What is the purpose of the scope of practice for the RN and LPN?

Scope of practice describes the services that a qualified health professional is deemed competent to perform, and permitted to undertake – in keeping with the terms of their professional license.

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What Is a Scope of Practice?
The Use of Electricity for Medical Purposes
Drug Administration

Scope of practice defined in nursing

The Nursing Scope and Standards of Practice describe the “who,” “what,” “where,” “when,” “why,” and “how” of nursing practice:

Who: Registered Nurses (RN) and Advanced Practice Registered Nurses (APRN) comprise the “who” constituency and have been educated, titled, and maintain active licensure to practice nursing.
What: Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; facilitation of healing; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, groups, communities, and populations.
Where: Wherever there is a patient in need of care.
When: Whenever there is a need for nursing knowledge, compassion, and expertise.
Why: The profession exists to achieve the most positive patient outcomes in keeping with nursing’s social contract and obligation to society.

When each of these questions is answered, the complex considerations in scope of practice become clear. In a profession as dynamic as nursing, and with evolving health care demands, changes in scope of practice and overlapping responsibilities are inevitable in our current and future health care system.

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Nursing Specialty Recognition, Scope and Standards Review, Affirmation of Competencies

The American Nurses Association has an established review program for recognition of a nursing specialty, approval of a specialty nursing scope of practice statement, acknowledgment of specialty nursing standards of practice, and affirmation of focused practice competencies. Details about each component of this program, specialty characteristics, review criteria, and submission process are described here.

Health care licensure

Currently, all health care licensure is state-based, and there is some variability between the qualifications for licensure and re-licensure for each state.

Defining scope of practice is generally a two-step process:

Step 1: The state legislature passes a law, known as a “nurse practice act.”
Step 2: Regulatory bodies then create and implement rules and regulations, intended to protect the public.

Choice in health care providers

The American Nurses Association (ANA) believes that patients’ interests are best served by a health care system in which many different types of qualified professionals are available, accessible, and working together – collaboratively. Therefore, it is important for scope of practice to reflect a professional’s true expertise.

ANA is a founding member of the Coalition for Patient’s Rights (CPR), which was established to improve patients’ access to the health care providers of their choice, and the range of services those providers offer. The CPR consists of more than 35 organizations representing a variety of licensed health care professionals, each providing a diverse array of safe, effective, and affordable care.

Protecting and advancing scope of practice

Protecting and advancing scope of practice for nurses is a major initiative for ANA. In the fast-moving world of health care, it is vital that nurses are able to practice to the full extent of their education and abilities, in order to deliver the most efficient, quality care to patients.

There is a growing body of evidence to support the safe and cost-effective provision of care by APRNs, and a national call to remove all barriers to full practice authority. ANA remains committed to monitoring and advocating for legislative and regulatory changes relating to scope of practice, with the aim of removing practice barriers for nurses and improving access to care.

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Nursing is a popular industry – especially in these times. Across the field, there are a variety of nursing positions and levels, all of which vary based on a variety of factors. What each nurse is allowed to do is called their scope of practice, and this varies based on their education, training, competence, and role. Essentially, the responsibilities that a Doctor, Nurse Practitioner (NP), Nursing Assistant, Registered Nurse (RN), Intensive Care Unit (ICU) Registered Nurse, or even Licensed Practical Nurse (LPN) have are all different based on a range of factors.

In this blog, we’ll be specifically looking into the scope of practice for a Licensed Practical Nurse in British Columbia.

What Is a Scope of Practice?

If you’re new to or unfamiliar with the healthcare field, you may not know what a scope of practice is. A scope of practice refers to the procedures, actions, and processes that a healthcare provider is permitted to carry out within the limits of their professional license. In other words, it’s the duties and responsibilities that a Licensed Practical Nurse is educated and authorized to perform in their work.

In BC, Licensed Practical Nurses are governed under the British Columbia College of Nurses and Midwives’ (BCCNM) Scope of Practice. This scope of practice is based on the Nurses (Licensed Practical) Regulation and sets out the activities that Licensed Practical Nurses are educated and authorized to perform if an employer policy permits it, and if the LPN has competence.

In essence, the BCCNM’s scope of practice outlines the standards, limits, and conditions for Licensed Practical Nurses in BC.

Licensed Practical Nurses can either act within an autonomous scope of practice or with client-specific orders.

An autonomous scope of practice refers to LPNs acting independently in their role. In this particular scope of practice, LPNs will assume all accountability and responsibility for their decisions on client care and for the actions that they do. Throughout all of their work, LPNs will also keep in mind the activities that they are educated, competent, and allowed to perform.

Logically, while LPNs are always solely responsible and accountable for their actions, they do have greater responsibility when acting within an autonomous scope of practice.

On the other hand, client-specific orders are when LPNs follow the direction of another regulated health professional. A client-specific order is an instruction or authorization by a regulated health professional for the LPN to provide care for a specific client, whether or not the care or service includes a restricted or non-restricted activity. When following a client-specific order, LPNs must still remain within their scope of practice and facility policies.

LPNs can carry out orders from nine different health professionals: medical doctors, midwives, naturopaths, nurse practitioners, pharmacists, podiatrists, registered nurses, registered psychiatric nurses, and dentists. In BC, LPNs are only allowed to act on client-specific orders from one of these authorized health professionals, given that they are registered to practice.

It’s important to also note that some skills that LPNs can do require additional education, which refers to structure education, either a workshop, course, or program of study, designed so that LPNs can attain the competencies required to carry out a specific activity as part of the LPN practice. Additional education builds on the entry-level competencies of LPNs, identifies the competencies expected of LPNs, includes both theory and application to practice, and includes an objective, external evaluation of the LPNs’ competencies.

Now that we’ve covered what a scope of practice, we can delve deeper into specific examples of the scope of practice for an LPN.

After successfully completing additional education and by following decision support tools, LPNs can engage in the following actions:

Wound Care

Wound care refers to techniques that enhance the healing of skin abrasions, blisters, cracks, craters, infections, lacerations, necrosis, and/or ulcers.

Licensed Practical Nurses are allowed to provide wound care if a wound care treatment plan is in place. In this scope, LPNs can probe, irrigate, pack, or dress a tunnelled wound only after successfully completing additional education. LPNs can also apply compression therapy, provide negative pressure wound therapy, or carry out maggot debridement therapy.

The Use of Electricity for Medical Purposes

In the course of emergency cardiac care, Licensed Practical Nurses can use automated external defibrillators (AEDs) after successfully completing a CPR course for health professionals that includes the use of AED.

To provide transcutaneous electrical nerve stimulation, LPNs can also apply transcutaneous electrical nerve stimulation (TENS) after successfully completing additional training.