Bridging the gap: medical directives for acute care nurse practitioners.

The following article describes the process by which a group of acute care nurse practitioners sought to address the legal challenges of working beyond the traditional scope of nursing practice. It was necessary to establish mechanisms for communicating a diagnosis, as well as for ordering diagnostic tests, treatments and procedures. Medical directives were viewed as an approach to address components of practice involving controlled acts not authorized to nursing. The process of developing medical directives began with a description of the components of a medical directive. Algorithms were then developed based on the College of Nurses of Ontario's decision tree (Purvis, 1995) for the performance of procedures. These algorithms were broad and applicable across all clinical programs. The final step, required each nurse practitioner/clinical nurse specialist in collaboration with physician colleagues, to develop individual appendices specific to each clinical program. Health care administrators may find the information provided of assistance in addressing legal concerns that arise when new opportunities for nursing involve movement beyond traditional boundaries.