LPN SCOPE OF PRACTICE - CLARIFICATIONPOSITION STATEMENTfor LPN PracticeA Position Statement does not carry the force and effect of law and rules but is adopted by the Board asa means of providing direction to licensees who seek to engage in safe nursing practice. Board PositionStatements address issues of concern to the Board relevant to protection of the public and are reviewedregularly for relevance and accuracy to current practice, the Nursing Practice Act, and BoardAdministrative Code Rules.INTRODUCTIONThe Nursing Practice Act, G.S. 90-171.20(8) and North Carolina Administrative Code, 21 NCAC 36.0225 (LPNrules) govern Licensed Practical Nurse (LPN) practice in North Carolina. Reading this Position Statement andthe LPN rules together serves to clarify the LPN Scope of Practice/Components of Practice for LPNs, RNs,employers, consumers, and others. Comparison with 21 NCAC 36.0224 (RN Rules) provides distinction fromRN scope of practice.LPN Scope of Practice in all steps of the nursing process is limited and focused because, by law, it is adependent and directed scope of practice. LPN practice requires assignment or delegation by andperformance under the supervision, orders, or directions of a registered nurse (RN), physician, dentist, or otherperson authorized by State law to provide the supervision. LPNs implement health care plans developed by theRN and/or by any person authorized by State law to prescribe such a plan.Note: The practice of nursing is constantly evolving as new and changing technology and therapies areintroduced. The North Carolina Board of Nursing defines and interprets scopes of practice for all levels ofproviders of nursing care. Each agency/employer is responsible for developing policies/procedures/standardsof practice and ensuring competency of the nursing staff. An agency/employer, including a registered nurse orphysician employer, may restrict the nurse’s practice but never expand the practice beyond the legal scope asdefined. LPN practice is not defined by specific activities or tasks, but rather as a process consisting of a set oflegally defined Components of Practice using the steps of the nursing process as outlined in the LPN rules, 21NCAC 36.0225.For specific questions, the NCBON Scope of Practice Decision Tree for the RN and LPN – select Nursing Practice on the top banner – select Position Statements and Decision Trees– select Scope of Practice Decision Tree. NCBON Practice Consultants can also be reached for clarification at919-782-3211.Critical Thinking: Critical thinking is used throughout all components of the nursing process. Critical thinkingis purposeful and reflective judgment in response to events, observations, experiences, and verbal or writtenexpressions. It involves determining the meaning and significance of what is observed or expressed todetermine need for action. Nurses (RNs and LPNs) use critical thinking in clinical problem-solving anddecision-making processes relative to scope of practice, knowledge, competency, and experience.Co-signature of LPN Documentation:North Carolina nursing law and rules do not require LPN documentation to be co-signed by the RN. All nursesare responsible and accountable for their own actions and documentation. Agencies may, however, establishpolicies requiring RN co-signature of LPN documentation. Agency policy should define what the RN cosignature means. (For example, the co-signature might indicate “review”, “agreement”, or that every elementhas been checked by the RN depending upon the policy requirements.)Page 1 of 5NORTH CAROLINA BOARD OF NURSINGPO BOX 2129 – Raleigh, NC 27602(919) 782-3211 – Nurse Aide II Registry LPN SCOPE OF PRACTICE - CLARIFICATIONPOSITION STATEMENTfor LPN Practice

ACCEPTING AN ASSIGNMENTThe first decision required by the LPN is whether or not to accept the assignment given by the registerednurse, physician or other person authorized to make the assignment. The LPN shall accept only thoseassigned nursing activities and responsibilities, as defined in Paragraphs (b) through (j) of the LPN rules.Paragraph (a) of the LPN rules lists the variables in each practice setting which the LPN must consider inmaking this decision. Please see Position Statement, Accepting an Assignment, for additional guidance onthis important topic – select Nursing Practice on the top banner – select PositionStatements – select Accepting an Assignment.COMPONENTS OF LPN PRACTICEASSESSMENT, the first step of the nursing process and an essential component of nursing practice, is anongoing process. Beginning with the initial encounter and continuing throughout the episode(s) of care,assessment is the basis for nursing judgments, decisions, and interventions. Nursing assessment is thegathering of information about a patient's physiological/biological, psychological, sociological, and spiritualstatus.Both registered nurses and licensed practical nurses assess clients. Some elements of assessment areidentical for both the RN and LPN. These include: The collection of data for a nursing history, psychological, spiritual, and social history, and physicalexamination (including vital signs, head to toe and/or targeted physical assessment, and otherphysiological/biological data); Comparison of the data collected to normal values and findings; Ongoing determination of client status for changes in condition, positive and negative.For the LPN, nursing assessment is a focused appraisal of an individual’s status and situation at hand,contributing to assessment, analysis, and development of a comprehensive plan of care by the RN. The LPNsupports ongoing data collection and decides who to inform of the information and when to inform them. TheLPN identifies the need for immediate assessment (beyond that specified in the plan of care) in response tocurrent client status and condition. (National Council of State Boards of Nursing, Model Law and Rules)The LPN participates in both initial and ongoing nursing assessments of the client’s health status, includingreaction to illness and treatment regimens while the RN retains overall responsibility for verifying datacollected, interpreting data, and formulating nursing diagnoses.“Participating in” means to have a part in or contribute to the elements of the nursing process.Participation of the LPN in assessment is limited to: Collection of data according to structured written guidelines, policies and forms; Recognition of existing relationships between data gathered and the client’s current health status; Determination of the need for immediate nursing interventions.LPN Participation in “Initial”, “Admission”, or “Event-focused” Assessment:These terms used by health care agencies to describe different types of assessments are not defined innursing law and rules. The components of “initial”, “admission”, “event-focused” (e.g., post patient fall, pretransfer, etc.), or other specifically-named assessment processes are defined by agency policy based on thelaws and regulations, standards of care, accreditation standards, and reimbursement requirements applicableto specific practice settings. (For example, if federal Medicare regulations require that an RN perform the initialassessment, then the LPN cannot perform this assessment by proxy for the RN.) The LPN within scope ofpractice participates in any assessment process, if permitted by agency policy, using structured writtenguidelines, policies, and forms that outline the data to be obtained.Page 2 of 5NORTH CAROLINA BOARD OF NURSINGPO BOX 2129 – Raleigh, NC 27602(919) 782-3211 – Nurse Aide II Registry LPN SCOPE OF PRACTICE - CLARIFICATIONPOSITION STATEMENTfor LPN Practice

PLANNING is the second step of the nursing process. For the LPN, planning includes participation in theidentification of the client’s needs related to the findings of the nursing assessment. Elements of planning arelisted in the LPN rules in Paragraph (c) and include: Identification of nursing interventions and goals for review by the RN; Participation in decision-making regarding the implementation of nursing and medical interventionsutilizing assessment data; Participation in multidisciplinary planning by providing resource dataTherefore, the LPN provides important input in the planning process while the RN has the responsibility fordeveloping the nursing plan of care and modifying the plan as indicated by ongoing assessment andevaluation.IMPLEMENTATION is the third step of the nursing process and consists of delivering nursing care accordingto an established health care plan and as assigned by the RN or other person(s) authorized by law. Elementsof implementation for the LPN are listed in the LPN rules in Paragraph (d)(1) and include the following: Procuring resources needed to implement the care plan; Implementing nursing interventions and medical orders consistent with nursing rules and within anenvironment conducive to client safety; Prioritizing performance of nursing interventions within assignment; Recognizing responses to nursing interventions; Modifying immediate nursing interventions based on changes in a client’s status; Delegating specific nursing tasks as outlined in the plan of care and consistent with nursing rules.The degree of supervision by an RN or other authorized person required for the performance of any assignedor delegated nursing activity by the LPN when implementing nursing care is determined by the variables listedin Paragraph (d)(3) of the LPN rules.The LPN also participates in implementing the health care plan by assigning nursing care activities to otherlicensed practical nurses and delegating nursing care activities to unlicensed assistive personnel (UAP)qualified and competent to perform such activities providing certain essential criteria are met. These criteriaare listed in the LPN rules in Paragraph (d)(2) and include: Assuring that competencies of personnel to whom nursing activities may be assigned or delegatedhave been validated by an RN; Continuous availability of a registered nurse for supervision; Participation by the LPN in on-going observations of clients and evaluation of client’s responses tonursing actions; Accountability is maintained by the LPN for responsibilities accepted, including care provided by selfand by all other personnel to whom care is assigned or delegated; Supervision provided by the LPN is limited to assuring that tasks have been performed as assigned ordelegated and according to established standards of practice.The appropriate and effective LPN delegation of nursing activities to UAP is an essential element in assuringsafe client care. The NCBON Decision Tree for Delegation to UAP and the Position Statement on Delegationand Assignment of Nursing Activities provide guidance for LPN practice.It is beyond LPN scope of practice to assign nursing responsibilities to RNs.Please note: Managing the Delivery of Nursing Care and Administering Nursing Services are notcomponents within LPN Scope of Practice. Supervision by LPNs is limited to the assuring that tasks havebeen performed as assigned or delegated and according to established standards of practice as stated inParagraph (d)(2)(E) of the LPN rules.Page 3 of 5NORTH CAROLINA BOARD OF NURSINGPO BOX 2129 – Raleigh, NC 27602(919) 782-3211 – Nurse Aide II Registry LPN SCOPE OF PRACTICE - CLARIFICATIONPOSITION STATEMENTfor LPN Practice

Therefore, it is beyond LPN scope of practice to be responsible for the following activities: nursingunit management, nursing administration, performance appraisal, orientation and teaching of nursingstaff, validation of competence, or nursing staff development.Please see Position Statements describing the limited role of the LPN in supervision within environmentsproviding care for clients with relatively stable status (such as Skilled Nursing/Long Term Care Facilities) andthe LPN role in staff development at – select Practice in left side column – select PositionStatements – select: Nurse in Charge Assignment to LPN Staff DevelopmentEVALUATION is the fourth step of the nursing process and consists of LPN participation in determining theextent to which desired outcomes of nursing care are met and in planning for subsequent care. Elements ofevaluation by the LPN are listed in Paragraph (e) of the LPN rules and include: Collecting evaluative data from relevant sources according to written guidelines, policies, and forms; Recognizing the effectiveness of nursing interventions; Proposing modifications to the plan of care for review by the registered nurse or other person(s)authorized by law to prescribe such a plan.REPORTING and RECORDING are those communications, written and verbal, required in providing thenursing care for which the LPN has been assigned responsibility. Reporting is the verbal communication ofinformation to other persons responsible for or involved in the care of the client. Recording is the written orelectronic documentation of information on the appropriate client record, nursing care plan or other documents.This documentation must reflect the verbal communication of information to other persons, and accuratelydescribe the nursing care provided by the LPN. Both reporting and recording must be completed within a timeperiod consistent with the client’s need for care and according to agency policies and procedures. See LPNrules, Paragraph (f), for more information on the required elements of reporting and recording.COLLABORATING involves communicating and working cooperatively in implementing the health care planwith individuals whose services may have a direct or indirect effect on the client’s health care. As assigned bythe RN or other person(s) authorized by law, the LPN participates in collabo