RN vs LPN/LVN Scope of Practice

An LPN reports a new cardiac arrhythmia and asks if she can adjust the heparin drip. Knowing why the answer is no — not just that it is — keeps patients alive.

The RN and LPN operate under different legal scopes defined by state nurse practice acts, but NCLEX tests a national baseline. The RN owns the nursing process in its entirety: assessment (initial and ongoing requiring clinical judgment), nursing diagnosis, care plan development, evaluation of outcomes, and patient teaching that requires interpretation or adaptation. The LPN performs focused, task-oriented care within an established plan: collecting routine data (vital signs, intake/output), reinforcing teaching the RN has already initiated, performing straightforward skills (wound care, urinary catheterization, oral/IM/SubQ medication administration), and providing stable, predictable patient care. The critical dividing line is clinical judgment under uncertainty. Any task requiring a new judgment call — triaging a change in condition, interpreting assessment data, initiating or modifying a care plan, administering IV push medications, or managing blood product transfusions — stays with the RN. The LPN can monitor an existing IV infusion in many jurisdictions but cannot initiate or titrate IV medications. When an LPN identifies a change in patient status, the correct action is to report findings to the RN, who then reassesses and decides the next step.

Key Distinctions

Don't confuse LPN data collection with RN assessment — the LPN gathers expected data points; the RN interprets unexpected findings and revises the plan. Students mix up 'reinforce teaching' (LPN) with 'develop or modify teaching' (RN). IV medication administration (push, titration, blood products) is RN-only territory; LPNs may monitor a running IV but not change its parameters.

Clinical Pearl

If the task needs a new decision, it needs the RN. LPNs execute the plan — RNs create, evaluate, and change it.