Key Takeaways
- RNs have exclusive scope for: comprehensive assessment, nursing diagnosis, care planning, evaluation, and initial patient education
- LPNs/LVNs can care for stable patients, perform focused assessments, reinforce teaching, and administer most medications except IV push and blood products
- UAPs perform ADLs, routine vital signs on stable patients, hygiene, ambulation, and specimen collection but NO medication administration or invasive procedures
- The mnemonic EAT (Evaluate, Assess, Teach) identifies functions that ONLY the RN can perform
- Scope of practice is defined by the Nurse Practice Act, facility policy, and individual competency; the most restrictive applies
Scope of Practice (RN vs LPN vs UAP)
The NCLEX tests delegation through the lens of a strict hierarchy of licensure. Understanding what each level of nursing personnel can and cannot do is critical for safe delegation and patient care.
Scope of Practice Hierarchy
| Level | Education | License | Supervision |
|---|---|---|---|
| RN | BSN or ADN | State RN license | Independent practice within scope |
| LPN/LVN | Certificate program | State LPN/LVN license | Under RN or provider direction |
| UAP (CNA) | Training program | State certification | Under RN or LPN supervision |
Registered Nurse (RN) Scope of Practice
The RN has the broadest scope of practice and is responsible for care coordination, assessment, and evaluation.
Mnemonic: EAT - Evaluate, Assess, Teach These functions cannot be delegated:
| Exclusive RN Function | Description |
|---|---|
| Evaluation | Determining if interventions are effective |
| Assessment | Comprehensive, admission, discharge, change in condition |
| Teaching | Initial education, teaching requiring professional interpretation |
Additional RN-Only Functions:
| Function | Examples |
|---|---|
| Nursing diagnosis | Identifying nursing problems |
| Care planning | Developing and modifying care plans |
| Blood products | Administration and monitoring |
| IV push medications | High-risk medications |
| Central line care | PICC, central venous catheters |
| Unstable/complex patients | Any patient requiring frequent assessment |
Licensed Practical/Vocational Nurse (LPN/LVN) Scope of Practice
LPNs/LVNs provide care for stable patients with predictable outcomes under RN supervision.
| LPN/LVN CAN Do | LPN/LVN CANNOT Do |
|---|---|
| Care for stable, predictable patients | Care for unstable patients |
| Focused assessments (post-initial) | Comprehensive admission assessment |
| Reinforce teaching provided by RN | Initial patient education |
| Oral, IM, SubQ medications | IV push medications (most states) |
| Sterile procedures (Foley, wound care) | Blood product administration |
| Tracheostomy care | Initial patient discharge teaching |
| NG tube feeding | Central line medication administration |
Key Points:
- LPNs collect data; RNs interpret data
- LPNs reinforce teaching; RNs develop and initiate teaching plans
- LPN scope varies by state - know your state's Nurse Practice Act
Appropriate LPN Assignments:
- Long-term care residents with stable chronic conditions
- Post-operative patients on day 2-3 with stable course
- Medical-surgical patients with predictable care needs
Unlicensed Assistive Personnel (UAP/CNA) Scope of Practice
UAPs perform basic care activities under nurse supervision. They have no license to practice nursing.
| UAP CAN Do | UAP CANNOT Do |
|---|---|
| Activities of Daily Living (ADLs) | ANY assessment |
| Hygiene, bathing, grooming | ANY medication administration |
| Bed making, linen changes | ANY invasive procedures |
| Ambulation of stable patients | Sterile procedures |
| Feeding (no aspiration risk) | Wound care |
| Routine vital signs (stable patients) | Tracheostomy care |
| Intake and output measurement | Tube feeding administration |
| Specimen collection | Urinary catheterization |
| Range of motion exercises | Interpretation of findings |
Critical Limitations:
- UAPs measure and report - they do not assess
- UAPs can report abnormal findings but cannot interpret them
- UAPs cannot administer medications in any form
Comparison Table: Who Can Do What?
| Task | RN | LPN | UAP |
|---|---|---|---|
| Comprehensive assessment | Yes | No | No |
| Focused assessment (stable patient) | Yes | Yes | No |
| Vital signs (stable patient) | Yes | Yes | Yes |
| Vital signs (unstable patient) | Yes | No | No |
| Care planning | Yes | No | No |
| Initial patient teaching | Yes | No | No |
| Reinforce teaching | Yes | Yes | No |
| Oral medications | Yes | Yes | No |
| IV push medications | Yes | No* | No |
| Blood transfusion | Yes | No | No |
| Sterile wound care | Yes | Yes | No |
| Foley catheter insertion | Yes | Yes | No |
| ADLs/Hygiene | Yes | Yes | Yes |
| Ambulation | Yes | Yes | Yes |
| Specimen collection | Yes | Yes | Yes |
*Some states allow LPN IV therapy with additional training
Clinical Scenario Decision-Making
Question Framework: For each patient, ask:
- Is this patient stable or unstable?
- What level of assessment is needed?
- What is the complexity of the intervention?
| Patient Scenario | Assign To |
|---|---|
| New admission requiring assessment | RN only |
| Post-op day 1 with chest tubes | RN only |
| Diabetic patient needing insulin teaching | RN only |
| Chronic dialysis patient, routine day | LPN or RN |
| Long-term care resident, ADL assistance | UAP (supervised) |
| Patient with new-onset confusion | RN only |
| Blood transfusion required | RN only |
| Stable patient needing IM injection | LPN or RN |
Determining Scope in Practice
Scope of practice is determined by the most restrictive of:
- State Nurse Practice Act - Legal scope
- Facility Policy - May be more restrictive than NPA
- Individual Competency - Person must have skills
If any one prohibits the action, it cannot be performed.
On the NCLEX
Delegation and scope of practice questions are among the most common. They test:
- Which tasks can be delegated to which personnel
- When stable vs. unstable patient requires RN care
- Understanding of EAT (cannot delegate Evaluate, Assess, Teach)
- Appropriate assignments based on patient acuity
Exam Tip: If a question mentions assessment, evaluation, teaching, unstable condition, or change in status, the answer usually involves the RN.
Which patient assignment is appropriate for the LPN?
A UAP reports that a patient's blood pressure is 82/50 mmHg. The patient was stable earlier in the shift. The RN should:
Which task can the RN delegate to the UAP for a patient who had a stroke 2 days ago?