What Is the RN Scope of Practice? Overview and FAQ

All nurses are legally responsible for providing care that aligns with their level of education and training. There are many different levels of nursing, and each one follows a different set of professional standards. The registered nurse (RN) scope of practice, for instance, defines what an RN is authorized to do and how their role differs from that of nurse practitioners (NPs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs).

If you’re a facility leader who wants to enforce appropriate care protocols, you may be looking for more information about these scope of practice guidelines. In this article, we’ll answer some of the most frequently asked questions about how RN duties are defined and carried out.

Registered Nurse Scope of Practice FAQs

Before a registered nurse performs a task or delivers an intervention, they’re expected to ask internally: Is this within my scope of practice? This helps RNs engage with the public in a safe and beneficent way, and refuse work that might cause harm. As a facility leader, it’s important to know how this concept guides your RN staff’s actions. Below, we’ll answer some FAQs to help you understand this foundational nursing principle.

Can you define scope of practice for nurses?

The nursing scope of practice is the regulatory framework defining what nursing professionals can and cannot do based on their education, training, and licensure. It’s not a single document, but rather a dynamic collection of guidelines that aims to ensure nursing care is safe and effective.

Individual RNs are expected to apply their own judgment when deciding on limitations. For example, an RN may determine that a task falls outside of her scope of nursing practice if she didn’t receive hands-on training regarding the task (i.e., in a clinical experience) and therefore doesn’t feel competent and safe performing it. Because of this, scope of practice isn’t set in stone. It can be different for each nurse.

What laws and documents influence the scope of an RN’s work?

In addition to personal judgment, the scope of practice for registered nurses is shaped by the following laws and documents:

• A state’s Nurse Practice Act is a group of laws that defines the legal standards that nurses must follow when providing patient care.
• The American Nurses Association’s book, Nursing: Scope and Standards of Practice provides overarching professional guidelines for nurses in the U.S.
• Registered nurse specialty area guidelines, such as the AACN Scope and Standards for Progressive and Critical Care Nursing Practice for ICU nurses, are highly influential.
• Policies and procedures are facility-specific guidelines that may limit the RN’s scope (not expand it).

What does the registered nurse scope of practice typically include?

Passing the NCLEX-RN examination demonstrates that a nurse has the competency to earn their RN license and provide nursing care to patients. While there are some minor differences in state-by-state practice regulations, RNs are generally responsible for:

• Assessing and monitoring a patient’s health status.
• Administering medications, therapies, and interventions.
• Monitoring vital signs and updating health records.
• Collaborating with supervising doctors and other healthcare professionals.
• Educating patients and their families about their conditions and treatments.
• Creating and implementing nursing care plans for patients.

How does the scope of practice for registered nurses differ by state?

Each state enacts its own version of the Nurse Practice Act (NPA). This is a vital piece of legislation that governs nursing standards within the state, including credentialing requirements, delegation rules, and differences in the scope of practice.

LVNs and NPs typically have more differences in the nurse scope of practice by state than do RNs, who follow fairly similar guidelines across state lines. However, some states have more intricate enforcement policies and procedures than others. For example, under the RN scope of practice, Texas RNs can request a peer-review process if they feel their work assignment puts patients at risk. New Mexico has similar legislation in place to protect nurses from unsafe assignments.

It’s important for healthcare leaders to know about state nursing laws, but sometimes these laws are complex or hard to understand. State nursing boards often publish position statements and interpretive guidelines to help professionals understand the differences in RN scope of practice by state.

LPN vs. RN scope of practice: What’s the difference?

While an LPN and RN may appear to have similar duties, they follow a different scope of practice. RN responsibilities are broader because RNs receive a higher level of education and training than LPNs do.

RNs typically have greater autonomy in their clinical decision-making, while LPNs require more supervision from RNs or other healthcare professionals. Here are a few examples of tasks that RNs can generally do that LPNs cannot:

• Perform initial comprehensive assessments on patients
• Administer IV push medications
• Create and change nursing care plans
• Insert NG tubes with a guide wire

RN vs. NP scope of practice: What’s the difference?

Beyond variations in the LPN scope of practice vs. RN regulations, you may also be wondering how the role of an RN differs from that of an NP. NPs undergo two to four more years of education and training than RNs. This grants NPs a more expansive scope, and they have many overlapping duties with physicians.

While NP practice authority also differs by state, here are some general examples of what NPs can generally do that RNs cannot:

• Diagnose health conditions
• Prescribe medications
• Initiate treatment plans
• Refer patients to other providers
• Order and interpret diagnostic tests

What happens if RNs step outside of their scope of practice?

RNs who step outside of the scope of practice can face a range of penalties. Depending on the severity of each violation, an RN might lose their license, undergo remedial education, or even be held liable for malpractice or negligence. Each state’s board of nursing has its own set of disciplinary procedures, and other penalties may be applied as deemed necessary.

What are some examples of registered nurses making decisions based on these guidelines?

Delivering patient care is often physical work that happens in dynamic, fast-paced settings. Each RN uses a personal concept of scope of nursing practice to help with decision-making. Here are some scope of practice nursing examples to help you see how this might look in practice:

Example One:An RN working for a home health agency arrives at her patient’s house and finds that he’s getting carried out through the door on a stretcher. One of the paramedics on scene is relieved that the RN has arrived. He asks her to start an Intraosseous (IO) line on the patient. She informs him that she can’t, because it’s outside of her scope of nursing practice. Although in this state nurses are allowed to start IO lines, she hasn’t received comprehensive training for this intervention and therefore doesn’t feel competent.

Example Two:A travel RN notes blood in his patient’s foley bag. The doctor orders continuous bladder irrigation (CBI) for the next six hours. The RN has been trained to initiate CBI, but he’s unsure of the state laws and the hospital’s policy. He speaks to his charge nurse, confirms that it’s within his scope, and then initiates the intervention.

Where can I find more resources on registered nurse practice guidelines?

In order to prevent practice violations and keep patients safe, it’s important for both staff and leaders to stay up to date on the most current nursing rules and regulations. Below are some fundamental resources that can help you and your staff make informed practice decisions:

• State-by-state NPA repository
• Scope of practice decision-making framework
• Guidance on when to refuse a nursing assignment
• National guidelines for nursing delegation

Stay Up To Date on the RN Scope of Practice and More

Keeping up with healthcare regulations can seem overwhelming, especially when you’re busy running a facility. Need more practical ways to stay informed? Get expert-written tips and insights on practice guidelines, nurse management, and more.

Legal Disclaimer: This article contains general legal information, but it is not intended to constitute professional legal advice for any particular situation and should not be relied on as professional legal advice. Any references to the law may not be current, as laws regularly change through updates in legislation, regulation, and case law at the federal and state level. Nothing in this article should be interpreted as creating an attorney-client relationship. If you have legal questions, you should seek the advice of an attorney licensed to practice in your jurisdiction.