Who may do what: RN, LPN/LVN, UAP, and the never-delegate list

THE SCOPE GRID

Carry this in working memory. Then check it against your own state board of nursing before you carry it onto a unit.

Assistive personnel may

• Bathe, provide oral care, position, and transfer.
• Feed a patient who has no swallowing risk and no new dysphagia concern.
• Ambulate a stable patient who has walked before without incident.
• Take routine vital signs on a stable patient and report the numbers.
• Measure and record intake, output, and weights.
• Collect routine specimens, stock supplies, and set up equipment.

Assistive personnel may not

• Assess, teach, evaluate, or interpret any finding.
• Take any patient whose condition is changing.
• Reporting a measured number is permitted. Deciding what the number means is not.

LPN/LVN may

• Reinforce teaching the RN has already given.
• Collect and monitor data, and report changes to the RN.
• Provide routine care for stable patients with predictable outcomes.
• Administer most oral, subcutaneous, and intramuscular medications.
• Perform dressing changes, tracheostomy care, enteral feeding, urinary catheter insertion, and suctioning.

LPN/LVN may not, in most states

• Perform the initial admission assessment.
• Create or revise the plan of care.
• Provide the initial patient teaching.
• Evaluate outcomes.
• Take the unstable or unpredictable patient.
• Intravenous push medication, blood product administration, and central line care vary widely by state and by facility.

RN only

• Initial and ongoing assessment.
• Nursing diagnosis and the plan of care.
• Patient and family teaching.
• Evaluation of outcomes.
• Triage, the unstable patient, and the decision to delegate itself.

The never-delegate list, in every state

• Assessment. Evaluation. Teaching. Nursing judgment. The unstable patient.

The stability rule

The deciding variable is almost never the task. It is the patient. The same vital signs check is delegable on the stable patient in bed 4 and is not delegable on the patient in bed 2 whose blood pressure has been trending down since the last round. When an item feels like it has two right answers, reread which patient the task is attached to.

What varies most

Intravenous therapy scope for LPN/LVNs, medication administration by assistive personnel in some long-term care settings, and what may be delegated across settings such as home health and school nursing.

Memory hook: YOU CANNOT DELEGATE WHAT YOU EAT — Evaluation, Assessment, Teaching.

Watch outevery row on this page is a scope claim. Scope of practice is set by your state Nurse Practice Act and by facility policy, and the Nurse Practice Act supersedes this grid.

Takeawaycheck the patient's stability before you check the task, then check the person's competence before you check the person's title.