A: A key scope of practice difference is that the RN has an independent nursing practice and the LPN has a dependent nursing practice. These differing scope of practice authorities are grounded in the type of nursing education program completed by the licensee.At the RN level of licensure, the Nurse Practice Act (NPA) makes no requirement for clinical direction or supervision of practice.
Division 45 of the NPA grants the RN the authority to conduct an independent nursing assessment, develop a plan of care, and evaluate outcomes related to the plan.
While a practice setting may enact supervision requirements related to the RN's role within the setting, the RN remains independent in their nursing practice.
At the LPN level of licensure, the practice act does make requirements for clinical direction and supervision of practice.
Division 45 of the NPA specifies that LPN practice may only occur under the clinical direction of a RN, or, under the clinical direction of a licensed independent practitioner (LIP) such as a physician.
Clinical direction of LPN practice means the communication from the RN to the LPN for the implementation of the RN's established plan of care or the communication from the LIP to the LPN for the implementation of the LIP's treatment plan. Any practice by an LPN that occurs outside of an established plan of care is not consistent with LPN scope of practice.
Foundational to the LPN's implementation of the established plan of care is the LPN's completion of a nursing assessment. At the LPN level of licensure, this is a focused assessment. Focused assessment means recognizing the priority condition at the time of intervention within the parameters of the established plan of care or treatment plan.
Additional resources:
- OSBN Sentinel - November 2017, Oregon's NPA: The foundation for scope of practice differences in LPN and RN practice.
- OSBN Sentinel – November 2018, Focused assessment and the licensed practical nurse.