Wednesday, December 29, 2010

How an LPNs' Scope of Practice Differs from an RN's

NOTE: This article has stimulated a lot of conversation which is great. Please understand that the LPN Scope of Practice will vary from state to state according to the LPN Nurse Practice Act. In many states the LPN can perform many more tasks; sometimes additional education and certification is required. The information here gives the reader a basic understanding. Refer to your state's LPN and RN Nurse Practice Act for more information.

A Guest Post from J.G. Enriquez RN...

Have you ever wondered why there are different types of nurses? Notice the rising cost of health care and you will find an answer. As hospitalizations become more expensive, patients are opting to be cared for in outpatient facilities. Meanwhile, old medical technologies are giving way to new ones. Now, patients in outpatient facilities require minimal care compared to those who remain hospitalized because of their unstable conditions. The licensed practical nurse (LPN) is the kind of nurse that is capable of caring for these stable patients. Another more skilled professional, the registered nurse (RN), is more suited to care for unstable patients. They each play distinct roles in caring for you and your loved ones. Their scopes of practice differ in terms of legal purposes and patient safety.

Their educational preparations are also different. LPNs complete their nursing degree in less than 18 months. But it takes longer for RNs to earn their degrees. In fact, it can take an RN student as long as four years to finish. The LPN is above the level of nursing assistants but subordinate to the RNs. They are the ones who are typically seen rendering bedside care. You can view them as more like technical nurses. On the other hand, RNs have a wider scope of practice than LPNs. They can delegate tasks to LPNs and usually shoulder more responsibilities. You might want to consider the distinctions before you decide whether you want to be an LPN or an RN. But exactly how divergent are LPNs and RNs in their day to day tasks? Here's a rundown of the differences.

Roles and Responsibilities: LPN vs. RN

  • Assessment: LPNs record patient data according to set rules and can report any abnormal findings to RNs. Can LPNs perform a complete, exhaustive physical assessment? No -- only RNs can do that. Because of their training, RNs have developed a better sense of what is going on with the patient. They are trusted to use their "clinical eye" to assess the patient and a particular situation. Of course, LPNs can contribute in this process by reporting observed data and suggesting interventions.
  • Planning: Now, who is responsible for the plan of care? Only the RN can craft and prepare the nursing care plan. Don't forget, this is an important distinction between LPNs and RNs. Surely, LPNs can give their input and recommendations, but only the RN has the responsibility of planning out interventions to achieve good outcomes based on her nursing judgement. LPNs are not allowed to create care plans under any circumstances.
  • Implementation: Simply put, LPNs perform routine and non-invasive tasks. They assist patients to do activities of daily living such as bathing, grooming, eating, dressing and walking. Giving oral medication and taking vital signs are other responsibilities. Meanwhile, RNs can do all things LPNs do, but they can do much more than simply feeding patients routinely. For instance, when a patient has a tube for liquid feeding, you would not expect an LPN to feed the patient even though feeding is a routine activity. Instead, an RN will administer tube feedings because it is considered more invasive. The same thing applies for giving medications. While LPNs can give tablets, only RNs are supposed to give injectable drugs. Again, LPNs take care of stable patients, while RNs take care of unstable ones. When a stable patient becomes unstable, RNs step in and take over from LPNs.
  • Delegation: RNs can assign tasks to LPNs. Does this mean any task can be delegated by the RN? Are LPNs at the mercy of the whims of RNs? Of course not. Any task to be delegated must be included in the list of allowable tasks under facility rules and the nursing practice law. RNs can never delegate assessment and patient teaching. However, interventions can be delegated provided RNs directly supervise LPNs. On the other hand, LPNs are obliged to accept the delegated task unless it is against policy, scope of practice or there is reasonable chance for the patient to be harmed. Remember, both RNs and LPNs are accountable for their actions when assigning or being assigned with tasks.
  • Evaluation and Documentation: Yes, both LPNs and RNs evaluate and document nursing care. It is crucial for them to collaborate to revise and improve the care plan. LPNs often look at specific results, reports and records them. On the other hand, RNs are more concerned with the overall picture by looking at all the information and piecing them all together.
  • Patient Teaching: What about patient teaching? RNs have the sole responsibility to teach patients. They are entrusted to do so because their education and training is longer and deeper than LPNs. But LPNs are not completely out of the picture when it comes to patient teaching. They can teach under a definite set of guidelines. For example, they can teach a patient how to perform range of motion exercises, but should not teach patients how to change dressings. Only RNs are tasked to do that since they are invasive and more complex.

To summarize, LPNs perform routine, non-invasive bedside care and work under the supervision of RNs. The RNs can do all LPN tasks plus the invasive procedures but is more focused in the plan of care and overall management. RNs delegate some tasks to the LPN and works with the LPN and the physician. Truly, LPNs and RNs have distinct roles to play in patient care.

J.G. Enriquez has worked as a Registered Nurse for 4 years. He writes about careers in nursing for BrainTrack.

Thanks for a great guest post!

Online master's programs can help you advance your nursing career.

Saturday, December 25, 2010

Merry Christmas!

To all who celebrate == Merry Christmas!!!

Thursday, December 23, 2010

News for Nurses

This post is going to be a hodgepodge of information as the holidays rapidly approach and the year winds down. I wish you all a safe and happy holiday season!!! Hope 2011 brings new and exciting times. I have a few guest posts in the queue that I hope you will enjoy as we move forward.

Being a nurse is always hard at this time of the year. We would all rather be at home with our loved ones. But it's important to remember that our patients need us and depend on us. We make a difference in someone's life everyday! Here's an inspirational story from

In 2010, the historic Patient Protection and Affordable Care Act was signed into law and has begun to be implemented. There are many ways in which nurses will be impacted by this law. For one, we will finally have the funding we have needed for education and workforce development and diversity needs. And as the new Congress takes their place in 2011, there will be new nurses joining in the fun in Washington DC. In fact, there will be seven nurses in the 112th Congress. Take a moment to read about them and resolve to keep in touch with them about what nurses need.

Here's some resources you might be interested in:

Top 40 Forums and Message Boards for Nurse Practitioners

50 Resources for Nurses Attending Online Nursing Schools (we are listed--thanks!)
20 Iconic Nurses Every Nursing Student Should Study
Nourish Interactive (started by a nurse)
A Nurse Case Manager's Success Story (You Tube Video)

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Thursday, December 16, 2010

Becoming a Nurse – What Does it Entail?

A guest post from Bobbie Walker...

Nursing is a profession that’s being looked at with new eyes today – people are waking up the fact that nursing involves more than just patient care and long hours. There’s a demand for nurses in all areas of healthcare, from hospitals to schools to private homes. So if you’re considering becoming a nurse, now is a good time to join this industry because hiring is on the rise. However, before you take a final call on this decision, it’s best you know what the nursing profession entails:
  • Nursing is a demanding job, one that requires you to spend long hours on your feet, keep erratic and long work hours, and put your patients before yourself. It’s not for everyone in that it could take a huge toll on you mentally and physically if you’re not cut out for it and ready to take the rough with the smooth.
  • At the same time, it’s an immensely satisfying profession if you’re the kind who thrives on giving other people your time and effort and taking pride in their well-being.
  • The educational qualifications required are not as demanding as going to medical school; however, your job status is not on par with that of doctors, even if you’re qualified academically and through experience as an advanced practice nurse.
  • You have to start out at the bottom of the ladder and work your way to the top – any nursing job that’s higher up requires a few years of experience as an RN and additional education as qualifications.
  • Most nurses who are ambitious choose to become advanced practice nurses by earning an MSN or a doctorate and becoming certified in the field of their choice; so you can choose to become a Nurse Practitioner, a Certified Registered Nurse Anesthetist, a Nurse Midwife or a Clinical Nurse Specialist. Nurse practitioners can become specialists in one of many areas of medicine including gerontology, neonatal care, pediatrics, oncology, acute care, critical care, women’s health, psychiatry, adult health, emergency medicine, and occupational healthcare.
  • There are opportunities to move to non-clinical positions once you have a few years of experience under your belt and are willing to go back to school to pick up a few extra credentials – you could choose to go into administration, education (teaching), legal nursing, organization and planning (case nurse manager), and research. Some nurses with vast experience in the medical field even enter the pharma industry as consultants and administrators.
  • If you love to travel and thrive on new places and new people, you could become a travel nurse.
  • From RNs to advanced practice nurses, all nursing professions include continuous education and meeting the necessary conditions to stay certified throughout their career. Nursing is not a job where you can rest on your laurels or stagnate in the same spot.
  • If you’re going back to school while continuing to work at your profession, remember that balancing a degree and the demands of a nursing career could become overwhelming and cause stress if you don’t have a good support system of friends and family.
  • So if you’re considering becoming a nurse, plan ahead, and go ahead with what works for you instead of adopting herd mentality and following the crowd.
This guest post is contributed by Bobbie Walker, she writes on the topic of Online BSN Degrees. She welcomes your comments at her email id: bobbiew862[@]gmail[.]com.

Thanks Bobbie!!
For More on Becoming a Nurse see The Nursing Site