Scope of Practice & Nurse Practice Act
A nurse performs a task legally allowed in one state but prohibited in another — same skill, different license consequences. The Nurse Practice Act draws the line.
Core Concept
The Nurse Practice Act (NPA) is state-specific legislation that defines the legal boundaries of nursing practice for each licensure level (LPN/LVN, RN, APRN). It establishes what you can and cannot do — your scope of practice — and is enforced by each state's Board of Nursing (BON). The BON has authority to grant, suspend, and revoke licenses. Scope of practice is NOT the same as job description; a facility policy can restrict your scope further but can never expand it beyond what the NPA allows. If a provider orders a task outside your legal scope, you must refuse and report up the chain. Practicing outside scope constitutes a violation of law, not just a policy breach, and can result in license revocation, fines, or criminal charges — independent of whether the patient was harmed. RNs perform assessment, care planning, evaluation, and delegation. LPNs collect data under RN direction but do not independently assess or create care plans. APRNs have expanded scope including prescriptive authority in many states. When NCLEX tests scope, it asks about the legal boundary, not clinical competence.
Watch Out For
Don't confuse scope of practice (defined by the NPA/law) with standards of care (defined by professional organizations and evidence). Scope tells you what is legal; standards tell you what is competent. Students often think employer job descriptions can expand scope — they cannot. Also, delegation does not transfer accountability: the RN retains accountability for the delegation decision even when the task is performed by a UAP.
Clinical Pearl
Policy can shrink your scope, never stretch it. When in doubt, the NPA is the ceiling — your facility is the floor.
Test Your Knowledge
3 quick questions — see how well you understood Scope of Practice & Nurse Practice Act