🏥 Lesson 1: LPN/LVN Scope of Practice & Basic Delegation

Introduction

Welcome to your NCLEX-PN preparation journey! As you prepare to become a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN), understanding your scope of practice is absolutely critical. This lesson focuses on what you CAN do, what you CANNOT do, and how to safely work within your role.

💡 Why this matters: The NCLEX-PN heavily tests your understanding of delegation and prioritization. You'll see many questions asking "What can the LPN do?" or "Which task can be delegated to the UAP?"

🎯 Learning Objectives:

• Identify the LPN/LVN scope of practice
• Understand what tasks LPNs can and cannot perform
• Learn basic delegation principles
• Recognize the difference between LPN, RN, and UAP roles

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Core Concepts

What is an LPN/LVN? 🩺

A Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) provides basic nursing care under the supervision of a Registered Nurse (RN) or physician. You are a vital member of the healthcare team!

Key characteristics of the LPN/LVN role:

• Works under supervision (RN, physician, or other licensed provider)
• Provides direct patient care
• Collects data and reports findings
• Implements care plans created by RNs
• Focuses on patients with stable, predictable conditions

What CAN LPNs/LVNs Do? ✅

Let's start with what's IN your scope of practice:

Basic Nursing Care:

• ✅ Take vital signs (temperature, pulse, respirations, blood pressure)
• ✅ Perform physical assessments and collect data
• ✅ Administer medications (oral, IM, subcutaneous, some IV in certain states)
• ✅ Change dressings and provide wound care
• ✅ Insert and maintain urinary catheters
• ✅ Insert nasogastric (NG) tubes
• ✅ Provide basic hygiene care
• ✅ Reinforce patient teaching (after RN does initial teaching)
• ✅ Document care provided
• ✅ Monitor IV infusions (in most states)

Patient Monitoring:

• ✅ Monitor patient responses to treatments
• ✅ Report changes in patient condition to RN
• ✅ Collect specimens (urine, stool, sputum)
• ✅ Perform glucose monitoring

💡 Important Note: State regulations vary! Some states allow LPNs to start IVs or administer IV push medications, while others don't. Always know YOUR state's nurse practice act!

What CANNOT LPNs/LVNs Do? ❌

This is critical for the NCLEX-PN! Know your limitations:

Assessment & Planning:

• ❌ Perform initial nursing assessment (you can collect data, but RN does assessment)
• ❌ Create nursing care plans (RN role)
• ❌ Develop patient teaching plans (you can reinforce, not develop)

Complex Procedures:

• ❌ Administer IV push medications (in most states)
• ❌ Administer blood products (in most states)
• ❌ Give medications through central lines (PICC, central venous catheters)
• ❌ Perform initial patient teaching
• ❌ Interpret assessment findings independently

Unstable Patients:

• ❌ Care for unstable or rapidly changing patients
• ❌ Care for patients requiring complex assessments
• ❌ Perform triage in emergency situations

┌─────────────────────────────────────────────────┐
│         LPN/LVN ROLE VISUALIZATION              │
└─────────────────────────────────────────────────┘

        RN Creates Plan
              │
              ↓
        ┌──────────────┐
        │ Nursing Care │
        │     Plan     │
        └──────────────┘
              │
              ↓
    LPN Implements Plan
              │
      ┌───────┼───────┐
      ↓       ↓       ↓
   Meds   Wound   Vital
          Care    Signs
      │       │       │
      └───────┼───────┘
              ↓
    LPN Reports to RN
              │
              ↓
     RN Evaluates & Updates Plan

Understanding Delegation 👥

Delegation means transferring the authority to perform a task to another person while retaining accountability. On the NCLEX-PN, you'll need to understand:

1. Who can delegate TO you (RN, physician)
2. Who YOU can delegate to (Unlicensed Assistive Personnel/UAP)

The Five Rights of Delegation (memorize these!):

Right	Meaning	Example Question to Ask
🎯 Right Task	Is this task appropriate to delegate?	"Is this within the UAP's scope?"
🎯 Right Circumstance	Is the patient stable enough?	"Is this patient's condition predictable?"
🎯 Right Person	Does this person have the skills?	"Has this UAP been trained for this?"
🎯 Right Direction	Have you given clear instructions?	"Did I explain exactly what to do?"
🎯 Right Supervision	Will you follow up appropriately?	"How will I monitor the outcome?"

🧠 Mnemonic: "TPCDS" - Task, Person, Circumstance, Direction, Supervision (or remember "The Pretty Cat Drinks Slowly")

Tasks You CAN Delegate to UAP 📋

As an LPN, you may supervise Unlicensed Assistive Personnel (UAP) like nursing assistants or patient care techs. You can delegate:

✅ Activities of Daily Living (ADLs):

• Bathing
• Feeding (stable patients)
• Dressing
• Toileting
• Ambulation (stable patients)
• Repositioning

✅ Basic care tasks:

• Taking vital signs on stable patients
• Measuring intake and output
• Specimen collection (urine, stool)
• Making beds
• Basic hygiene

Tasks You CANNOT Delegate to UAP ❌

Never delegate anything requiring:

• ❌ Nursing judgment
• ❌ Assessment skills
• ❌ Medication administration
• ❌ Patient teaching
• ❌ Sterile procedures
• ❌ Care of unstable patients

The Healthcare Team Hierarchy 🏥

Understanding where you fit in the team is essential:

View original ASCII

HEALTHCARE TEAM HIERARCHY
          👨‍⚕️ Physician
              │
              ↓
    ┌─────────────────────┐
    │                     │
    ↓                     ↓
🩺 RN (Registered)    Advanced Practice
   Nurse              (NP, CNS)
    │
    ↓
👩‍⚕️ LPN/LVN
(You!)
    │
    ↓
👤 UAP/Nursing
   Assistant</pre>

Key relationships:

• RN → LPN: RN supervises LPN, creates care plans, handles complex/unstable patients
• LPN → UAP: LPN can supervise UAP for delegated tasks
• LPN → RN: LPN reports patient data and changes to RN

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Detailed Examples 📖

Let's apply these concepts to realistic scenarios you'll see on the NCLEX-PN:

Example 1: Delegation Decision 🤔

Scenario: You are an LPN working on a medical-surgical unit. You have four tasks to complete this morning:

1. Give oral medications to a patient with stable diabetes
2. Assess a new postoperative patient just admitted from recovery
3. Help a patient with breakfast
4. Change a simple dry dressing on a healing surgical wound

Question: Which task MUST be performed by the RN?

Answer: B - Assessing a new postoperative patient

Explanation:

• Task A (medications): ✅ Within LPN scope for stable patient
• Task B (initial assessment): ❌ ONLY RN can do initial assessments, especially post-op
• Task C (feeding): ✅ Can be delegated to UAP
• Task D (dressing change): ✅ Within LPN scope

💡 Key Learning: Remember the word "INITIAL"! Initial assessments, initial teaching, initial care plans = RN only!

Example 2: Safe Delegation to UAP 👥

Scenario: You're caring for four patients and need to delegate some tasks to the UAP on your team:

Patient A: 85-year-old with stable heart failure, needs vital signs and assistance with bath Patient B: 45-year-old post-appendectomy (Day 1), needs ambulation in hallway Patient C: 60-year-old with uncontrolled diabetes, blood sugar was 350 this morning Patient D: 72-year-old with COPD, needs respiratory assessment

Question: Which patient care can you safely delegate to the UAP?

Answer: Patient A - vital signs and bath assistance

Explanation:

• Patient A: ✅ Stable condition, ADLs (bathing) appropriate for UAP
• Patient B: ⚠️ Post-op Day 1 = potentially unstable, LPN should ambulate and assess
• Patient C: ❌ Uncontrolled diabetes = unstable, needs nursing judgment
• Patient D: ❌ Respiratory assessment requires nursing judgment (cannot delegate assessment)

💡 Key Learning: The word "stable" is your clue! Stable + basic care = safe to delegate.

Example 3: Scope of Practice Boundary 🚧

Scenario: The RN asks you to perform the following tasks. Which one is OUTSIDE your LPN scope of practice?

1. Reinforce discharge teaching about wound care that the RN taught yesterday
2. Insert a urinary catheter for a patient with urinary retention
3. Develop a teaching plan for a newly diagnosed diabetic patient
4. Administer insulin subcutaneously to a stable diabetic patient

Answer: C - Develop a teaching plan

Explanation:

• Task A (reinforce teaching): ✅ LPNs can REINFORCE what RN already taught
• Task B (catheter insertion): ✅ Within LPN scope
• Task C (develop teaching plan): ❌ DEVELOPING plans = RN role; LPNs implement
• Task D (administer insulin): ✅ Within LPN scope for stable patient

💡 Key Learning: "Develop," "create," "formulate" = RN words. "Implement," "reinforce," "assist" = LPN words!

Example 4: Priority and Delegation Combined ⚡

Scenario: You're working the evening shift with one UAP. You receive report on these patients:

1. Mr. Jones: Stable CHF, needs 6 PM medications
2. Mrs. Smith: Post-stroke Day 3, needs help with dinner
3. Mr. Brown: New complaint of chest pain
4. Ms. Garcia: Needs routine vital signs

Question: What should you do FIRST, and what can you delegate?

Answer:

• First action: Assess Mr. Brown (chest pain = potential emergency)
• Delegate to UAP: Help Mrs. Smith with dinner (stable patient, ADL)
• Do yourself after chest pain: Give Mr. Jones medications
• Delegate or do later: Ms. Garcia vital signs (routine, not urgent)

Explanation: This scenario combines prioritization (ABCs - airway, breathing, circulation) with delegation:

• Chest pain is life-threatening → assess immediately
• Feeding stable patient → safe for UAP
• Medications → important but not life-threatening
• Routine vital signs → lowest priority

💡 Key Learning: Always use ABCs (Airway, Breathing, Circulation) to prioritize! Life-threatening situations come first.

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Common Mistakes ⚠️

Mistake 1: Confusing "Data Collection" with "Assessment"

❌ Wrong thinking: "I collected vital signs and breath sounds, so I did an assessment."

✅ Correct thinking: "I collected DATA (vital signs, breath sounds). The RN will ASSESS what this data means and update the care plan."

Why it matters: Assessment involves analyzing and interpreting data to make nursing diagnoses. LPNs collect data; RNs assess.

Mistake 2: Delegating Tasks Requiring Judgment

❌ Wrong: "The patient is stable, so I'll have the UAP give the morning medications."

✅ Correct: "I'll give the medications myself. Even for stable patients, medication administration requires nursing judgment."

Why it matters: Medication administration ALWAYS requires assessment of the patient's ability to take meds safely - this needs a licensed nurse.

Mistake 3: Accepting Tasks Outside Your Scope

❌ Wrong: "The RN is busy, so I'll go ahead and assess that new admission."

✅ Correct: "Initial assessments are outside my scope. I'll let the RN know the patient needs assessment and I can help with other tasks."

Why it matters: Working outside your scope puts your license at risk AND puts patients in danger. Always stay within your boundaries!

Mistake 4: Not Supervising Delegated Tasks

❌ Wrong: "I delegated the bath to the UAP, so that's done."

✅ Correct: "I delegated the bath to the UAP. I'll check on them halfway through and verify completion afterward. I'm still accountable!"

Why it matters: Delegation doesn't mean dumping tasks. You remain responsible for ensuring the task is done correctly.

Mistake 5: Thinking "Stable" Means "No Changes"

❌ Wrong: "This patient was stable yesterday, so they're stable today. The UAP can handle everything."

✅ Correct: "Even stable patients need nursing assessment each shift. I'll check the patient myself before delegating routine care."

Why it matters: Patient conditions change! What was stable yesterday might not be stable today. Always verify before delegating.

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Key Takeaways 🎯

Let's summarize the most important concepts from this lesson:

1️⃣ LPN/LVN Scope Basics

• Work under RN/physician supervision
• Care for stable, predictable patients
• Implement care plans (not create them)
• Collect data (not perform assessments)
• Reinforce teaching (not develop teaching plans)

2️⃣ The "Cannot" List (Memorize This!)

• ❌ Initial assessments
• ❌ Create care plans
• ❌ Develop teaching plans
• ❌ Care for unstable patients
• ❌ Give IV push meds (most states)
• ❌ Administer blood products (most states)

3️⃣ Delegation Essentials

• Use the Five Rights of Delegation
• Delegate ADLs and basic care to UAP
• NEVER delegate: assessment, teaching, medications, sterile procedures
• You remain accountable for delegated tasks

4️⃣ Priority Framework

• ABC = Airway, Breathing, Circulation (always first!)
• Life-threatening before non-life-threatening
• Actual problems before potential problems
• Unstable before stable

5️⃣ Key Words to Recognize

RN-only words: Initial, assess, develop, create, formulate, evaluate, unstable, complex

LPN-appropriate words: Implement, reinforce, assist, collect data, monitor, stable, routine

UAP-appropriate words: ADLs, basic care, stable, routine, assistance

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📚 Further Study

To deepen your understanding of LPN/LVN scope of practice and delegation:

1. National Council of State Boards of Nursing (NCSBN) - Official NCLEX-PN test plan and scope of practice guidelines: https://www.ncsbn.org/nclex-pn-exam.htm

2. American Association of Colleges of Nursing (AACN) - Delegation resources and nursing roles: https://www.aacnnursing.org/

3. Your State Board of Nursing - Always check your specific state's nurse practice act, as regulations vary by state. Find yours at: https://www.ncsbn.org/contact-bon.htm

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🔧 Try This: Self-Check Exercise

Before moving to the practice questions, test yourself:

1. List 3 things you CAN do as an LPN
2. List 3 things you CANNOT do as an LPN
3. Name one task you can delegate to UAP
4. Name one task you cannot delegate to UAP
5. What does "stable patient" mean to you?

If you can answer these confidently, you're ready for the practice questions! If not, review the core concepts section again.

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🎉 Congratulations! You've completed Lesson 1 on LPN/LVN Scope of Practice and Basic Delegation. Understanding these concepts is your foundation for NCLEX-PN success. Remember: when in doubt about your scope, ask yourself "Is this patient stable? Does this require nursing judgment? Am I qualified to do this?" These three questions will guide you through most delegation and scope decisions.

Now let's practice with questions that will prepare you for the real exam! 💪