Protocols that are used to allow NPPs to do tasks that are generally reserved for licensed physicians must be much more rigid and specific than physician protocols or teaching protocols. The exercise of medical judgment remains with the physician who authorized the protocols. The NPP must follow the protocol to the letter, without deviation or the exercise of independent judgment. If state law allows NPPs to practice medicine without supervision, strict protocols are not necessary, but even in such a state, strict protocols are desirable for risk management, quality assurance, and compliance with federal laws.