Licensed practical nurses (LPNs) provide hands-on patient care in hospitals, handling everything from monitoring vital signs and changing wound dressings to inserting catheters and helping patients with daily needs like bathing and eating. They work under the supervision of registered nurses (RNs) and physicians, acting as a frontline caregiving presence on the hospital floor. About 16% of all LPNs work in hospitals, with the rest spread across nursing homes, home health, and outpatient clinics.
Day-to-Day Duties on the Floor
An LPN’s typical hospital shift revolves around direct patient care. That includes checking blood pressure and other vital signs, changing bandages, inserting urinary catheters, drawing blood, monitoring blood sugar levels, and managing feeding tubes. LPNs also help patients with basic comfort needs: bathing, dressing, repositioning in bed, and eating meals. In states that allow it, LPNs can start IV fluid drips, administer IV medications, and draw blood through peripheral IV lines, though each hospital sets its own policies on exactly which tasks LPNs are authorized to perform.
Record-keeping is a major part of the job. LPNs document every patient interaction, from vital sign readings to changes in condition, and they’re responsible for reporting that information to the supervising RN or physician. If something looks off, the LPN flags it so the care team can respond. This reporting role makes LPNs essential to catching early warning signs, since they’re often the staff members spending the most continuous time at the bedside.
How LPN Work Differs From RN Work
The core distinction is that LPNs work within a “directed scope of practice,” meaning they carry out care plans created by RNs and physicians rather than developing those plans themselves. An RN performs a full patient assessment, interprets the findings, and decides what interventions are needed. An LPN collects data using structured guidelines, recognizes when something is abnormal, and reports it, but the clinical judgment about what to do next belongs to the RN.
LPNs cannot independently manage or administer nursing care at the unit level, and they cannot supervise RNs. They can, however, suggest goals and interventions to the RN and participate in teaching patients and families when following an established teaching plan. In practice, this means an LPN might walk a patient through wound care instructions at home, but the RN is the one who developed that teaching plan and approved it.
Supervision and Reporting Structure
Every LPN in a hospital works under the direction of an RN, advanced practice nurse, or physician. The supervising RN provides initial guidance for each task and periodically checks the LPN’s work. When an LPN administers IV medications, for instance, the delegating RN must verify that the LPN has been trained and is competent with the specific access devices and medications used in that facility. The RN also remains available to assess the patient and interpret data whenever needed.
LPNs carry out physician orders just as RNs do, and they’re personally accountable for their actions. If an order seems inaccurate or potentially harmful, the LPN is expected to seek clarification before proceeding. This accountability extends to orders from nurse practitioners, physician assistants, and pharmacists managing drug therapy.
What Changes in Specialized Units
On a general medical-surgical floor, LPNs handle a broad range of bedside tasks with relatively standard oversight. In intensive care units, the role narrows and the collaboration with RNs becomes much tighter. One hospital model described by the American Association of Critical-Care Nurses pairs each ICU LPN directly with a co-assigned RN. They listen to shift report together, and the RN completes the first assessment while the LPN is present. After that, the LPN performs ongoing data collection and observations in place of the RN’s reassessment, updating the RN on any changes throughout the shift. All LPN documentation in the ICU gets co-signed by the RN.
ICU LPNs can still perform a wide range of tasks: peripheral IV insertion and removal, blood draws, in-line suctioning for patients on ventilators, tracheostomy care, urinary catheter insertion, enteral feeding, arterial line setup, and even chest compressions during a code. What they cannot do in the ICU includes administering IV push medications, caring for central lines, titrating medication drips, inserting feeding or nasogastric tubes, initiating patient education, or independently altering a care plan. These restrictions reflect the higher acuity and faster decision-making required in critical care.
Staffing and Patient Ratios
Hospitals staff LPNs alongside RNs and nursing assistants, and the ratios vary by unit, shift, and facility. On a typical medical-surgical floor, you might see one to three LPNs working alongside five or six RNs during a day shift, plus three or four certified nursing assistants. When an RN is paired with an LPN rather than a nursing assistant, the team may take on a slightly larger patient load. One acute care facility’s staffing plan shows RN-to-patient ratios of 5:1 during the day with a nursing assistant team, compared to 6:1 with an LPN team, and 6:1 versus 7:1 on night shifts.
This difference reflects the fact that LPNs can handle more clinical tasks than nursing assistants, freeing the RN to focus on assessments and care planning for a larger group of patients.
Where Hospital LPNs Fit in the Bigger Picture
Hospitals employ a relatively small share of LPNs compared to other healthcare settings. The largest employers are nursing homes and long-term care facilities, where LPNs often take on broader responsibilities because the pace and acuity differ from acute care. Employment for LPNs overall is projected to grow about 3% from 2024 to 2034, driven largely by the aging population’s increasing need for care in residential and home health settings.
In hospitals, LPNs fill a practical gap: they’re trained to perform clinical tasks that nursing assistants cannot, while costing less than RNs. For patients, this means the LPN is often the person you see most frequently during a hospital stay, the one taking your blood pressure, adjusting your IV, helping you get comfortable, and making sure the rest of your care team knows exactly how you’re doing.