Can a LPN delegate nursing tasks to a RN? State Nurse Board Complaints served hot and fresh for everyone!

I was asked this question yesterday by a RN in Ohio.

LPNs and RNs have a different legal scope of practice based on the State Nurse Practice. The education and training of RNs is broader and more expansive than the training of LPNs which is why there is difference in the legal scopes of practice between LPNs and RNs.

See these brochures from the Ohio Board of Nursing discussing the differences.

  http://www.nursing.ohio.gov/PDFS/Practice/RN-LPN-ScopeofPractice.pdf

http://www.nursing.ohio.gov/pdfs/Practice/Decmodel.pdf

http://www.nursing.ohio.gov/PDFS/Practice/RN_LPN_FAQs_6_09.pdf

Kentucky Board of Nursing

http://kbn.ky.gov/NR/rdonlyres/1D42B514-A2E5-4AE6-93D8-D3195397C367/0/LPNSCopeofPracticeBrochure.pdf

http://kbn.ky.gov/NR/rdonlyres/74A5FF75-543D-4E12-8839-720B7623DA87/0/ScopeDeterminGuidelines.pdf

In general a RN functions independently and is authorized to perform in all aspects of nursing practice. The LPN has a dependent role and functions at the direction of the RN, MD, or another licensed healthcare professional as indicated in the State Nurse Practice Act.

So why the confusion? Because some employers (hint: primarily skilled nursing facilties but also home health agencies) don't craft and draft job descriptions, assign patient care, or develop nursing workflow processes which the State Nurse Practice Act and Board of Nursing regulations as the guiding principle.

If this was done, an explanation and rationale could be provided and all nurses would really understand "delegation" and the difference between the RN and LPN scope of practice and how this is applied in a particular facility, on a specific unit or floor, and/or with this patient population. This would also help ease the tension seen in some facilties between RNs, LPNs, and nursing assistive personnel like STNAs and HHAs.

In general it is outside of the scope of practice of a LPN to delegate nursing tasks to a RN. This doesn't mean a LPN can't do the scheduling and other clerical or administrative tasks because these are not NURSING tasks.

Do LPNs in some facilities delegate nursing tasks to RNs? Of course and we all know it happens and we know "management" is aware of the practice. This doesn't make it right or acceptable and IMO this is where the journey to the dark side of the force starts as it did for Young Anakin Skywalker. http://en.wikipedia.org/wiki/Anakin_Skywalker

Violations of the Nurse Practice Act which everyone assumes are "no big deal" and "an accepted practice" are tolerated and accepted which in IMO leads to additional rule bending and violations of the Nurse Practice Act (we are doing this and its accepted so why not do try this also).

All of this is "okay" until something happens and things get reported to the State Department of Health and then the State Board of Nursing. That's where the finger pointing starts. Can you say State Nursing Board complaints served hot and fresh for everyone including the LPN, the RN, the RN unit manager, and maybe the ADON and/or DON?

My nurse attorney colleagues Suzie Collins and Cynthia Mikos from Florida published an excellent article discussing State Nursing Board complaints and the impact of rule bending in the workplace. I will find the cite and publish it later.

As a nurse you are a licensed professional. Its your license not your employers and you should know the legal and professional underpinnings and regulations/rules/policies governing your nursing practice. Don't rely on your employer to interpret the State Nurse Practice Act for you. You are individually accountable and responsible  and potentially liable for your nursing practice. If something doesn't feel right, ask questions and seek assistance. You shouldn't perform tasks you know violate your Nurse Practice Act and you should under no circumstances practice outside of your legal scope of practice. This isn't legal advice, its common sense. Happy Friday!!!

Comments

[LaTonia]

I tell you folks, I am on the money here with this post. The Online Journal of Nursing current topic addresses nursing delegation and of the article discusses nursing
delegation in the context of a job description vs. the State Nurse Practice Act.

See Corazzini, K., Anderson, R.A., Rapp, C., Mueller, C., McConnell, E., Lekan, D., (May 31, 2010) "Delegation in Long-Term Care: Scope of Practice or Job Description?" OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 2, Manuscript 4.

If you are a member of ANA, you can view the Online Journal of Nursing at no cost. http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN.aspx