Editing LPN Delegation and Reporting (section)

== What the LPN Should Decline ==

The LPN should decline, and immediately notify the RN, when a request falls into any of these categories:

* '''Outside legal scope.''' Examples that are restricted or prohibited for LPNs in many states include the initial or comprehensive nursing assessment, formulating a nursing diagnosis, developing or revising the plan of care, evaluating overall progress toward goals, IV push medications, administering blood or blood products, administering chemotherapy, initial patient teaching on new content, telephone triage, and accepting verbal or telephone orders.
* '''Outside employer policy.''' A facility may permit less than state law allows. If policy prohibits it, the LPN does not do it even if state law would allow it.
* '''Outside personal competence.''' If the LPN has never performed the skill, has not been checked off on it, or does not feel competent with this patient, the LPN must say so and request supervision or reassignment.
* '''Unsafe patient conditions.''' An unstable, deteriorating, or unpredictable patient requires RN assessment.
* '''Unsafe staffing or an unreasonable workload''' that the LPN cannot complete safely. The correct response is to notify the charge nurse or supervisor and document the concern through the chain of command, not to walk away.

The professional way to decline is to state the reason objectively, tie it to scope, policy, or competence, and offer what the LPN '''can''' do. For example: "I am not checked off on that and my scope does not include IV push. I can obtain the vital signs and stay with the patient while you administer it."

Refusing a task that is outside scope is not insubordination. Performing a task outside scope places both the patient and the license at risk, and the fact that a supervisor ordered it is not a defense.