Healthcare is a collaborative profession where patient safety and quality of care depend on the proper delegation of tasks and clear role boundaries. In nursing, understanding the scope of practice for Registered Nurses (RN), Licensed Practical/Vocational Nurses (LPN/LVN), and Unlicensed Assistive Personnel (UAP) is essential for effective teamwork and safe patient outcomes.
This article provides a comprehensive breakdown of the scope of practice, highlighting the roles, responsibilities, and differences among RNs, LPNs/LVNs, and UAPs.
What is Scope of Practice in Nursing?
The scope of practice defines the activities and responsibilities that a healthcare professional is legally allowed to perform, based on their education, training, licensure, and regulatory standards.
In nursing, scope of practice ensures:
- Clear task delegation
- Patient safety and accountability
- Professional role boundaries
- Efficient collaboration among healthcare workers
Registered Nurse (RN)
Definition: RNs are licensed professionals who provide comprehensive patient care, from assessment to evaluation. They use critical thinking and the nursing process (ADPIE: Assess, Diagnose, Plan, Implement, Evaluate) to guide clinical decisions.
Key Responsibilities:
- Post-operative assessment and ongoing clinical evaluations
- Initial client teaching and discharge education
- Starting blood product administration
- Performing sterile procedures (e.g., catheter insertions, wound care)
- Administering IV medications and initiating IV therapy
- Conducting full clinical assessments and developing nursing care plans
Special Note on Delegation:
When RNs delegate tasks, responsibility is transferred but accountability remains. The RN is always accountable for overall patient care outcomes.
Licensed Practical Nurse (LPN) / Licensed Vocational Nurse (LVN)
Definition: LPNs/LVNs are licensed nurses who provide care under the supervision of RNs or physicians. Their role focuses on stable patients and specific procedures.
Key Responsibilities:
- Care for stable clients (not critically ill)
- Monitor and document findings as reported by the RN
- Perform specific assessments (e.g., lung sounds, bowel sounds, neurovascular checks)
- Reinforce client teaching (but not initial teaching)
- Administer injections and oral medications (excluding IV push meds and the first IV bag)
- Monitor IV fluids and blood products (but not initiate)
- Perform routine procedures such as catheterization, ostomy care, and wound care
- Ensure tube patency and manage enteral feedings
- Participate in sterile procedures
Limitations:
- Cannot perform initial assessments or create nursing diagnoses
- Cannot administer high-risk medications like IV push narcotics
- Cannot handle unstable or critical patients
Unlicensed Assistive Personnel (UAP)
Definition: UAPs, also called Nursing Assistants or Patient Care Technicians, are non-licensed staff who provide supportive care under the direction of licensed nurses.
Key Responsibilities:
- Documenting input and output
- Obtaining stable vital signs
- Collecting blood from the blood bank (but not administering)
Assisting with Activities of Daily Living (ADLs):
- Feeding (only if no aspiration risk)
- Positioning
- Ambulation and mobility support
- Cleaning and linen changes
- Hygiene and basic personal care
Limitations:
- Cannot perform invasive procedures
- Cannot administer medications
- Cannot perform assessments or make clinical judgments
Delegation in Nursing Practice
Delegation is a critical aspect of healthcare teamwork. To delegate effectively, the RN must consider:
- The client’s condition: Stable vs. unstable patients
- The complexity of the task: Whether it requires critical thinking or judgment
- The scope of practice of the delegatee: Ensuring legal and safe task delegation
Rule of Thumb:
- RNs = Comprehensive assessment, teaching, complex care, IV meds
- LPN/LVN = Stable patients, routine procedures, reinforcement of teaching
- UAP = Basic care and ADLs
Quick Reference Table: Nursing Scope of Practice
| Role | Can Do | Cannot Do |
|---|---|---|
| RN | Assess, diagnose, teach, IV meds, blood products, discharge planning | Delegate accountability, unstable patients |
| LPN/LVN | Care for stable patients, reinforce teaching, administer meds (not IV push), wound/ostomy care | Initial teaching, IV push meds, unstable patients |
| UAP | ADLs, stable vitals, documentation, assist with feeding & hygiene | Clinical assessments, meds, invasive procedures |
Frequently Asked Questions (FAQs)
Q1. Can an LPN start an IV line?
No, LPNs can monitor IV fluids but cannot initiate the first IV bag or IV push medications.
Q2. Who is responsible if a UAP makes a mistake?
The RN remains accountable, as delegation does not transfer responsibility for patient care outcomes.
Q3. Can a UAP take vital signs?
Yes, but only routine and stable vital signs. Abnormal findings must be reported to an RN or LPN.
Q4. Why can’t LPNs do initial teaching?
Because teaching requires comprehensive patient assessment and critical thinking, which fall under the RN’s scope.
Q5. What tasks are most appropriate for UAPs?
Basic, repetitive tasks such as feeding (if no aspiration risk), hygiene care, ambulation, and repositioning.
