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This article compares clinical skills that commonly fall within LPN/LVN scope against skills that are typically reserved for the registered nurse. It is a general study overview for NCLEX-PN preparation and is not legal advice.

'''An important caution before the lists below.''' The specifics vary significantly by state board of nursing, by employer policy, and by the individual nurse's documented competence. A skill listed here as commonly permitted may be prohibited in a given state or facility, and a few skills listed as typically RN only are permitted for LPNs in some states, often only after additional certification. Always verify against the nurse practice act and board rules of the state of licensure and against current facility policy. On the examination, answer according to the widely accepted national standard rather than an outlier state rule.

== The Four Layer Test ==

Before performing any skill, the LPN should be able to answer yes to all four questions:

# Does the '''state nurse practice act and board of nursing''' permit an LPN to do this?
# Does '''employer policy and the job description''' permit it? A facility may restrict more than the state does, never less.
# Has the LPN been '''trained and validated''' on this skill, and is the competency current?
# Is '''this particular patient''' stable and appropriate, and is a supervising RN available?

If any answer is no, the LPN declines and notifies the RN. See [[LPN Delegation and Reporting]].

== Skills Commonly Within LPN Scope ==

=== Medication administration ===

* Oral, sublingual, and buccal medications.
* Topical, transdermal, ophthalmic, otic, nasal, rectal, and vaginal medications.
* Inhaled medications, including metered dose inhalers and nebulizer treatments.
* Subcutaneous injections, including insulin and most anticoagulants.
* Intramuscular injections, including immunizations where state law permits.
* Enteral medication administration through a nasogastric or gastrostomy tube where state rules permit.
* Application of the rights of medication administration, checking allergies, verifying dose calculations, and independent double checks of high alert drugs such as insulin per policy.
* Observation for therapeutic effect and adverse reactions, and prompt reporting of both.

Controlled substance handling, waste with a second licensed witness, and narcotic counts are ordinarily within LPN scope.

=== Urinary elimination ===

* Straight or intermittent urinary catheterization using sterile technique.
* Insertion, care, irrigation where ordered, and removal of an indwelling urinary catheter.
* Collection of sterile and clean catch urine specimens.
* Bladder scanning where the facility has trained the LPN on the device.
* Ostomy and urostomy appliance care and skin protection.

=== Wound and skin care ===

* Clean and sterile dressing changes for established wounds.
* Wound irrigation and packing per an established order and plan.
* Ongoing observation of wounds and documentation of size, drainage, odor, and periwound skin.
* Pressure injury prevention: repositioning, support surfaces, moisture management, and use of a validated risk scale as an ongoing screening tool.
* Application of prescribed topical treatments and negative pressure dressing maintenance where the facility trains and permits it.
* Suture and staple removal where state rules permit.

=== Respiratory and airway care ===

* Oxygen administration by nasal cannula and mask per order or protocol.
* Pulse oximetry and incentive spirometry coaching.
* Oropharyngeal, nasopharyngeal, and tracheal suctioning.
* Tracheostomy care, including inner cannula care and site care.
* Assisting the patient with a stable, established airway and reporting any change.

=== Gastrointestinal and nutrition ===

* Nasogastric tube insertion, verification per policy, and care where state rules permit.
* Administration of enteral feedings and flushes, and gastrostomy tube site care.
* Feeding assistance, aspiration precautions, and intake documentation.
* Enema administration and bowel program implementation.

=== Data collection and monitoring ===

* Vital signs, weights, intake and output, and pain rating using validated scales.
* Focused physical observation and comparison to established baselines.
* Capillary blood glucose monitoring.
* Application and monitoring of continuous pulse oximetry and, in many settings, application of cardiac monitoring leads and obtaining a twelve lead electrocardiogram where the facility trains the LPN. Interpretation of the tracing and clinical decision making on it are generally not LPN functions.
* Specimen collection: urine, stool, sputum, wound cultures, and capillary blood.
* Neurovascular checks, incision checks, and drain output measurement.

=== Other common skills ===

* Positioning, transfers, ambulation, range of motion, and use of assistive devices.
* Application of antiembolism stockings and sequential compression devices.
* Restraint application and monitoring per order and policy, with the RN and provider responsible for the assessment and the order.
* Preoperative and postoperative routine care within an established plan.
* '''Reinforcement''' of teaching the RN has already initiated, using approved materials.
* Documentation, handoff reporting, and participation in care conferences.
* Supervision of unlicensed assistive personnel where state law permits.
* Postmortem care.

== 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.

== Settings Where LPN Practice Is Broadest ==

LPN autonomy in practice tends to be greatest in long term care, skilled nursing, rehabilitation, correctional health, home health, hospice, physician offices, and clinics, where patients are often more stable and RN supervision may be indirect. In acute care hospitals many organizations have narrowed the LPN role over time, and in critical care, emergency, and obstetric units LPNs are used less frequently. The wider practice latitude in long term care does not change the legal boundary. It reflects patient stability, established plans of care, and facility staffing models.

== Practical Guidance for the LPN ==

* Know your own state's nurse practice act and read the board's advisory opinions. They are published and free.
* Keep skills validations current, and be honest when a skill is unfamiliar. "I have not been checked off on that" is a complete and professional answer.
* When in doubt, contact the RN before acting. An unnecessary call is cheaper than an out of scope act.
* Document the finding, the notification, and the response.
* Carry personal professional liability coverage and understand that employer coverage protects the employer's interests first.
* When practicing across state lines under a multistate license, follow the scope rules of the state where the patient is located.

== Quick Reference Table ==

{| class="wikitable"
! Skill !! Commonly LPN !! Typically RN only
|-
| Oral, topical, IM, subcutaneous medications || Yes ||
|-
| IV push or bolus medication || || Yes in most states
|-
| Peripheral IV insertion and maintenance fluids || Varies by state, often with certification ||
|-
| Blood product initiation and verification || || Yes in most states
|-
| Straight and indwelling urinary catheterization || Yes ||
|-
| Routine and sterile wound care || Yes ||
|-
| Tracheostomy care and suctioning || Yes ||
|-
| Nasogastric tube insertion and enteral feeding || Commonly, state dependent ||
|-
| Focused data collection and monitoring || Yes ||
|-
| Initial and comprehensive nursing assessment || || Yes
|-
| Nursing diagnosis, care planning, evaluation || || Yes
|-
| Initial patient and discharge teaching || Reinforcement only || Yes for initiation
|-
| Telephone or verbal orders || Restricted or prohibited in many states || Commonly RN
|-
| Triage and telephone advice || || Yes
|-
| Chemotherapy and TPN administration || || Yes
|}

== References ==

American Nurses Association, & National Council of State Boards of Nursing. (2019). ''National guidelines for nursing delegation''. https://www.ncsbn.org

National Council of State Boards of Nursing. (2023). ''2023 NCLEX-PN test plan''. https://www.ncsbn.org

National Council of State Boards of Nursing. (n.d.). ''Nurse practice act, rules and regulations''. https://www.ncsbn.org

== See Also ==

* [[LPN Scope of Practice]]
* [[LPN Delegation and Reporting]]
* [[NCLEX-PN Exam Blueprint]]

[[Category:Licensed Practical Nurse (NCLEX-PN)]]
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LPN Skills and Practice Limitations - Revision history

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