Nurse practice acts, LPN and aide scope, delegation principles, and liability
Scope of practice defines the boundaries of safe and legal clinical practice for every role in home care — and delegation determines how tasks are appropriately shared across those roles. Understanding both is essential for protecting clients from harm, protecting clinicians from legal liability, and ensuring that the right person is providing the right care at the right time.
Scope of practice is not a single document — it is defined by the intersection of three sources: the state nurse practice act (the legal minimum and maximum), professional standards and guidelines (ANA nursing standards, specialty organization competencies), and agency policy (which may be more restrictive than state law but never less). When these three sources conflict, the most restrictive applicable standard governs.
RNs perform: initial comprehensive assessments, care plan development and modification, complex medication management, IV therapy, skilled treatments, client and family education, supervision of LPNs and aides, and OASIS completion. RNs practice independently within their scope with physician oversight for medical orders.
LPNs implement established care plans, administer medications (oral, subcutaneous, intramuscular — IV push typically requires RN), perform treatments, observe and report to the RN, and provide client teaching on established topics. Initial assessment, care plan development, and IV push medications are generally outside LPN scope. Verify your state's specific LPN practice act.
Aides provide personal care (bathing, dressing, grooming, mobility assistance, meal preparation) and basic health-related tasks specifically delegated by and supervised by an RN. They do not perform skilled nursing tasks, administer medications, or make clinical assessments. Aide assignments are documented and based on the care plan.
Before delegating any task to an LPN or aide, the RN must assess: right task (is this task safe and appropriate to delegate for this client?), right circumstance (is the client's condition stable enough?), right person (does this delegate have the competency?), right directions and communication (has the task been clearly communicated with expected outcomes?), and right supervision and evaluation (is appropriate supervision in place and follow-up planned?). Delegation transfers the task — not the accountability. The delegating RN remains responsible for the appropriateness of the delegation and the supervision of its performance.
Complete this 5-question quiz with 80% or higher to earn your CEU credit for this lesson.