Licensed practical nurses (LPNs) work under the supervision of registered nurses or physicians and face several legal restrictions on what they can do independently. The core distinction is straightforward: RNs function at an independent level, while LPNs function at a dependent level. This means LPNs cannot make many of the clinical judgments, assessments, and care decisions that RNs handle every day.
These restrictions vary somewhat by state, but certain limitations are nearly universal. Understanding them matters whether you’re considering an LPN career, comparing it to an RN path, or working alongside LPNs in a healthcare setting.
Initial Assessments and Nursing Diagnoses
The biggest restriction for LPNs involves patient assessment. LPNs cannot perform a comprehensive initial assessment or interpret clinical data independently. When a patient is first admitted, an RN must be the one to conduct the full intake assessment, which involves collecting extensive data, analyzing biological, psychological, and social factors, and using that analysis to build a care plan.
What LPNs can do is perform a “focused assessment,” which is a narrower appraisal of a patient’s current status. They collect data, compare it to the patient’s previous condition, and decide who needs to be informed and when. Think of it as monitoring and reporting rather than diagnosing and planning. The LPN contributes to the bigger picture that the RN is responsible for assembling.
LPNs also cannot formulate a nursing diagnosis. A nursing diagnosis is the clinical judgment about a patient’s response to a health condition, and it drives the entire plan of care. That analytical step, synthesizing assessment data into a conclusion about what the patient needs, is reserved for RNs.
Care Planning and Independent Decision-Making
Because LPNs can’t formulate diagnoses, they also can’t develop the nursing care plan. The care plan is the roadmap for a patient’s treatment: what interventions to use, what goals to set, and how to evaluate progress. RNs create and modify these plans. LPNs carry out the interventions outlined in them.
This is the practical reality of “dependent level” practice. An LPN follows protocols, standing orders, and care plans established by someone with a higher scope of authority. They don’t independently decide to change a patient’s treatment approach, adjust a care strategy, or make clinical judgments about complex or unexpected situations without consulting the supervising RN or physician.
Supervision Restrictions
LPNs must practice under the direction or supervision of a registered nurse, a physician, or in some states a licensed dentist. They cannot practice nursing independently without this oversight structure in place. The specifics of what “supervision” means (whether the RN needs to be physically present or simply available by phone) vary by state and by setting, but the requirement itself is universal.
One restriction that surprises some people: LPNs cannot supervise or direct the practice of a registered nurse. The hierarchy only flows one direction. An LPN can never be placed in a position of clinical authority over an RN, regardless of how many years of experience they have.
Complex and Unstable Patient Situations
When patients become unstable or situations grow complex, LPNs are generally expected to defer to the RN or another qualified team member. For example, in telephone triage, an LPN may handle straightforward calls if trained and following standing orders, but cases involving potential self-harm, danger to others, or clinical complexity should be referred to the RN.
Washington State’s nursing board illustrates this well: LPNs can triage calls under standing orders from an authorized practitioner, but the standing orders themselves should define the point at which a situation becomes too complex for the LPN to handle alone. In practice, this means high-acuity environments like emergency departments and intensive care units typically rely on RNs for direct patient care and clinical decision-making, though LPNs may work in supportive roles depending on the facility.
IV Therapy and Medication Restrictions
In many states, LPNs cannot start IV lines, administer IV medications, or manage IV therapy without completing additional certification. Some states prohibit LPN IV therapy entirely, while others allow it only after the nurse completes a board-approved expanded scope course. Iowa, for instance, offers an LPN IV Expanded Therapy certification that trains LPNs to work with peripheral IV catheters, midline catheters, and PICC lines, but only in specific settings like hospitals, skilled nursing facilities, and dialysis units.
Even with IV certification, LPNs typically cannot administer IV push medications (drugs injected directly into the vein all at once) or blood products in most states. Administering chemotherapy, total parenteral nutrition, and other high-risk IV infusions is also generally outside their scope.
What Varies by State
Nursing scope of practice is governed by each state’s Nurse Practice Act, and the details differ meaningfully. Some states allow LPNs to perform wound care independently, while others require RN oversight. Some permit LPNs to administer certain controlled substances; others don’t. A few states allow LPNs to pronounce death in long-term care settings, while most restrict this to RNs or physicians.
Tasks that commonly fall into the “depends on your state” category include:
- IV insertion and IV medication administration (often requires extra certification where allowed)
- Blood draws and lab specimen collection
- Administering blood products
- Patient education beyond reinforcing existing teaching (in many states, LPNs can reinforce education an RN has already provided but cannot develop or initiate a teaching plan)
- Delegation to unlicensed assistive personnel (some states allow LPNs to delegate certain tasks to CNAs, others do not)
If you’re an LPN or considering becoming one, your state board of nursing website will have the most current and specific scope of practice guidelines. Many boards publish decision trees or comparison charts that walk through exactly which tasks are permitted, which require additional training, and which are off-limits entirely.
How These Limits Play Out at Work
In long-term care and skilled nursing facilities, LPNs often function as the primary nurse on the floor, handling medication administration, wound care, vital signs, and day-to-day patient monitoring. But when something changes, when a resident’s condition deteriorates or a new admission arrives, the LPN needs to loop in the supervising RN for assessment and care planning decisions.
In hospitals, LPNs tend to work in more structured roles. They may assist with patient care on medical-surgical units but are less commonly assigned to ICUs, labor and delivery, or emergency departments where independent clinical judgment is constantly required. Outpatient clinics and physician offices are common LPN workplaces because the physician provides direct oversight and the pace of clinical decision-making is more predictable.
The restrictions aren’t a reflection of skill or intelligence. They reflect the difference in training: LPN programs typically take about one year, while RN programs require two to four years and include significantly more coursework in assessment, pharmacology, pathophysiology, and clinical reasoning. Many LPNs eventually bridge to RN licensure through LPN-to-RN programs, which removes these scope limitations.