual source can resolve many practice questions quickly. A written policy carries different authority from unit tradition, just as a formally adopted Board rule differs from a coworker’s recollection of what the Board supposedly requires. Before defending or trying to change a requirement, determine whether the requirement actually exists and which authority created it.
DNP Practice Includes Identifying Misalignment
Systems improvement often begins when evidence, policy, workflow, regulation, and professional expectations no longer align. A policy may lag behind current evidence. Staff may believe a requirement comes from state law when it actually originates in organizational policy. A regulatory change may require new education or competency processes. An evidence-supported intervention may be difficult to implement because the existing workflow was designed around a different practice.
The 2026 AACN Essentials include advanced-level competencies involving evidence translation, systems-based practice, quality improvement, and leadership within complex healthcare environments (American Association of Colleges of Nursing [AACN], 2026). Applied to practice change, those competencies require more than finding evidence. Before proposing a change, the clinician or project team needs to identify why the current practice exists, which authority supports it, what evidence challenges or reinforces it, and who has authority to revise it.
When a requirement is described as prohibited, mandatory, or “the standard,” identifying the source provides more useful information than the label alone. For DNP-prepared clinicians, that distinction is also part of systems improvement. Before challenging a policy or proposing a practice change, determine what created the current requirement, whether the evidence still supports it, which legal or professional boundaries apply, and who actually has authority to revise the process. Regulatory literacy turns a vague disagreement about “how we do things” into a question that can be investigated and acted on.
Related YourDNP resources:
- Boards & Licensure
- Why Every Future Nurse Practitioner Should Know Their Nurse Practice Act
- The Board of Nursing Is Not Your Employer
- Scope of Practice for Nurse Practitioners
References
American Association of Colleges of Nursing. (2026). The Essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2026.pdf
American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.).
American Nurses Association. (n.d.). State law and regulation. Retrieved August 7, 2026, from https://www.nursingworld.org/practice-policy/state-law-and-regulation
Institute of Medicine. (2011). Clinical practice guidelines we can trust. The National Academies Press. https://doi.org/10.17226/13058
Minn. Stat. § 145.682 (2025). https://www.revisor.mn.gov/statutes/cite/145.682
National Council of State Boards of Nursing. (n.d.-a). About U.S. nursing regulatory bodies. Retrieved August 7, 2026, from https://www.ncsbn.org/nursing-regulation/about-nursing-regulatory-bodies.page
National Council of State Boards of Nursing. (n.d.-b). Nurse Practice Act toolkit. Retrieved August 7, 2026, from https://www.ncsbn.org/policy-gov/npa-toolkit.page
National Council of State Boards of Nursing. (n.d.-c). Scope of practice decision-making framework. Retrieved August 7, 2026, from https://www.ncsbn.org/nursing-regulation/practice/decision-making-framework.page