A Licensed Practical Nurse (LPN) is a licensed healthcare provider who delivers directed, hands-on patient care under the supervision of a higher-level practitioner.
Defining the Licensed Practical Nurse Role
The title Licensed Practical Nurse, or LPN, is used in the majority of states across the country to designate this entry-level licensed nursing role. In the states of California and Texas, the identical professional role is officially termed a Licensed Vocational Nurse (LVN). Regardless of the title, these professionals must complete an accredited educational program, typically lasting about one year, and pass the National Council Licensure Examination for Practical Nurses (NCLEX-PN) to obtain licensure. The LPN is authorized to provide nursing care that is focused and directed, meaning the care is implemented based on a plan developed by a Registered Nurse or physician. The core philosophy of the LPN’s practice is to provide fundamental care to patients whose conditions are stable or predictable.
Core Responsibilities and Patient Care Duties
Basic Patient Needs and Hygiene
A significant portion of the LPN’s daily work involves assisting patients with activities of daily living (ADLs) and ensuring their comfort. This includes hands-on tasks like helping patients with bathing, dressing, and personal hygiene. LPNs also assist with patient mobility, which can involve helping individuals ambulate, repositioning them in bed to prevent skin breakdown, or assisting with transfers.
Monitoring and Reporting Patient Status
LPNs are responsible for the routine collection of objective data used by the entire healthcare team to track patient progress. This involves meticulously taking and recording vital signs, such as blood pressure, temperature, pulse rate, and respiratory rate. They also monitor and measure fluid intake and output, which provides data on kidney function and hydration status. A duty is the timely recognition and reporting of any changes in a patient’s condition to the supervising RN or physician.
Specimen Collection and Testing
LPNs frequently collect non-invasive specimens such as urine, stool, and sputum for laboratory analysis. They also perform common point-of-care testing, most notably routine blood glucose checks using a glucometer.
Wound Care and Dressing Changes
LPNs are routinely involved in the care of wounds, which includes cleaning and applying sterile or non-sterile dressings. They often manage wounds that are stable, non-complex, or chronic in nature. This duty requires the LPN to observe the wound site closely for any signs of infection, such as increased redness, drainage, or swelling, and document their findings. The ability to perform catheter insertion and maintenance is also a common technical skill within their scope of practice.
Patient Education and Health Promotion
While the comprehensive teaching plan is developed by an RN, the LPN plays an active role in reinforcing patient education. They provide instruction on specific, prescribed self-care techniques, such as how to manage a new medication schedule or perform a simple dressing change at home. LPNs also promote general health and wellness principles within their patient interactions.
The LPN’s Role in Medication Administration
The administration of medications is a core LPN duty, though the specific routes and types of drugs permitted vary significantly by state and facility policy. LPNs are authorized to administer medications via common routes, including oral, topical, subcutaneous, and intramuscular injections.
State Nurse Practice Acts (NPAs) govern the most complex area of medication administration, which involves intravenous (IV) therapy. In many states, LPNs are restricted from initiating IV lines or administering IV push (bolus) medications because of the immediate, high-risk nature of these drugs. However, some states allow LPNs to perform certain IV tasks, such as monitoring existing IV fluids or administering medications via a peripheral IV, provided they have completed specialized, board-approved IV certification courses. LPNs are generally prohibited from performing high-acuity tasks like initiating blood transfusions or administering medications through central lines.
Understanding the Limits of LPN Practice
To ensure patient safety, the LPN’s scope is deliberately defined to exclude certain high-level, complex clinical activities reserved for the Registered Nurse. The LPN’s education focuses on data collection and implementation, not on the independent analysis and planning required for comprehensive patient care. LPNs are legally constrained from performing the initial, in-depth comprehensive assessment of a patient upon admission.
The development of the nursing diagnosis is a function reserved for the RN. Consequently, LPNs do not create the initial comprehensive nursing care plan, which outlines the goals and interventions for the patient. Instead, the LPN follows and executes the established plan, providing valuable input and collecting evaluative data that the RN uses to modify the plan as needed.
Supervision and Professional Hierarchy
The LPN operates within a dependent scope of practice, meaning their actions require direction and oversight from a higher licensed professional. Legally, LPNs must practice under the supervision of a Registered Nurse, a licensed physician, a dentist, or, in some settings, a podiatrist.
Supervision can be either direct or indirect, depending on the setting, the patient’s acuity, and state regulations. Direct supervision requires the supervising professional to be physically present and immediately available to intervene. Indirect supervision, which is more common in stable environments like long-term care, allows the LPN to perform tasks with the supervising professional available by telephone or in the building.
Common Work Environments for Practical Nurses
LPNs are employed across a diverse range of settings, with their roles being most prominent in environments that focus on chronic care and stable patient populations. Long-term care facilities, such as nursing homes and skilled nursing facilities, represent one of the largest employers for practical nurses.
Other common work settings include physician’s offices, clinics, home health agencies, and assisted living facilities. In these outpatient environments, LPNs often perform patient intake, administer immunizations, and assist with minor procedures. While LPNs do work in hospitals, their roles tend to be less prevalent in acute-care units compared to RNs, and they are often found in non-acute or specialized units.