LPN vs RN Roles in Home Healthcare Settings

Introduction

Although both nursing professionals perform functions that are critical to patient care in the home healthcare setting, the licensed practical nurse (LPN) and the registered nurse (RN) have distinct responsibilities and specifically delineated and limited capacities, according to both the law and each profession's ethical codes and chains of command. The registered nurse acts as the guide and definer of a patient's treatment in the absence of the physician. The licensed practical nurse assists the registered nurse by observing the patient and administering treatment under the RN's supervision.

Unlike the LPN, the RN is registered with a professional organization and must comply with that organization's ethical codes and legal requirements, while also maintaining certain levels of competency in accordance with evolving standards. The licensed practical nurse holds evidence of having passed a licensing examination and is professionally licensed to dispense care (Carter, 2005).

Educational Requirements and Legal Framework

The Nurse Practice Act justifies the different levels of allowed competency on the part of the LPN and the RN based on the rigor of testing and the levels of education required of each type of nursing professional. Because the RN holds a professional degree — unlike the LPN — the RN has the ability to make decisions regarding treatment as well as to administer care, a critical distinction in the home healthcare setting where a physician is often absent. The RN has a unique responsibility to manage a patient's long-term treatment, rather than merely attending to the immediate care demands of a specific patient as the LPN does (Carter, 2004).

Thus, unlike an LPN, an RN can act as a director and decision-maker in the home healthcare environment, as well as an observer, advisor, and caregiver. In some settings, the RN may be assigned to making on-site treatment decisions while assisted by an LPN (Carter, 2004).

Scope of Practice: LPN vs. RN

The practice of nursing by a licensed practical nurse is defined as the performing of selected tasks and the sharing of responsibilities under the direction and decision-making authority of a registered nurse. The LPN functions primarily within a framework of supportive and restorative care, health counseling and teaching, case finding and referral, and collaborating in the implementation of the total healthcare regimen — executing the medical regimen under specific, guided directions rather than independent ones ("Summary of the LPN Declaratory Ruling," 2003).

The RN, by contrast, can assist the physician in diagnosing the patient, issue specific orders regarding how a patient's treatment, medication, and care ought to progress according to goals established at the onset of treatment, and make decisions that alter such goals and treatment — provided those decisions are reviewed by the physician responsible for the patient. The registered nurse can also manage the care provided by other nurses, including LPNs and RNs of less seniority or specialized expertise ("Summary of the LPN Declaratory Ruling," 2003).