Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN)

An LPN/LVN has specific education and skills and is licensed to work in a health care setting under the supervision of a primary health care provider, dentist, podiatrist, or, most commonly, an RN (or NP). The role of the LPN/LVN is defined by the theoretical and clinical content taught in practical/vocational nursing programs within each state and approved by the individual state board of nursing/regulatory body.

Scope of Practice/Role of the LPN/LVN

Each state has a specific scope of practice for LPN/LVNs under which they may practice. Under the supervision of an RN, LPN/LVNs provide care for which they are specifically trained. They care for stable clients and perform procedures with predictable outcomes.

The LPN/LVN is often the bedside nurse, providing care to stable clients. LPN/LVNs monitor vital signs, collect data, monitor intake and output, check blood glucose levels, apply dressings, insert and care for indwelling urinary catheters as well as nasogastric tubes, empty Jackson-Pratt (JP) drains, administer enemas, maintain oxygen protocols, and administer prescribed medications. Some states restrict the administration of intravenous (IV) medications and solutions by LPN/LVNs.

Many of the duties of an LPN/LVN involve data collection. The LPN/LVN is taught to distinguish normal from abnormal findings when observing clients (for example, normal versus abnormal heart sounds) and to recognize changes from previously recorded data (for example, a sudden drop in blood pressure). The data, especially abnormal findings and changes in clinical findings, are reported to an RN (or primary health care provider) to provide the necessary information for client care.

The LPN/LVN does not perform an initial client assessment: that is the responsibility of the supervising RN (or primary health care provider). However, after the initial assessment has been made and a plan of care initiated, the LPN/LVN may collect data, reporting the findings to the supervising RN. In general, the LPN/LVN carries out the plan of care developed by the RN.

LPN/LVNs may also be involved in reinforcing client teaching, such as educating pregnant women about childbirth and the care of an infant. LPN/LVNs may also practice “telephone nursing,” using protocols developed by a primary health care provider. The protocols state what information to request of a caller, what to tell the caller, and how to direct the caller to proceed, depending on the condition for which he or she is calling.

In some states, LPN/LVNs, with additional education and certification, may have an expanded role in IV therapy and hemodialysis under the supervision of an on-site RN. The specific situations, medications, and procedures that the LPN/LVN may perform are strictly limited and outlined by state regulations. However, in most states, LPN/LVNs are responsible for assessing IV infusions and administration sites on their assigned clients, but they do not initiate, manage, or deliver IV therapy. LPN/LVNs also cannot pronounce a client dead in most states.

Also, in some states, LPN/LVNs assume the care of specific clients utilizing an overall plan of care developed by the RN. This situation most often arises in cases where rapid changes are not expected in the client’s condition. The LPN/LVN may be assigned to monitor the client regularly while the RN is available for consultation and periodic monitoring. In long-term care facilities, the LPN/LVN may assume the “charge nurse” role with consultation of an in-house supervising RN.

Specifically, LPN/LVNs:

Provide emotional and physical comfort for the client.
Carry out the client plan of care initiated by the RN.
Observe a client’s signs and symptoms and report any changes to the supervising RN.
Perform nursing procedures for which the LPN/LVN has the necessary skills and training, such as routine bedside care, data collection, dressing changes, indwelling urinary catheter insertion and care, respiratory care and suctioning, ostomy care, and non-IV medication administration.
May help RNs in the care of seriously ill clients in intensive care units or in delivery rooms or neonatal units.
Assist with the rehabilitation of clients according to the client’s plan of care.

Let’s look at a question that focuses on the scope of practice and roles of the LPN/LVN.

Which of the following client-care activities would it be appropriate for an LPN/LVN to perform?
1. Obtain detailed 24-hour diet recall from client newly admitted with a suspected eating disorder.
2. Obtain catheterized urine sample from client with a fever and slight lower abdominal discomfort.
3. Collect data for an adolescent client experiencing an acute asthma attack.
4. Care for a school-age client with a new tracheostomy for laryngotracheal bronchitis.

Strategy: Remember that LPN/LVNs perform activities concerning stable clients with predictable outcomes.

A 24-hour diet history is an important part of the initial assessment of a client with suspected anorexia nervosa or other eating disorder. It helps guide the treatment plan. RNs, not LPN/LVNs, provide the initial clinical assessment. Eliminate this answer choice.
LPN/LVNs routinely collect catheterized urine samples. It is a routine procedure that the LPN/LVN is qualified to perform. Keep this answer choice for consideration.
An adolescent client experiencing an acute asthma attack is unstable. The care of such an unstable client with an uncertain outcome would not normally be assigned to an LPN/LVN. Eliminate this answer choice.
A school-age client with a new tracheostomy for laryngotracheal bronchitis is unstable and, therefore, needs the assessment and care of an RN. Eliminate this answer choice.

The correct answer is (2).