RN to LPN delegation within scope of practice??

  1. Question- If a patient has clear lung sounds yesterday and has developed crackles today, can a LPN assess them or does it legally have to be the RN to do the auscultation? I am confused on the LPN scope of practice.. Its not a new pt, so it isnt the initial assessment.. any help..
    I am a student and it was a question I was presented with, I am looking for after hours help..lol

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    About glanca3046

    Joined: Nov '09; Posts: 3


  3. by   pandora44
    Well, the particular scope of practice depends on the laws in the state where the incident occurred.

    That being said, if the LPN was doing a routine assessment and discovered a change in the patient's condition, s/he should notify the RN. Any change in patient condition needs to be assessed by the RN, not just the LPN. The RN should do a full assessment, not just lung sounds, to check for any other changes and then notify the physician. If I were the RN involved, I would keep a close eye on this patient personally. I think the answer to your question is that the RN needs to do the assessment.
  4. by   glanca3046
    Thanks much Pandora44!!
  5. by   NRSKarenRN
    good articles on delegation listed below.

    first issue: scope of practice
    does your lpn practice act permit lpn to perform patient assessments or is language only "data collection"

    second issue: practice act have delegation language
    does state have delegation language and decision making tree?

    third issue: training and competency, practice setting, employer job descriptions,
    lpn's are considered dependent practitioner in all states, meaning needs to be supervised by licensed rn, physician or dentist

    tasks can be delegated to an lpn provided the following conditions are met:
    1. the task has been properly delegated to the lpn by the supervising licensed nurse, physician, podiatrist or dentist. delegated via oral communication, job description & procedure manual etc.
    2. additional training and competency in the task to be to be delegated if needed

    if practice act permits lpn to make assessment and report result to physician, then lpn can independently perform task. otherwise, lpn needs to perform lung auscultation, report results to rn for further assessment and physician intervention, especially in hospital setting as there is always an rn on duty.

    [color=#2200cc]ncsbn and ana issue joint statement on nursing delegation

    delegation decision-making tree

    delegation by licensed nurses in new hampshire an online program ...

    state boards of nursing:
    nc:[color=#004478]scope of practice decision tree for the rn and lpn
    [color=#004478][color=#004478]assignment and delegation by rn and lpn
    the licensed practical nurse may be involved in assignment and/or delegation of specific tasks to other licensed practical nurses and unlicensed personnel only after the registered nurse has assessed the client and indicated through the care planning process what tasks may appropriately be completed by each level of licensed or unlicensed personnel.

    wy: decision tree model

    minn: decision tree model
    only rn's can delegate

    manitoba canada: decision making: a framework for delegation

    from us gov: department of health and human services, health resources and services administration, bureau of health professions, office of workforce evaluation and quality assurance

    supply, demand, and use of licensed practical nurses
    chapter 3: scope of practice and practice acts

    ...states have elected to explicate the work of practical nurses in a variety of ways. some, such as louisiana, montana, maine, and nevada, have detailed lists of tasks that practical nurses can and cannot do. other states, such as georgia, alaska, kentucky, and oklahoma, have decision trees that are to be used to decide on appropriate tasks that can be done. connecticut has an extensive algorithm for decision-making that can be used regarding issues of practice. washington has a decision tree that is used for making decisions and specifically states that there is no "laundry list" of approved and prohibited tasks. some states such as colorado and nebraska use the sections of the nursing care plan to detail work that can be done by different nursing personnel (rns, lpns, and aides). south carolina has developed extensive skills charts that are organized by body system, job categories, and experience level within job categories. neither michigan nor texas has a scope of practice or practice act for practical nurses.

    there are several points of contention that exist in the scopes of practice of registered nurses and practical nurses. these issues typically surround the words "assessment", "delegation", "supervision or charge nurse" and, more recently, "decision-making" and "critical thinking". since the american nurses association defined registered professional nursing as the diagnosis and treatment of human responses to actual or potential health problems, assessment has been a key to the boundary of practice between the registered nurse and other nurses and nurse assistants. practical nurses and nurse assistants are permitted to "collect data" rather than assess patients; however, the boundary between data collection and assessment is difficult to define.

    delegation has traditionally been thought of as a management function reserved for the registered nurse. however, practical nurses delegate functions to other providers in many settings, and some practice acts acknowledge that fact. the positions of supervisor and charge nurse are similar, in that those roles traditionally involve management. in long-term care settings practical nurses function in those roles routinely. in 1994, the u.s. supreme court upheld a decision by the sixth circuit court of appeals that said in that case, the licensed nurses involved were supervisors, and therefore no longer covered by collective bargaining agreements (supreme court of the united states, 1994) . the concepts of decision-making and critical thinking are now included in some scopes of practice, usually in order to define the practice boundary between the practical and registered nurse. however, as with the term "assessment", it is difficult to argue that practical nurses do not engage in decision-making and critical thinking activities.

    as in many fields, the professions of rn and lpn seek to protect and expand their jobs and opportunities. the scope of practice regulations delineate the roles of these licensed nurses and thus rn and lpn organizations lobby for scopes of practice that protect jobs. additionally, in states with powerful rn unions, union contracts and proposed legislation have been explicit about what is and is not the practice of the rn, as compared to the lpn. for example, there has been a controversy in california over whether or not lpns may administer intravenous medications to patients as part of hemodialysis and blood bank procedures. (editor, 2003) the california nurses association (cna), which represents rns, bitterly opposed a change in regulations permitting these activities, while service employees international union (seiu), which represents lpns and other hospital workers, supported it. on january 29, 2003, the california office of administrative law approved the new regulation. (editor, 2003)

    ana's american nurse today, nov 06: delegating without doubts

    delegation, how and when - anderson review - nclex test prep ...
    Last edit by NRSKarenRN on Nov 18, '09
  6. by   NRSKarenRN
    Great question.
    Moved thread --Added as stiky note in student section as multiple requests ---and will help in NCLEX prep study.