Hello and welcome to our article on LPN scope of practice.
This article will explore what a Licensed Practical Nurse (LPN) can and cannot do according to the scope defined by the state board of nursing.
In this article, we will cover the following topics:
- What is within the LPN Scope of Practice
- How does LPN/LVN scope of practice differ from RN
- What is not within the LPN Scope of Practice
Without much ado, let’s begin!
Introduction to LPN scope of practice
Licensed Practical Nurses have a specific purpose of covering the institutions they serve.
Still, unfortunately, not many people are aware of the scope of their duties, even within the healthcare system itself.
The LPN may not have the same credential as a registered nurse because they look at a different version of the NCLEX.
Still, they have a very important role in the nursing services industry despite differences in nursing education.
If you are an LPN who has been working in nursing care, you might have been expected to fulfill tasks that are only for registered nurses – there needs to be a more specific designation of duties, starting from the nursing programs.
To avoid such misunderstandings and break standard procedures, we will go through the Licensed Practical Nurse scope of practice and dive deep into the LPN role’s designated duties and what is not.
It is not a simple question of competency but the observance of standard operating procedures that will minimize mistakes in the workplace and give more awareness to the educational preparation of being a healthcare worker.
The LPN scope of practice may also vary from state to state since each state has its board of nursing that determines the needs and requirements of its regional healthcare system – though there is a consensus on what should be expected from LPNs.
This exercise is very important so that the inconsistent curriculums surrounding the education and employment of practical nurses become more consistent.
This will benefit healthcare workers and the system that they serve.
What is Within the LPN Scope of Practice?
Here are the roles and responsibilities of the Licensed Practical Nurse role:
Performing Specific Medical Processes
The LPN can perform the following basic patient care procedures:
- Monitoring vital signs like blood pressure
- Changing bandages and dressing changes
- Inserting of catheters
- IV therapy
Assisting in Patient’s Activities of Daily Living
Aside from the required procedures patients must undergo, they are receiving help from LPNs when they cannot independently perform basic activities of daily living (ADLs), such as:
- Mobility or ambulating (being able to walk from Point A to Point B)
- Personal hygiene such as bathing and grooming
- Toileting, including the ability to clean after oneself
- Feeding and nutrition
- Dressing and undressing
Steps of the Nursing Process
The nursing process is a scientific method formulated as a framework for the standards of practice of nurses in the field.
It comprises five steps: Assessment, Diagnosis, Planning, Implementation, and Evaluation.
The scope of practice of the LPN states that the LPN is a part of four out of these five steps: everything except for the Diagnosis step, which is reserved for registered nurses only.
To assist the supervising nurse in their diagnosis of the patient’s situation, the LPN helps out how they can.
In the Assessment phase, the LPN must collect and compare the patient’s health status data against standard measures and see if there are any correlations with the findings.
LPNs will go through the collection of data processes and offer their assessment based on the information they collected from the patient.
In the Planning phase, the LPN should participate in the discussion and identification of the patient’s needs and plan of care, guided by the previous assessment findings.
The LPN can put forward their ideas for the nursing interventions to use in the situation, subject to the review of the registered nurse.
The LPN can be part of the nursing diagnosis decision-making process by contributing to more stable situations, noting the specific needs and concerns of the patient, and helping the RN determine the problems and priorities of the patient.
In the Implementation phase, the LPN is expected to deliver the care that has been formulated as the patient’s health care plan and care needs, as approved by the supervising personnel such as the advanced practice registered nurses (APRN).
The strategy of care as formulated by the head nurse will be the one that the LPN will follow to the best of their abilities – this includes following orders, administering treatments, and addressing the concerns of the patient and their family.
In the Evaluation phase, an LPN can contribute their observations and suggestions to the executed plan of care, given the results and documentation of the case.
Together with the RN, they will also note the client’s response and review points of improvement for the plan of care.
Teaching and Counseling of Clients (Patient and Family)
While LPNs do not have a staff of their own, and it is not in their scope to “teach” coworkers, they do have the duty of relaying information to the patient’s family.
Patient teaching is part of the LPN’s duties – they are entrusted with discussing with the patient’s guardians regarding their plan of care,
LPNs also make up the human element of counsel and comfort for the guardians or family, ensuring they remain level-headed and guided by science and medicine as they continue to administer care to their loved ones, especially in the practice setting of long-term care.
Of course, the health information relayed by the LPN must be directed and according to a proper teaching plan by the RN.
The LPN must also document all relevant activity, statistics, and notable.
Delegation of Tasks to Unlicensed Assistive Personnel
Unlicensed Assistive Personnel (UAP) have a variety of nursing activities that do not require licenses and certifications to fulfill – they are expected to have the competency of understanding and work with the health care providers.
The tasks that can be delegated must follow a rigid standard procedure and address reasonably predictable situations to avoid faulty execution that could harm the patient’s case with errors.
The tasks should also be simple enough not to require the entire nursing process to execute.
As such, an LPN can delegate some of the tasks to them, provided that those activities are within the scope of the UAP.
What is Not Within the LPN Scope of Practice?
LPNs have a specific role in the industry and do not have the necessary training and certification to fulfill other complex nursing responsibilities.
Here are some examples of tasks that are not within their scope of practice:
As mentioned in the earlier section, LPNs cannot diagnose patients.
In the Diagnosis phase, the registered supervising nurse uses their clinical judgment to decide what is best for the patient’s care plan.
The diagnosis is a critical portion of the nursing process.
It is typically accomplished by nurses who have the proper licenses and nursing education or training covering the most important procedures and knowledge.
Prescribing medication and medical procedures to address some patient concerns is also outside of the scope of the LPN.
Nurse Unit Management and Nursing Administration
However, some states have allowed LPNs to do some supervisory work for medical assistants and other staff that do not have licenses or do not need to be licensed.
Nursing Staff Development
Training nursing staff is an important function of higher-status nurses.
It is in the head nurses’ interest to organize their team to work as efficiently and effectively as possible.
Connected to staff development, an LPN should not give an official performance appraisal to the nursing staff, as this should be done by the supervising nurse who has noted their observations of the staff.
It is important to be aware of the LPN scope of practice because it helps LPNs understand their responsibilities in the practice setting and how they should conduct themselves according to the rule of their state board of nursing.
The working expectations of nurses are different, and thus they should be more aware of these differences to avoid malpractice and miscommunication.
However, the law (such as the Nurse Practice Act) may dictate the scope of practice, but different settings with different requirements, especially if the facility has a unique set of policies and guidelines.
It is in the best interest of everyone to operate within these scopes at all times.
How they may vary in different settings – hospitals, private clinics, nursing homes, and other facilities, these different roles should be focused on their scope and responsibilities.
Is there a standard LPN scope of practice in the US?
No, the role and legal scope of the LPN differs from state to state due to the rules set in place by the local state board of nursing with different position statements. The rules are in place to address the management of capabilities within various care settings and makeup up some manpower needs.
Can an LPN supervise an RN?
No, because according to the scope of practice of the LPN, it should be the otheway around. LPNs are not allowed to supervise nursing staff. However, they do have the authority to delegate tasks to unlicensed assistant personnel who would be able to take on simple tasks without decision-making capabilities.
What cannot be delegated to an LPN?
According to the NCSBN’s 1995 decision on the Five Rights of Delegation, supervising nurses cannot delegate any tasks that involve clinical reasoning, nursing judgment, and critical decision-making. The nurse in charge of these decisions must only be made and should not come from an LPN or UAP.