MN Nurse Practice Act LPN scope of practice
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This document outlines changes to the scope of practice for licensed practical nurses (LPNs) in Minnesota based on revisions to the state's Nurse Practice Act. It summarizes the key differences between the scopes of LPNs and registered nurses (RNs), such as LPNs conducting focused assessments versus RNs providing comprehensive assessments. It also discusses implications of the changes for LPN education programs and differences in how LPNs practice in various hospital departments. Recommendations are made to better educate RNs and standardize LPN roles across units.
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MN Nurse Practice Act LPN scope of practice
- 1. MINNESOTA NURSE PRACTICE ACT SCSU NURSING STUDENTS Vanessa Albright Elise Fortier Sarah Heins Licensed Practical Nurse (LPN) Scope of Practice
- 2. OBJECTIVES Review new changes in the LPN scope of practice Briefly review LPN and RN scope of practice differences Review curriculum changes at St. Cloud Technical & Community College Discuss current LPN department differences within the St. Cloud Hospital Suggestions & Recommendations for practice
- 3. CHANGES New changes effective August 1st, 2013 Last revision over 40 years ago! Purpose of scope revision? Key components Definitions Practical Nurse Scope (Handout)
- 4. SCOPE STATEMENTS Practice of Practical Nursing (LPN) Practice of Professional Nursing (RN) The performance, with or without compensation of those services that incorporates caring for individual patients in all settings through nursing standards recognized by the board at the direction of a registered nurse, advanced practice registered nurse, or other licensed health care provider and includes but is not limited to… The performance, with or without compensation of those services that incorporates caring for all patients in all settings though nursing standards recognized by the board and includes but is not limited to…
- 5. ASSESSMENT Practice of Practical Nursing (LPN) Conducting a focused assessment of the health status of an individual patient through the collection and comparison of data to normal findings and the individual patient's current health status, and reporting changes and responses to interventions in an ongoing manner to a registered nurse or the appropriate licensed health care provider for delegated or assigned tasks or activities Practice of Professional Nursing (RN) Providing a comprehensive assessment of the health status of a patient through the collection, analysis, and synthesis of data used to establish a health status baseline and plan of care, and address changes in a patient’s condition
- 6. ASSESSMENT Practice of Practical Nursing (LPN) Conducting a focused assessment of the health status of an individual patient through the collection and comparison of data to normal findings and the individual patient's current health status, and reporting changes and responses to interventions in an ongoing manner to a registered nurse or the appropriate licensed health care provider for delegated or assigned tasks or activities Practice of Professional Nursing (RN) Providing a comprehensive assessment of the health status of a patient through the collection, analysis, and synthesis of data used to establish a health status baseline and plan of care, and address changes in a patient’s condition
- 7. CARE PLAN Practice of Practical Nursing (LPN) Participating with other health care providers in the development and modification of a plan of care Practice of Professional Nursing (RN) Collaborating with the health care team to develop and coordinate an integrated plan of care Developing nursing interventions to be integrated with the plan of care
- 8. PROVIDING CARE Practice of Practical Nursing (LPN) Determining and implementing appropriate interventions within a nursing plan of care or when delegated or assigned by a registered nurse Implementing interventions that are delegated, ordered, or prescribed by a licensed health care provider Practice of Professional Nursing (RN) Implementing nursing care through the execution of independent nursing interventions Implementing interventions that are delegated, ordered, or prescribed by a licensed health care provider
- 9. EVALUATION Practice of Practical Nursing (LPN) Assisting in the evaluation of responses to interventions Practice of Professional Nursing (RN) Evaluating responses to interventions and the effectiveness of the plan of care DELEGATION Practice of Practical Nursing (LPN) Assigning nursing activities or tasks to other licensed practical nurses Assigning and monitoring nursing tasks or activities to unlicensed assistive personnel Practice of Professional Nursing (RN) Delegating nursing tasks or assigning nursing activities to implement the plan of care
- 10. SUPERVISION OF NURSING Practical Nursing involves monitoring, but professional nurses are responsible for supervision and monitoring Supervision of nursing is an RN function only ACCOUNTABILITY LPNs and RNs have accountability for the quality of care delivered, recognizing the limits of knowledge and experience; addressing situations beyond the nurse's competency; and performing to the level of education, knowledge, and skill ordinarily expected
- 11. Practice of Professional Nursing (RN) Design and implement teaching plans based on patient need, and evaluating their effectiveness Teaching the theory and practice of nursing Practice of Practical Nursing (LPN) Provide health care information to individual patients EDUCATION
- 12. COLLABORATION Practice of Professional Nursing (RN) Collaborating and coordinating with other health care professionals in the management and implementation of care within and across care settings and communities Providing health promotion, disease prevention, care coordination, and case finding Practice of Practical Nursing (LPN) Collaborate and communicate with other health care providers
- 13. POLICY DEVELOPMENT Practice of Practical Nursing (LPN) Providing input into the development of policies and procedures Practice of Professional Nursing (RN) Participating in the development of health care policies, procedures, and systems Practical Nursing (LPN) and Professional Nursing (RN) Promote a safe and therapeutic working environment, as well as advocate for the best interests of individual patients ADVOCACY
- 14. CURRENT RESEARCH Search Engines CINAHL PubMed Medline Centranet Key Terms Used Licensed practical nurse LPN scope of practice LVN scope of practice Licensed vocational nurse RN vs LPN
- 15. LPN EDUCATION Meeting with Jan Richardson, RN, MA LPN Nursing Instructor St. Cloud Technical & Community College Curriculum Changes Teaching Scope Focused Assessments Head-To-Toe Assessment Graduates feel prepared
- 16. DEPARTMENT DIFFERENCES Emergency Trauma Center LPNs practice at the top of their scope Float Pool “Depends on the unit and the team you’re working with” Medical and Other Seasoned LPNs more reluctant to change “I wouldn’t want to change things” Benefit from educating RNs on LPN scope “Some things get lost when RNs delegate too much”
- 17. SUGGESTIONS & RECOMMENDATIONS Pair up with a department Find similarities/differences in how you utilize LPNs Unite new graduate LPN’s with seasoned LPN’s Learn from each other Develop general hospital-wide LPN scope policy
- 18. SUGGESTIONS & RECOMMENDATIONS Develop a committee RNs and LPNs from each unit Discuss scopes and unit differences Orientation/Education Discuss RN and LPN scope of practice upon hiring RN will review RN scope of practice & LPN scope of practice LPN will review LPN scope of practice Education day regarding LPN/RN scope of practice
- 19. REFERENCES Anonymous LPN Interviews. February & March 2014. Minnesota Board of Nursing. Nurse Practice Act- Minnesota Statute Section 148.171 (2013). Retrieved from:http://mn.gov/health-licensing- boards/images/NPA_2013_Combined_Definitions.pdf Minnesota Nurse Practice Act. Minnesota Board of Nursing Webinar (2013). Retrieved from: http://mn.gov/health-licensing- boards/nursing/practice/npa-toolkit/ https://www.revisor.mn.gov/statutes/?id=148.171 Richardson, J. (2014, March 24). (V. Albright, interviewer)
Editor's Notes
- Purpose of revising the scope of practice definitions was to provide better clarity in the respective roles of the LPN and RN & to help ensure nurses practicing in Minnesota are allowed to practice to the full extent of their education and training. When looking at the scope of practice you’ll notice many key components: assessment, planning care, delegation and assignment (supervision and monitoring), accountability and education. We’ve provided a few handouts for you, so if you are unfamiliar with these definitions you can refer to the handout.
- The bolded phrasing “with or without compensation” - the previous language said “compensation or personal profit” Mn board of nursing felt this had a double meaning- the practice act applies whether or not one is being paid. Definition of patient- Depending on one’s practice setting, the term patient may or may not be applicable. In the scope of practice- patient means “a recipient of nursing care including an individual, family, group, or community.” When comparing the two scope statements- that of the LPN is more limited – the LPN’s practice is more focused on individual patients. This doesn’t mean that LPN’s do not interact with anyone involved besides the patient, the interaction is used as a method to assist in providing care to the individual patient. -The RN focuses on caring for the family as a unit. Also bolded, at the direction- practical nursing is described as a directed scope of practice. This direction may come from the RN, APRN, or other licensed health care professionals.
- LPN practice includes conducting a “focused” assessment, while the RN practice involves a more “comprehensive” assessment. (No assessment in the prior scope of practice) A comprehensive assessment will bring in the holistic view of the patient circumstance (it is a level of assessment which is comprehensive of the physical, medical, social and emotional aspects of the client’s condition) , while the focused assessment is pertaining to one system – set apart from the others (focused is more of an alteration in client condition and comparison to previous condition or normal findings).(When an RN is completing a more focused assessment, it is done in a comprehensive manner, taking into consideration the particular assessment data they are collecting, as well as is known about the patient’s current condition)LPN education includes the knowledge and skill required to conduct a focused assessment (we will discuss this further through our interview with the Technical College). Depending on patient needs the LPN may be doing focused assessments on one particular issue or body system, while the next may be a whole different need or concern requiring assessment of a different body system. Even though they are trained on a head-to-toe basis, this does not correlate as “comprehensive” assessments.
- The practical nurse in addition to collecting the data of the focused assessment, will compare this data to what is previously known about the individual patient and also will compare this data against normal findings. The LPN is also reporting these changes and responses, this follows the statement that the LPN practices at the direction of an RN. (explain further all together)The professional nurse is functioning at a higher level during the comprehensive assessment, which deals with analysis and synthesis. The output of the analysis and synthesis will result in creating a baseline and/or forming, revising a plan of care for the patient. While the LPN is reporting to the nurse, the RN is free to address and establish a plan for changes in a patient’s condition. The RN makes independent nursing decisions.
- The LPN and RN both have a role in care planning. The LPN participates in the development and modification of a plan of care, but does not develop the care plan. The RN will have the responsibility for coordinating the nursing elements of the plan of care with the team, utilizing input and suggestions from the LPN.The assessment, care planning, and evaluating functions lie with the RN, while the LPN participates and contributes to the development of the care plan by reporting pertinent observations, focused assessments, and suggesting nursing intervention modifications based on client responses. The RN revises the plan as is appropriate to meet the changing needs of the client.
- Both the LPN and the RN provide care for the patient. If the RN is identifying appropriate nursing interventions and implementing them, the LPN is performing the interventions within a care plan or when delegated to.
- (*Important to note the definitions of delegation in the handout given, if they are unfamiliar)The LPN assists in the evaluation and identifies to the extent interventions are effective, while the RN will consider whether the interventions are effective and if they are meeting the identified patient care needs. The LPN assists in evals, and determines if the interventions are effective. The RN changes or revises the plan of care depending on evaluations results. LPNs cannot delegate. LPNs are responsible for assigning tasks to other LPNs, and also assigning and monitoring tasks to other unlicensed assistive personnel. RNs are responsible for delegating tasks. The main difference is the word assign and delegate (delegation involves a transfer of authority, assignment does not), LPNs cannot delegate – that is left to professional nursing.
- Supervision of nursing is an RN function only. There is no comparison in the LPN scope. The responsibility for managing, supervising, and evaluating the practice of nursing is in the RN realm only. Definitions are provided in the handout of “monitoring” and “supervision”. Both LPNs and RNs have accountability for the care they provide. This definition is the same in the practical and professional nurse scope of practice.
- The LPN will provide health care information, but the RN is responsible for teaching plans on particular patient needs, and the evaluation of teaching effectiveness.
- The LPN does collaborate with other health care providers, but the RN collaborates as well as coordinates in the management of care within and across care settings and communities (the RN collaborates, but also can manage and implement care). The RN also provides health promotion, disease preventions, care coordination, and case finding.
- The LPN will provide their input in the development of policies and procedures, while the RN will actually participate directly in the development of policies, procedures, and systems. Both the LPN and RN have the same role in patient advocacy.
- No current research found- scope of practice change is new. Just changed August, 2013.
- Going into this slide: Each interviewed or shadowed LPNs on different units. We found mixed feelings about the change in the scope of practice and the knowledge of the scope of practice. These are the questions we asked: How long have you been an LPN? Do you feel your education has prepared you for your current position? Do you feel you are always practicing within your scope, or at the top of your scope? Is there more or less you believe you should/could be doing? Do your feel RNs delegate to you within your scope of practice? Why or why not? OverallLPN’s interviewed feel comfortable with their scope- However we found many either don’t fully know their scope or trust RN’s/other staff to delegate properly. This can be a dangerous situation, especially if the RN’s do not fully know LPN’s scope of practice. ETC- LPN’s practice at the top of their scopeIV’s, ECG’s, Fast Track, Medical and Other = Med Units, Bone and Joint, Sur 1 LPNs interviewed. Each of these nurses were “seasoned” LPNS and seemed unaware of the updates to their scope of practice. One indicated they feel unsure of what their scope actually is and it would be valuable to have a policy laying out the basics of what an LPN can do (regardless of specialty or unit). They also seemed a little reluctant to the change and comfortable with what their role currently was, even if it was not at the top of their practice. Each of these LPNs were experienced, an this view seems to differ greatly when compared with new graduate LPNs. LPNs interviewed feel that too much can get lost with delegation.
- Going into this slide: we perceive there to be barriers both with the LPN and RNs attitudes to this change. A lot of this also has to do with the RNs confidence in the LPN ability and knowledge. Some LPNs may not feel comfortable, while some RNs also may not. A lot of team manager support needed for this change.
- Develop a committee of LPNs and RNs – we think this could help in eliminating the nursing “hierarchy”, also to aid conversations about RN and LPN scope of practice. Having nurses from different units could help discuss unit differences