Are Labs Within a Nurse’s Scope of Practice? Let’s Reframe the Conversation

by Brigitte Sager, DNP

When I first started teaching functional medicine to nurses and nurse practitioners years ago, I was incredibly cautious when it came to lab work.

My recommendation back then? Focus on the intake. Patient-reported symptoms. Existing lab results, if available. And then encourage the patient to request updated and expanded labs from their primary care provider. It felt like the safest route. After all, scope of practice is no small thing. We must protect our licensure, our training, and keep our responsibility to the patients we serve and their safety top of mind at all times.

But over time, I realized something important: this overly cautious approach wasn’t just limiting. It was leaving patients without guidance in a system that often wasn’t listening to them. And it was making nurses feel like their clinical judgment didn’t count.

So, let’s talk about it. Let’s explore where lab work fits into the nursing scope of practice for both RNs and NPs—and why now, more than ever, nurses need to rethink their relationship with lab data.

Why Nurses Hesitate to Use Labs (And Why That Needs to Change)

Let's start with a peice of information that often surprises my students. For nurse practitioners wanting to order labs, one barrier is often invisible to those outside the healthcare system- insurance credentialing.

When you’re a credentialed provider with insurance, you’re expected to order and bill only those labs you are trained to interpret and equipped to build a plan of care around. If a patient requested a full thyroid panel early in my NP career, I was hesitant. I said "No." Why? Because I had been trained to manage thyroid disorders using TSH (maybe T4), and anything beyond that felt like stepping into unfamiliar territory and violating my agreement with the insurance companies to only order labs I was trained to address. This wasn't part of the guidelines I was trained to follow, so it felt wrong to order anything beyond TSH and T4 for thyroid evaluation. And ordering a lab you can’t justify or explain? That’s risky—both legally and ethically.

But the reality today is that patients are getting these labs anyway.

The direct-to-consumer lab market has exploded. Patients are ordering their own comprehensive hormone panels, food sensitivity tests, micronutrient profiles- you name it. They’re walking into our offices, inboxing us, and emailing us with lab results they have gotten elsewhere and no idea what to do next.

So, here’s the truth we have to face:

Patients are accessing lab work with or without us. The question is—are we prepared to help them make sense of it safely?

What’s Within a Nurse's Scope of Practice When It Comes to Labs?

Let’s break it down:

For RNs:

I often hear people saying nurses can't use labs to diagnose patients, and that is true. An registered nurse cannot develop a medical diagnosis under any circumstances, but RNs absolutely work with lab results every day. If you’ve ever:

• Interpreted electrolyte values to follow a potassium replacement protocol

• Educated a patient on why they’re getting a magnesium infusion

• Notified a provider of abnormal labs

• Taught a patient with type 2 diabetes how their A1c reflects long-term blood sugar trends

  
  

…you’re already working with labs. Most of us do it every shift.

Nurses are trained to recognize, report, monitor, and educate. While RNs don’t typically order labs independently (unless under protocol or within a standing order), they can review lab results with patients and offer education based on evidence and scope-aligned practices.

Example: A cardiac nurse sees that a patient’s increased Lasix dose has dropped their potassium. They advocate for replacement, follow a protocol, and educate the patient on the role of potassium. This is clinical judgment in action, and it’s exactly what we need to acknowledge in the functional medicine space.

What About NPs Using Labs:

Nurse Practitioners, depending on their license and setting, often have full authority to order and interpret labs. However, there are some nuances to understand:

• Billing and insurance (as I mentioned above)

• Familiarity with functional vs conventional labs

• Responsibility for critical lab values

And this last one matters a lot.

Let’s say you order a functional lab panel and CMP, and it returns a potassium level of 6.0 or a glucose over 400. You now carry legal responsibility for urgent follow-up, and if you’re not trained in that interpretation or working within a team that supports you, that can quickly become dangerous or overwhelming.

And this is an excellent example of why labs have been ordered through prescribing providers like MDs and NPs with advanced training in handling these critical lab values. But that is changing! Patients are getting these results from direct-to-consumer lab companies online, and they are using "Dr. Google" to treat themselves- often with potentially harmful interventions.

Why the Resistance from Other Providers?

Early in my journey teaching functional medicine to RNs and NPs, I encouraged nurses to send patients back to their PCPs to request additional labs. "Write a letter listing what you're hoping for and how you help their patients." It seemed collaborative, but what I saw over and over again was this:

Resistance. Providers said no.

Many primary care providers aren’t trained in functional lab interpretation. They may not see the need for a full thyroid panel, nutrient markers, or GI health testing. What's worse, some see these requests as undermining their authority or "Dr. Google" inspired.

This created a dead end for my students- leaving nurses and patients frustrated and unsupported.

After several years of students coming back saying they were told no, and very, very few students reporting success, I knew we had to reframe this approach. Nurses need to understand labs within their scope, and they need to understand how to partner with the right systems to support them and their patients.

Reframing How Nurses Use Labs

It’s time for a mindset shift.

Functional labs aren’t just for MDs. Nurses already have the skills to support patients on their health journey using lab results. They just need the language and structure to confidently apply it in their own scope.

Here’s what that can look like:

• Using labs to inform education and coaching: RNs can use existing lab work to guide lifestyle, nutrition, and wellness conversations. Teaching patients how blood sugar patterns reflect dietary choices, or explaining how inflammatory markers may be tied to lifestyle habits, is fully within nursing scope.

• Learning through real-life data: Many nurses order labs for themselves, loved ones, or practice clients, and then schedule interpretation sessions with lab companies. These experiences are invaluable for learning. But here’s the catch: not all companies allow RNs to schedule interpretation calls- something to be aware of when choosing lab partners.

• Recognizing when to refer and collaborate: Understanding critical values and knowing when a provider needs to step in is a key piece of safe nursing practice. But that doesn’t mean stepping back from labs. It means knowing your role, and finding collaborative systems that support you and your patients.

  
  

The Two Biggest Challenges Nurses Face with Labs

We know that lab results can provide patients with accountability and motivation for healthy lifestyle changes. If we want nurses to fully embrace the use of lab data in functional practice, we need to acknowledge two major barriers:

1. The Accountability Factor

It’s not enough to just “order labs.” Whoever orders them must take full responsibility for critical values and urgent follow-up. That’s not a bureaucratic burden. It’s a patient safety issue. Nurses must work within frameworks that support this legal and ethical requirement.

2. Limited Access to Lab Interpretation Support

Many functional lab companies allow NPs and MDs to schedule case reviews or interpretation calls—but bar RNs from being able to ask questions or get support. Some of them even allow health coaches to schedule, but not RNs (I'm rolling my eyes here). This creates a major learning gap and makes it harder for RNs to build confidence and feel supported.

It’s something I’ve seen over and over: RNs can technically access some functional labs, but then they’re locked out of the tools that help make sense of them. And that’s not okay. In most corporate healthcare settings, if a nurse has questions about diagnostics, protocols, or prescriptions, they can call the imaging department, lab, or pharmacy. Somehow this most often is not the case for nurses in the integrative and functional space.

I teach RNs and NPs they need to be very well educated on any tools or interventions they will be using in their practice, so its important to be well versed and supported in any labs nursing professional might choose to incorporate into their practice. Plus- once again- our patients are getting these labs online from direct-to-consumer lab companies, but then nurses are excluded from support in understanding how the results apply to their unique patient. And their PCP probably has NO CLUE what these functional labs are or how to support them, so back to "Dr. Google" our patients are going.

So What’s the Solution?

That’s exactly what I’ll cover in my next article. I have some meetings, research, and ideas brewing, and I'll be sharing more in my next article.

In the Meantime…

If this topic resonates with you, I invite you to read or revisit my earlier blog: Understanding Laboratory Reference Ranges: A Functional Medicine Perspective. It lays the foundation for this conversation and helps you think differently about what "normal" lab values actually mean.

Nurses, Let’s Reclaim Our Role

You already have the knowledge. You already understand labs more deeply than you realize. The next step is embracing that power and finding the tools and support that help you practice safely, ethically, and within your full scope.

Functional nursing isn’t about going rogue. It’s about going deep. And nurses are already trained to do just that. If you're looking for education and support in using standard and functional labs in your practice, consider joining us at the Institute for Functional Nursing. We have our upcoming Functional Nursing Program launching soon, and we already have a thriving Functional Nursing Membership full of RNs and NPs seeking support and connection for their practice.

Let’s stop asking if labs are “allowed” in nursing. Let’s start asking how we can use them responsibly, ethically, and effectively to guide whole-person care. Let's change healthcare!

🎧 Listen: The Functional Nurse Podcast: How Evexia Diagnostics Simplifies Functional Medicine Lab Testing for Nurses with Ryan Obermeier

📖 Read: How Functional Medicine Nurses Can Access Lab Tests—Legally and Safely

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