Editing LPN Skills and Practice Limitations (section)

== Skills Typically Reserved for the RN ==

=== The nursing process ===

* The '''initial and comprehensive nursing assessment''' on admission, on transfer, and at any significant change in condition.
* Formulating '''nursing diagnoses'''.
* Developing and revising the '''plan of care''', and setting goals and outcomes.
* '''Evaluating''' overall progress toward outcomes.
* '''Initial patient teaching''' on new content, including new diagnoses, new medications, and discharge teaching. The LPN reinforces, the RN initiates.
* Triage, including telephone triage and advice.
* Care of the '''unstable or unpredictable patient''' whose needs require continuous assessment and independent judgment.

=== Intravenous therapy ===

IV therapy is the area of greatest state variation, so the exam tends to test only the clear boundary.

* '''IV push or IV bolus medication administration''' is prohibited for LPNs in most states and is the classic NCLEX-PN answer for an out of scope task. A small number of states permit a limited, defined list of IV push medications for LPNs with additional certification.
* Administration and titration of '''high alert or vasoactive infusions''' such as heparin, insulin drips, vasopressors, and antiarrhythmics is generally RN only.
* '''Chemotherapy and other hazardous drug administration''' is generally restricted to RNs with specialty certification.
* '''Total parenteral nutrition''' initiation and management is generally RN only.
* '''Central line''' care, medication administration, and access are restricted for LPNs in many states, and central line insertion assistance and removal are commonly RN or provider functions.
* Peripheral IV insertion, maintenance of routine maintenance fluids, and administration of certain secondary piggyback infusions are permitted for LPNs in a number of states, frequently only after an approved IV therapy course and facility validation. This is state specific and should never be assumed.

=== Blood and blood products ===

* Verification of the blood product with a second qualified person, initiation of the transfusion, and the initial monitoring period are generally RN or provider functions.
* Some states permit the LPN to monitor an ongoing transfusion after the RN has initiated it and completed the initial observation period. Others prohibit LPN involvement with transfusion altogether.
* Regardless of state, the LPN who observes any sign of a transfusion reaction, such as fever, chills, back or flank pain, rash, dyspnea, hypotension, or dark urine, should stop the infusion, maintain the IV line with normal saline per policy, stay with the patient, and notify the RN and provider immediately.

=== Orders and provider communication ===

* Accepting and transcribing '''verbal and telephone orders''' is prohibited or restricted for LPNs in many states, and many facilities restrict it further. Where it is permitted, read back and verification are required.
* Interpretation of critical laboratory values and independent decision making on them is generally an RN or provider function. The LPN who receives a critical value should document who reported it and notify the RN and provider immediately.

=== Higher acuity and specialty skills ===

Generally outside LPN scope, though a few jurisdictions and settings differ:

* Advanced cardiac life support interventions such as defibrillation, cardioversion, and administration of code medications. Basic life support and participation in a code within scope are expected of the LPN.
* Cardiac rhythm interpretation as the basis for clinical decisions.
* Management of arterial lines, epidural catheters, chest tube insertion assistance and removal, and ventilator management.
* Initial care of the critically ill patient in intensive care, emergency triage, labor and delivery assessment, and the initial assessment of the newborn.
* Conscious or moderate sedation monitoring.
* Case management, utilization review, and formal care coordination functions in many settings.
* Delegation of nursing care to another licensed nurse.