Registered Nurse (RN)

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The RN is responsible for the quality of nursing care, including the assessment of nursing needs, the planning of nursing care and its implementation, the monitoring and evaluation of the plan, and the supervision of LPN/LVNs.

Scope of Practice/Roles of the RN

The RN is responsible and accountable for making decisions based on his or her knowledge, competency, experience, and use of nursing processes; compliance with state laws and regulations; practice within the scope of practice for RNs in his or her specific state; and awareness of the scope of practice for LPN/LVNs. The decisions made must afford quality nursing care to clients and may include the assignment of specific duties to other qualified personnel (e.g., LPN/LVNs) and the appraisal of the care given by these assigned caregivers. Assignment of specific duties is essential if proper care is to be provided.

Specific responsibilities of the RN include:

• Assessing, evaluating, and making nursing judgments. These tasks cannot be delegated or assigned to LPN/LVNs or other members of the health care team.
• Assigning specific tasks to LPN/LVNs and other personnel for stable clients with predictable outcomes. If the client is unstable or the outcome of a specific procedure is unknown, the RN should personally monitor the client.
• Assigning standard activities involving unchanging procedures, such as feeding and bathing a stable client, to the appropriate member of the health care team. Feeding, bathing, and dressing a stable client are usually assigned to an NAP, while bedside monitoring following the client’s individual plan of care is usually assigned to an LPN/LVN.

Coordination with LPN/LVNs

RNs and LPN/LVNs have a unique and delicate relationship within the health care setting. Although the RN assigns the LPN/LVN specific care or tasks for a specific client, the RN is ultimately responsible for the work of the LPN/LVN and how it affects the client. At the same time, the RN must recognize that LPN/LVNs are licensed by their state board of nursing and have completed a program of study that qualifies them to perform certain tasks and to have certain responsibilities. The LPN/LVN provides client care based on his or her own license.

The degree of supervision the RN exercises over the LPN/LVN is based on an evaluation of the condition of the client; of the education, skill, and training of the LPN/LVN; and of the nature of the tasks being assigned to the LPN/LVN. The supervision of the RN, physically present in the health care facility, may be a direct continuing presence or an intermittent observation and direction.

The next question may help you understand how this works in practice.

1. The LPN/LVN should question which of the following assignments?
   1. Obtain a stool sample for occult blood.
   2. Provide information on nutrition to a new mother.
   3. Adjust the position of a client who has received medication for pain relief.
   4. Assess a client who has just returned to the room following abdominal surgery.

1. Obtaining a stool sample is a routine procedure and thus can be performed by an LPN/LVN. Eliminate this answer choice.
2. Providing information on nutrition to a new mother is within the scope of practice of an LPN/LVN. Eliminate this answer choice.
3. Positioning a client is within the scope of practice of an LPN/LVN. Eliminate this answer choice.
4. An LPN/LVN cannot perform the initial assessment of a client following surgery. This is outside the scope of practice of an LPN/LVN.

The correct answer is (4).