It is not within the scope of practice for a registered nurse to start an intravenous line without an order from an authorized health care practitioner. The RCW 18.71.011 Definition of the Practice of Medicine stipulates the practice of medicine to include severing or penetrating the tissues of human beings. Standing orders may be an option to allow the nurse to start an intravenous line based on specific criteria (such as a high acuity patient), admission to a specific unit (such as intensive care), or for a specific condition. Standing orders may also be used to allow a nurse to start more than one intravenous line based on specific criteria. The nurse must be competent to carry specific steps identified in the standing order. The registered nurse should use the Scope of Practice Decision Tree to determine if specific activities are within the nurse’s legal and individual scope of practice. The Nursing Care Quality Assurance Commission's Standing Orders and Verbal Orders Advisory Opinion and Verbal Orders provides additional guidance and recommendations.