2.7 Scope of Practice (RN vs LPN vs UAP)

NCLEX-RN Registered Nurse

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1 Introduction

About the NCLEX-RN Exam Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM) How to Use This Course

2 Chapter 2: Management of Care

2.1 Legal Rights and Responsibilities 2.2 Advance Directives and Self-Determination 2.3 Informed Consent Protocols 2.4 Client Advocacy and Rights (HIPAA) 2.5 Assignment, Delegation, and Supervision 2.6 Five Rights of Delegation 2.7 Scope of Practice (RN vs LPN vs UAP) 2.8 Ethical Practice Principles

3 Chapter 3: Safety and Infection Prevention and Control

3.1 Standard Precautions and Hand Hygiene 3.2 Transmission-Based Precautions (Contact, Droplet, Airborne) 3.3 PPE Donning and Doffing Sequences 3.4 Fall Prevention and Restraints 3.5 Fire Safety (RACE/PASS) 3.6 Disaster Triage and Emergency Response

4 Chapter 4: Health Promotion and Maintenance

4.1 Growth and Development (Erikson/Piaget) 4.2 Developmental Stages: Infancy through Older Adult 4.3 Maternal and Newborn Care (Antepartum) 4.4 Intrapartum Care and Fetal Monitoring 4.5 Postpartum Care (BUBBLE-HE) 4.6 Health Screening Guidelines 4.7 Immunization Schedules

5 Chapter 5: Psychosocial Integrity

5.1 Therapeutic Communication Techniques 5.2 Non-Therapeutic Communication (What to Avoid) 5.3 Anxiety Disorders and Mental Health Concepts 5.4 Schizophrenia: Hallucinations and Delusions 5.5 Depression and Suicide Assessment 5.6 Substance Misuse and Withdrawal 5.7 Grief and End-of-Life Care

6 Chapter 6: Basic Care and Comfort

6.1 Mobility and Hazards of Immobility 6.2 Assistive Devices (Crutches, Canes, Walkers) 6.3 Nutrition and Diet Therapy 6.4 Enteral Nutrition (Tube Feeding) 6.5 Bowel Elimination and Ostomy Care 6.6 Urinary Elimination and Catheter Care

7 Chapter 7: Pharmacological and Parenteral Therapies

7.1 Medication Administration Rights 7.2 Medication Calculations 7.3 High-Alert Medications: Insulins 7.4 High-Alert Medications: Anticoagulants 7.5 High-Alert Medications: Opioids 7.6 High-Alert Medications: Digoxin and Electrolytes 7.7 IV Therapy and Complications 7.8 Blood Product Administration 7.9 Total Parenteral Nutrition (TPN)

8 Chapter 8: Reduction of Risk Potential

8.1 Laboratory Values: Hematology (CBC) 8.2 Laboratory Values: Metabolic Panel (BMP) 8.3 Laboratory Values: Coagulation Studies 8.4 Vital Signs and Trend Recognition 8.5 Perioperative Care (Pre-Op and Post-Op) 8.6 Nasogastric Tubes and Therapeutic Procedures

9 Chapter 9: Physiological Adaptation

9.1 Fluid Imbalances (Hypovolemia and Hypervolemia) 9.2 Arterial Blood Gases (ABGs) and Acid-Base Balance 9.3 Medical Emergencies: Stroke (CVA) 9.4 Medical Emergencies: Myocardial Infarction (MONA) 9.5 Diabetic Emergencies (Hypoglycemia and DKA) 9.6 Respiratory Conditions (COPD, Pneumonia) 9.7 Cardiac Conditions (Heart Failure) 9.8 Neurological Conditions (Seizures)

2.7 Scope of Practice (RN vs LPN vs UAP)

Key Takeaways Explain This Topic AI

RNs have exclusive scope for: comprehensive assessment, nursing diagnosis, care planning, evaluation, and initial patient education

LPNs/LVNs can care for stable patients, perform focused assessments, reinforce teaching, and administer most medications except IV push and blood products

UAPs perform ADLs, routine vital signs on stable patients, hygiene, ambulation, and specimen collection; they do not give medications unless state law and facility policy allow a certified medication aide to do so under delegation, and they do not perform invasive procedures

The mnemonic EAT (Evaluate, Assess, Teach) identifies functions that ONLY the RN can perform

Scope of practice is defined by the Nurse Practice Act, facility policy, and individual competency; the most restrictive applies

Last updated: October 2026

The NCLEX tests delegation through the lens of a strict hierarchy of licensure. Understanding what each level of nursing personnel can and cannot do is critical for safe delegation and patient care.

Scope of Practice Hierarchy

• Level Education License Supervision
• RN BSN or ADN State RN license Independent practice within scope
• LPN/LVN Certificate program State LPN/LVN license Under RN or provider direction
• UAP (CNA) Training program State certification Under RN or LPN supervision
• Registered Nurse (RN) Scope of Practice

The RN has the broadest scope of practice and is responsible for care coordination, assessment, and evaluation.

Mnemonic: EAT - Evaluate, Assess, Teach These functions cannot be delegated:

• Exclusive RN Function Description
• Evaluation Determining if interventions are effective
• Assessment Comprehensive, admission, discharge, change in condition
• Teaching Initial education, teaching requiring professional interpretation

Additional RN-Only Functions:

• Function Examples
• Nursing diagnosis Identifying nursing problems
• Care planning Developing and modifying care plans
• Blood products Administration and monitoring
• IV push medications High-risk medications
• Central line care PICC, central venous catheters
• Unstable/complex patients Any patient requiring frequent assessment
• Licensed Practical/Vocational Nurse (LPN/LVN) Scope of Practice

LPNs/LVNs provide care for stable patients with predictable outcomes under RN supervision.

• LPN/LVN CAN Do LPN/LVN CANNOT Do
• Care for stable, predictable patients Care for unstable patients
• Focused assessments (post-initial) Comprehensive admission assessment
• Reinforce teaching provided by RN Initial patient education
• Oral, IM, SubQ medications IV push medications (most states)
• Sterile procedures (Foley, wound care) Blood product administration
• Tracheostomy care Initial patient discharge teaching
• NG tube feeding Central line medication administration

Key Points:

• LPNs collect data; RNs interpret data
• LPNs reinforce teaching; RNs develop and initiate teaching plans
• LPN scope varies by state - know your state's Nurse Practice Act

Appropriate LPN Assignments:

• Long-term care residents with stable chronic conditions
• Post-operative patients on day 2-3 with stable course
• Medical-surgical patients with predictable care needs
• Unlicensed Assistive Personnel (UAP/CNA) Scope of Practice

UAPs perform basic care activities under nurse supervision. They have no license to practice nursing.

• UAP CAN Do UAP CANNOT Do
• Activities of Daily Living (ADLs) ANY assessment

Hygiene, bathing, grooming Medication administration (except certified medication aides where the state allows)

• Bed making, linen changes ANY invasive procedures
• Ambulation of stable patients Sterile procedures
• Feeding (no aspiration risk) Wound care
• Routine vital signs (stable patients) Tracheostomy care
• Intake and output measurement Tube feeding administration
• Specimen collection Urinary catheterization
• Range of motion exercises Interpretation of findings

Critical Limitations:

• UAPs measure and report - they do not assess
• UAPs can report abnormal findings but cannot interpret them

UAPs do not administer medications unless state law and facility policy allow a certified medication aide to do so under delegation

Comparison Table: Who Can Do What?

• Task RN LPN UAP
• Comprehensive assessment Yes No No
• Focused assessment (stable patient) Yes Yes No
• Vital signs (stable patient) Yes Yes Yes
• Vital signs (unstable patient) Yes No No
• Care planning Yes No No
• Initial patient teaching Yes No No
• Reinforce teaching Yes Yes No
• Oral medications Yes Yes No†
• IV push medications Yes No* No
• Blood transfusion Yes No No
• Sterile wound care Yes Yes No
• Foley catheter insertion Yes Yes No
• ADLs/Hygiene Yes Yes Yes
• Ambulation Yes Yes Yes
• Specimen collection Yes Yes Yes
• *Some states allow LPN IV therapy with additional training
• †Certified medication aides may give some medications where state law allows
• Clinical Scenario Decision-Making

Question Framework: For each patient, ask:

Is this patient stable or unstable?

What level of assessment is needed?

What is the complexity of the intervention?

• Patient Scenario Assign To
• New admission requiring assessment RN only
• Post-op day 1 with chest tubes RN only
• Diabetic patient needing insulin teaching RN only
• Chronic dialysis patient, routine day LPN or RN
• Long-term care resident, ADL assistance UAP (supervised)
• Patient with new-onset confusion RN only
• Blood transfusion required RN only
• Stable patient needing IM injection LPN or RN
• Determining Scope in Practice

Scope of practice is determined by the most restrictive of:

• State Nurse Practice Act - Legal scope
• Facility Policy - May be more restrictive than NPA
• Individual Competency - Person must have skills

If any one prohibits the action, it cannot be performed.

On the NCLEX

Delegation and scope of practice questions are among the most common. They test:

• Which tasks can be delegated to which personnel
• When stable vs. unstable patient requires RN care
• Understanding of EAT (cannot delegate Evaluate, Assess, Teach)
• Appropriate assignments based on patient acuity

Exam Tip: If a question mentions assessment, evaluation, teaching, unstable condition, or change in status, the answer usually involves the RN.