RN vs LPN Scope of Practice: What Each Nurse Can and Cannot Do (2026)
Updated 16 April 2026
The scope of practice is the single biggest functional difference between RNs and LPNs. It determines what each nurse can do independently, what requires supervision, and what is completely outside their authority. Scope varies by state.
Core Scope Comparison
What RNs Can Do
- +Independently assess patients and identify changes in condition
- +Create, modify, and evaluate nursing care plans
- +Administer all medications including IV push, IV drip, and blood products
- +Start and manage IV lines and central lines
- +Perform triage in emergency and urgent care settings
- +Supervise LPNs, CNAs, and unlicensed assistive personnel
- +Provide complex patient and family education
- +Administer chemotherapy (with additional certification)
- +Perform discharge planning and coordinate care across providers
- +Interpret diagnostic test results and adjust care accordingly
What LPNs Can Do
- +Monitor vital signs, intake and output, and basic patient status
- +Administer oral medications and some injections (state-dependent)
- +Provide basic wound care, dressing changes, and catheter care
- +Assist with activities of daily living (bathing, dressing, feeding)
- +Collect specimens and perform point-of-care testing
- +Document observations and report changes to the supervising RN
- +Provide patient comfort measures and emotional support
- +Maintain IV fluids already started by an RN (in some states)
- +Perform tracheostomy care and suctioning (with training)
- +Administer tube feedings and manage enteral nutrition
Clinical Scenario Walkthroughs
These scenarios illustrate how scope of practice differences play out in real clinical situations.
Scenario 1: Patient in a Skilled Nursing Facility Has a Fall
LPN Response:
- Checks vital signs and documents findings
- Provides first aid for any visible injuries
- Documents the fall and circumstances in the medical record
- Immediately notifies the supervising RN
- Follows fall protocol for repositioning and monitoring
RN Response:
- Performs a comprehensive neurological assessment
- Determines if the patient needs imaging or physician evaluation
- Modifies the care plan to prevent future falls
- Orders appropriate monitoring frequency
- Notifies the physician and family as needed
Scenario 2: Patient Arrives in the ER with Chest Pain
LPN Role:
- Not typically staffed in ER triage
- If present, may collect vital signs and apply cardiac monitor
- Administers oral medications as ordered
- Assists with positioning and comfort measures
RN Role:
- Performs triage assessment and assigns acuity level
- Initiates cardiac monitoring, starts IV access
- Administers IV medications including nitroglycerin and heparin
- Interprets 12-lead EKG for ST changes
- Activates code team or cath lab if needed
Scenario 3: Home Health Visit for Post-Surgical Patient
LPN Role:
- Checks vital signs and assesses wound appearance
- Performs dressing change per the established care plan
- Administers prescribed oral medications
- Reports any concerns (redness, swelling, fever) to supervising RN
- Documents the visit and patient status
RN Role:
- Performs comprehensive wound assessment with measurements
- Modifies wound care plan based on healing progress
- Provides patient education on signs of infection
- Manages IV antibiotics if ordered
- Coordinates with physician on treatment adjustments
Medication Authority
| Medication Type | RN | LPN |
|---|---|---|
| Oral medications | Yes | Yes |
| Intramuscular injections | Yes | Yes (most states) |
| Subcutaneous injections (insulin, heparin) | Yes | Yes (most states) |
| IV push medications | Yes | No (most states) |
| IV drip medications | Yes | No (most states) |
| Blood product administration | Yes | No |
| Chemotherapy | Yes (with certification) | No |
| Controlled substances | Yes | Yes (with RN co-sign in some states) |
| Starting IV lines | Yes | State-dependent (with IV cert) |
| Monitoring existing IV infusions | Yes | Yes (most states) |
Supervision Requirements
What "Under Supervision" Actually Means
LPNs practice under the supervision of an RN or physician. In practice, this does not mean an RN is standing next to the LPN at all times. There are two types of supervision:
Direct Supervision
The supervising RN is physically present in the same area and immediately available. Required for certain high-risk procedures and new LPN employees during orientation.
Indirect (General) Supervision
The supervising RN is available by phone or pager and can respond within a reasonable time. This is the most common supervision model for experienced LPNs in long-term care and home health settings.
Notable State Variations
Scope of practice is regulated at the state level, and there are meaningful differences. Here are the most notable variations.
| Topic | Notable States |
|---|---|
| LPN IV therapy allowed (with certification) | Texas, Ohio, Pennsylvania, Florida, North Carolina, Georgia (and ~30 others) |
| LPN IV therapy NOT allowed | Michigan, New York (limited), California (limited) |
| Nurse Licensure Compact (NLC) states | Texas, Florida, Ohio, Georgia, North Carolina, Pennsylvania (as of 2024), and 37+ total |
| NOT in Nurse Licensure Compact | California, New York, Illinois, Michigan, Minnesota |
| Mandatory nurse-to-patient ratios | California (only state with legislated ratios) |
| LPN supervision of CNAs allowed | Most states in long-term care settings |
| BSN requirement for new RN hires | New York (BSN in 10 law), many individual hospitals nationwide |
Scope Changes and National Trends
Expanding LPN Scope in Long-Term Care
The nursing shortage in long-term care facilities is driving some states to expand LPN scope in these settings. Several states have recently allowed LPNs to perform additional assessments and medication administration in skilled nursing facilities where RN coverage is limited, particularly on night shifts and weekends.
Narrowing LPN Role in Acute Care
Conversely, hospitals continue to move away from LPN staffing in acute care units. The Magnet Recognition Program and evidence-based staffing models emphasize BSN-prepared RN care. This trend is unlikely to reverse, making hospital employment increasingly difficult for LPNs.
Compact Licensure Expansion
The Nurse Licensure Compact (NLC) continues to add member states, with 39+ states now participating. Compact licensure allows both RNs and LPNs to practice across state lines with a single license. This is particularly beneficial for telehealth nurses and those in border communities.
Frequently Asked Questions
Can LPNs start IVs?
It depends on the state. Some states allow LPNs to start IVs and administer IV medications after completing additional IV therapy certification. Other states prohibit LPNs from initiating IV access but allow them to monitor existing IV infusions. Always check your state board of nursing regulations for specific rules.
Can LPNs work in hospitals?
Yes, but hospital employment for LPNs has been declining. Currently about 10% of LPN positions are in hospitals, primarily in long-term care units, outpatient departments, and post-surgical recovery areas. Most acute care hospital units (ICU, ER, med-surg) now require RN staffing. LPNs are more commonly employed in long-term care (38%), home health (17%), and physician offices (13%).