LPNs have a “dependent” practice, which means the LPN is authorized to practice only when the practice is directed by a registered nurse or any of the following who is authorized to practice in this state: a physician, physician assistant, dentist, podiatrist, optometrist or chiropractor (Section 4723.01(F), ORC) (OBN, 2018b).
The “direction” required for LPN practice is further defined as “communicating a plan of care to a licensed practical nurse” in Rule 4723-4-01(B)(6), OAC. A physician, physician assistant, dentist, podiatrist, optometrist or chiropractor, or the RN may provide LPNs verbal or written direction of the plan that each of these healthcare providers have established for the patient. LPNs are authorized to execute the plan in accordance with the standards of LPN practice in accordance with Rule 4723-4-04, OAC (OBN, 2018b).
When the RN communicates the plan of care to the LPN, it may be verbally, in the form of an established nursing plan of care, or both. Rule 4723-4-04, OAC, further explains that the direction provided by RNs to LPNs about nursing practice is not meant to imply the RN is supervising the LPN in the employment context. The LPN is accountable to identify the RN or other authorized healthcare provider who is directing the LPN’s practice. Otherwise, the LPN may be engaging in practice beyond the LPN authorized scope (OBN, 2018b).
[The following is taken from Chapter 4723-4-08 of the Ohio Administrative Code, 2017; http://codes.ohio.gov/oac/4723-4]
The licensed practical nurse shall contribute to the nursing process in the practice of nursing as set forth in division (F) of section 4723.01 of the Revised Code and in the rules of the board. The nursing process is cyclical in nature so that the nurse’s actions respond to the patient’s changing status throughout the process. The licensed practical nurse is directed in providing nursing care by the established nursing plan.
The following standards shall be used by a licensed practical nurse in utilization of the nursing process.
Contribution to the Assessment of a Patient’s Health Status
The LPN shall contribute to the nursing assessment of the patient. The LPN shall, in an accurate and timely manner:
- Collect and document objective and subjective data related to the patient’s health status; and
- Report objective and subjective data to the directing registered nurse or health care provider, and other members of the healthcare team.
The LPN shall, in an accurate and timely manner:
- Contribute to the development, maintenance, or modification of the nursing component of the care plan;
- Communicate the nursing component of the care plan and all modifications of the plan to members of the healthcare team.
The LPN shall, in an accurate and timely manner, implement the nursing plan of care, which may include:
- Providing nursing interventions;
- Collecting and reporting patient data as directed;
- Administering medications and treatments prescribed by an individual who is authorized to practice in this state and is acting within the course of the individual’s professional practice;
- Providing basic nursing care as directed by a registered nurse, advanced practice registered nurse, or licensed physician, dentist, optometrist, chiropractor or podiatrist;
- Collaborating with other nurses and other members of the health care team;
- Delegating nursing tasks as directed, including medication administration, only in accordance with Chapter 4723-13, 4723-23, 4723-26, or 4723-27 of the Administrative Code.
Contributing to Evaluation
The LPN shall, in an accurate and timely manner:
- Contribute to the evaluation of the patient’s response to nursing interventions;
- Document the patient’s responses to nursing interventions;
- Communicate the patient’s responses to nursing interventions to the directing registered nurse or health care provider, and members of the health care team; and
- Contribute to the reassessment of the patient’s health status and to the modifications of any aspect of the nursing plan of care as set forth in this rule.
[The above effective as of 02/01/2014]
LPN Practice Prohibitions
The following are specific LPN practice prohibitions contained in the Nurse Practice Act and rules:
- Engaging in nursing practice without RN or authorized healthcare provider direction.
- Administering IV push medications (IV medications other than heparin or saline to flush an intermittent infusion device).
- Teaching the “practice of nursing.”
- Supervising and evaluating “nursing practice.”
- Assessing health status for purposes of providing nursing care. (OBN, 2018b)
The LPN contributes to all steps of the nursing process by communicating with the RN or the directing authorized health care provider concerning the patient’s status and needs. When a RN is directing LPN practice, it is the RN who establishes the nursing regimen and communicates the nursing practice needs of the patient (OBN, 2018b).