1.1. Scope of Practice Introduction
Learning Objectives
- Distinguish among the different levels of nursing education
- Specify the ethical and legal boundaries of the student nurse as presented in the Code of Ethics and the Nurse Practice Act
- Detail responsibility for maintaining client confidentiality
- Describe the contribution of all members of the health care team
- Identify the role of evidence-based practice in nursing
- Identify the concept of quality in client care
- Discuss nursing scope of practice and standards of care
- Compare various settings in which nurses work
- Outline professional nursing organizations
In Louisiana, the practice of practical nursing is defined in Section 961 of Chapter 11, Louisiana Revised Statutes of 1950. According to this law, practical nursing involves the performance, for pay, of acts related to the care, treatment, or observation of the ill, the maintenance of health, and the promotion of healthcare. Practical nurses may also train or supervise other nurses and subordinate personnel, and they are authorized to instruct patients (Louisiana State Board of Practical Nurse Examiners [LSBPNE], n.d.).
A licensed practical nurse (LPN) in Louisiana must practice under the direction of a licensed physician, optometrist, dentist, or registered nurse. LPNs can perform duties that are consistent with their educational background, and with appropriate training (approved and documented by the Louisiana State Board of Practical Nurse Examiners, or LSBPNE), they may also carry out additional specific tasks as authorized by the board, when directed by one of the aforementioned licensed healthcare providers.
The LSBPNE does not provide a fixed “laundry list” of tasks that LPNs are permitted to perform, as such lists could restrict their practice. The scope of practice for LPNs is fluid and evolves with advances in knowledge and technology. Ultimately, the scope of practice is determined by the competency of the individual LPN, as they must possess the necessary knowledge, skills, and abilities to safely perform their duties.
While the following list is not exhaustive, it includes some of the tasks LPNs are most frequently inquired about and are allowed to perform, provided the above conditions are met:
- Initiating and maintaining IV therapy and administering IV medications via IVPB or IVP (including hyperalimentation, blood, and blood products).
- Reinsertion of suprapubic catheters.
- Accepting verbal or phone orders directly from prescribers, such as optometrists, advanced practice registered nurses, physicians, or dentists.
- Performing heparinization during hemodialysis.
- Serving as a first surgical assistant (though not permitted to suture, dissect, or cauterize).
- Maintaining and administering medications via heparin locks.
- Performing Pap smears, GC cultures, IUD string checks, fundal heart tone assessments, and Leopold’s maneuvers.
- Applying Unna Boots.
- Loading and monitoring PCA machines.
- Caring for patients with external venous catheters (e.g., Hickman, Groshong, Brovia) and performing tasks such as obtaining blood specimens, connecting and monitoring IV fluids, and providing site care, including dressing changes.
- Caring for patients with internal venous access devices (e.g., port-a-cath, life port), which includes accessing or removing Huber needles, drawing blood, connecting and monitoring IV fluids, and providing site care.
- Inserting feeding tubes in neonates.
- Reinserting tracheostomy tubes in established tracts.
- Removing sheaths in a cardiac catheterization lab and later discontinuing these lines.
- Performing tasks that promote pulmonary health and hygiene, such as administering oxygen, aerosol treatments, IPPB treatments, suctioning, and chest physiotherapy (CPT), although LPNs may not hold themselves out as respiratory therapists or respiratory therapy technicians.
- Conducting “head-to-toe” physical assessments.
- Administering Botox for cosmetic purposes, provided specific conditions are met (see LSBPNE Practice Opinions for details).
As a practical nursing student in Louisiana, it is essential to always assess whether the tasks you are asked to perform fall within your scope of practice, both now and as a licensed nurse. Doing so helps ensure that you protect both your nursing education and future licensure, while providing safe and competent care to your patients.
Louisiana State Board of Practical Nurse Examiners. (n.d.). Scope of Practice: Frequently asked questions. https://www.lsbpne.com
