Licensed Nurse Responsibilities in Nursing Homes: A Scope-of-Practice Issue

A mailed survey of licensed practical nurses (LPNs) employed in nursing homes in Minnesota and North Carolina examined their role and responsibilities as well as barriers to and facilitators for working within their scope of practice. The study focused on the nursing practice domains of assessment, care planning, evaluation, delegation, and supervision. The respondents reported they were actively engaged in these domains. Factors that made staying within their legal scope of practice challenging were not having registered nurses (RNs) available to help with direct care, having RNs spend time on administrative work, and having an inadequate number of licensed nurses in the facility. Factors that helped LPNs stay within their scope of practice were having sufficient RNs involved in direct care and having a supportive director of nursing. This study underscores the need for further investigation on the delivery and organization of care by licensed nurses in nursing homes, including the development and testing of RN-LPN practice models that reflect RN and LPN competencies and scopes of practice. Boards of nursing are encouraged to provide guidance to nurses and their nursing home employers who interpret RN and LPN scopes of practice as a means of promoting accountable, safe, quality care for nursing home residents.

Duke Scholars

Author Ruth A. Anderson School of Nursing

Author Eleanor Schildwachter McConnell School of Nursing

Author Kirsten N Corazzini School of Nursing