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!

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