As the student nurse transitions from the role of a nursing student to the professional level of nursing, the licensed registered nurse shall perform only those nursing activities for which the RN has been prepared through basic education and those additional skills, which are obtained through subsequent nursing education and within the scope of practice of an RN as determined by the board of Nursing.
The Licensed Practical Nurse works in hospitals, clinic, as well as skilled nursing facilities, assisted living facilities, correctional facilities and dental offices. A licensed practical nurse may perform specific nursing skills and procedures under the supervision of an RN, Nurse Practitioner, Physician Assistant, Medical Doctor or Dentist. The licensed practical nurse may delegate to Certified Nurse Assistants or other non-licensed assistants. The LPNs scope of practice includes performance and documentation of basic patient care, vital signs, data collection on all body systems.
The LPN carries out wound care orders, preparing patients for diagnostic testing, including specimens. The licensed practical nurse can place the insertion and care of urinary catheters and naso-gastric tubes. The LPN administers medications, but cannot administer IV push medications. IV push medications are under the scope of practice of the RN ( azbn, 2009). A LPN can collect blood specimens. The Licensed practical nurse does not have the same level of education to perform at the same level of the professional nurse.
The licensed practical nurse is task oriented as the RN is more challenged in the coordination and flow of the care plan. Concerns from transitioning from the practical nurse transition are registered nurses hold a higher degree of legal responsibility. The registered nurse delegates tasks to the licensed practical nurse and nursing assistants. The RN has a broader and longer education with more knowledge of anatomy and physiology, pharmacology, clinical practice, patient care, and team functioning.
RNs are responsible for creating and implementing nursing care plans, and emotional care to the client and at times, often the client’s family (Helium, 2002-2009). The RN provides clear directions and guidelines regarding the delegated task and verifies that the Licensed practical nurse or the unlicensed assistant follows each written policy or procedure when performing the delegated task. The RN observes and communicates the outcome of the delegated tasks and provides feedback. The RN can think to critically think to make clinical decisions based upon evidence based practices incorporated upon the foundation of the nursing process.
The license practical nurse does not have the supervisory skills that a RN has. The role of clinical judgment raises concern for the professional nurse, because their professional judgment may be questioned, the professional nurse may be undermined where the nurse is expected to take on the knowledge and skills of other health professionals to carry out quality patient care (Jones,1996). The professional nurse has the accountability of aspects to the patient and as a professional nurse. The professional nurse will assume responsibility for nursing judgment and actions.
The professional nurse has to be socially accountable to behave in a manner that is excepting to the public not behaving inappropriately. To be ethical, the professional must be consistent with agreed principles of correct moral conduct, and legally a nurse must be an advocate for the patient. The patient and professional accountability is everyone involved in healthcare. Autonomy is attributed in the nursing profession, including self-determination, self direction, the freedom to interact on an independent level with other professionals, and being left on one’s own to work (Keenan, 1999).
The professional nurse must be competent to work alone and make decisions in a critical situation where the nurse may be the only one there to assess. Nurses spend considerably more time with patients than any of other health professional. The professional nurse can give report to the physician, so that he or she can make the best decision on the care that is carried out for the patient by the professional nurse ( Raymond, 2005). The doctor relies heavily on the nurse and the nurse relies upon her critical thinking and other professional nurses as well as the unlicensed professionals.
The pharmacy has a role in the collaboration of the outcome of the patient. The pharmacy relies upon the orders of the physician and the nurse that will be administering the drug. The professional nurse relies upon the pharmacy for the accurate dosing if there is a discrepancy to the dosage. The occupational therapist, physical therapist and all other specialties rely upon the physicians orders and the professional nurse who knows the patient and what has been implemented and what has worked for the patient.
This revolving circle of the healthcare professionals is what leads to the positive outcome of the patient. New nurses can incorporate leadership fundamentals while developing competency in their profession. Leadership skills consist of effective communication. The nurse must be able to listen and understand what is being said. Make notes and encourage questions. The RN will carry the flow of the group in a professional manner. The RN must be able to solve a conflict in the workplace. Explore different techniques in finding a median to the situation. A professional nurse must set the tone and be an example.
This is an effective way to show others the proper way to conduct themselves. Delegating tasks to a subordinate, it is essential that the RN know the capability of the worker. A license authorized the same scope of practice for persons licensed, not all licenses have the same amount of education and experience. The functions vary. The professional nurse will need to display counseling skills to solve problems in the workplace upon the need. The RN will show a professional teaching style and explanation of the skill. The RN will show the ability to choose the learning objectives.
The professional nurse will continue to grow and learn new ways and techniques of applying new concepts to the new technology of nursing care (Raymond, 2005) The professional RN has gained the knowledge to show proficiency of the leadership skills using clinical decision making to delegate and implement tasks based on the fundamental principle of protection of the health, safety and welfare of the public (csbn, 2010). Boards of Nursing are responsible for the regulation of nursing. Provision of any care which constitutes nursing or any activity represented as nursing is a regulatory responsibility of Boards of Nursing.
The professional RN will assign nursing care within the RN scope of practice to other RNs who assign nursing care to a licensed practical nurse. The LPN scope of practice is based on the RN’s assessment of the client. In maintaining accountability for the delegation, an RN shall ensure that the unlicensed assistant has the education, legal authority, and has demonstrated the competency to perform the delegated task assigned. The tasks that the nurse delegates are consistent with the unlicensed assistant’s job description. The RN concurrently deems the delegated task can be safely performed.
The RN will provide clear directions and guidelines regarding the delegated task t to the licensed and unlicensed to validate that each facility written policy or procedure was performed correct. The professional RN provides supervision and feedback to the licensed and unlicensed, and observes and communicates the outcomes of the delegated task (azbn, 2009). The licensed RN must have responsibility and accountability for the management and provision of the staff. Nursing is a knowledge-based process discipline and cannot be reduced solely to a list of duties. The nurse does not delegate task that the nurse would not do.
The professional nurse makes sure that all equipment is needed of the task to be completed. The nurses’ specialized education and professional judgment are necessary for quality nursing care. As the student nurse gain more professional knowledge of leadership skills the nurse will have the opportunity to evaluate the skills acquired to delegate tasks and show leadership in a clinical setting when transitioning from the LPN to RN. In the transitional phase a nurse will learn autonomy and feel comfortable. The level of the responsibility for the professional nurse is more complex than that of the licensed practical nurse.
In comparison to the two, the RN will have gained the expertise to think critical and make the decisions to care for the patient in a timely and efficient manner. By delegating tasks to the licensed and the unlicensed the professional nurse can prioritize tasks. As the nurse transitions, the professional becomes a leader for the patient and colleagues. By delegating tasks to the licensed and the unlicensed the professional nurse can prioritize tasks.
- Finlay, T. (2000). The Scope of professional practice; a literature review to determine the documents impact on nurse’s role. NT Research 5(2):115-125
- Jones, M. (1996) Accountability in Practice: A guide to professional responsibility for nurses in general practice. Salisbury: Quay Books
- Keenan, J. (1999) A concept analysis of autonomy. Journal of Advanced Nursing 29 (3) : 56-562
- National council of state boards of nursing Inc. (2010). Retrieved from http://www. ncsbn. org
- Standards related to Registered Nurse Scope of Practice. (2009) Retrieved from, www. azbn. gov
- Nurse/Physician Collaboration necessary for better care. (2005). Journal of Nursing Administration, 36(5), 6-8.