Nurses perform a wide range of clinical procedures, from basic wound care to prescribing medications and managing ventilators. What any individual nurse can do depends on their license level: licensed practical nurses (LPNs), registered nurses (RNs), and advanced practice registered nurses (APRNs, including nurse practitioners) each have distinct scopes of practice defined by state law.
What Licensed Practical Nurses Can Do
LPNs handle foundational patient care tasks under the supervision of a registered nurse or physician. Their day-to-day procedures include monitoring vital signs, administering oral and injectable medications, changing wound dressings, inserting urinary catheters, and collecting specimens for lab work. They also provide personal care like bathing, repositioning patients, and feeding assistance.
What LPNs generally cannot do is where the distinction matters most. LPNs do not develop care plans on their own, delegate tasks to other staff, or administer certain high-risk treatments like blood transfusions or IV push medications. They carry out an established care plan rather than creating one, and they require RN supervision for clinical decision-making. In most states, LPNs cannot perform initial patient assessments or triage.
Procedures Registered Nurses Perform
RNs have a significantly broader scope. They independently assess patients, develop and modify care plans, and make clinical judgments about when a patient’s condition is changing. The procedural list for an RN in a typical hospital setting includes:
- IV therapy: starting peripheral IV lines, administering IV medications, and managing infusion pumps
- Blood transfusions: verifying blood products with a second nurse, monitoring for reactions during infusion, and managing transfusion emergencies
- Wound care: debriding wounds, packing surgical sites, removing sutures and staples
- Medication administration: all routes including IV push, intramuscular injections, and high-alert medications
- Catheter and tube management: inserting nasogastric tubes, urinary catheters, and managing chest tube drainage systems
- Patient assessment and triage: performing head-to-toe assessments, interpreting cardiac rhythms, and prioritizing patient acuity
Blood transfusions illustrate how detailed RN-level procedures can be. Before a unit of blood reaches the patient, two nurses must independently verify the patient’s identity, blood type, and Rh factor against the blood product. They check the expiration date and visually inspect the bag for abnormal color or clumping. The transfusion must begin within 30 minutes of the blood arriving to the unit, and the nurse monitors closely during the first 15 minutes because that window carries the highest risk of a reaction. A blood incompatibility error is classified as a sentinel event by The Joint Commission, putting it in the same severity category as wrong-site surgery.
Emergency and Critical Care Settings
RNs working in emergency departments and ICUs perform additional specialized procedures. These include CPR and defibrillation, ventilator management, arterial blood draws, conscious sedation monitoring, and trauma assessments using primary and secondary survey protocols. Emergency nurses also perform wound suturing in some facilities and assist with procedures like chest tube insertion and central line placement. These expanded roles typically require additional certifications in advanced cardiac life support and trauma life support.
Cosmetic and Aesthetic Procedures
RNs with specialized training can administer cosmetic injections like Botox, dermal fillers, and sclerotherapy medications. These procedures always require a prescription from an authorized prescriber, and the nurse must have documented competency training. In Washington state, for example, the delegating physician does not need to be physically present but must be reachable by phone and able to respond within 30 minutes to manage complications. Many states follow similar delegation models, though requirements vary. Nurses considering aesthetic practice should check their specific state board’s rules, as some states restrict these procedures to nurse practitioners rather than RNs.
What Nurse Practitioners Can Do
Nurse practitioners (NPs) occupy the top tier of nursing practice and function much closer to physicians in their procedural authority. NPs can independently evaluate patients, diagnose conditions, order and interpret diagnostic tests like imaging and bloodwork, and initiate treatment plans. In states with full practice authority, NPs do all of this under the licensing authority of the state board of nursing alone, with no physician oversight required.
NPs prescribe medications, including controlled substances, in all 50 states. A handful of states place restrictions on the most tightly regulated drugs: Georgia, Oklahoma, South Carolina, and West Virginia do not allow NPs to prescribe Schedule II medications (which include drugs like oxycodone and amphetamines). Arkansas and Missouri limit NPs to prescribing only hydrocodone combination products within that category.
In acute care and critical care settings, NPs trained in those specialties perform invasive procedures that go well beyond the RN scope. These can include placing central venous lines, performing lumbar punctures, intubating patients, inserting chest tubes, and managing mechanical ventilation independently. Training programs like the one at the University of Pittsburgh School of Nursing use high-fidelity human simulation labs to prepare NPs for these critical care interventions before they perform them on patients.
Telehealth and Remote Procedures
Telehealth has expanded the settings where nurses practice, though it changes the type of procedures they perform. In remote patient monitoring, nurses track chronic disease data like blood glucose trends, blood pressure patterns, and weight changes transmitted from patients’ homes. This is asynchronous work, meaning the nurse reviews data over time rather than during a live visit.
For real-time telehealth encounters, nurses and NPs conduct triage to determine whether a patient’s condition can be safely managed virtually or requires escalation to an in-person visit. The triage process sorts patients by acuity and matches them to the right telehealth format: video visits with digital medical tools like electronic stethoscopes, video visits relying on visual observation alone, or audio-only calls for straightforward follow-ups. NPs are increasingly leading the development of standardized telehealth triage protocols, particularly for post-hospital discharge check-ins and chronic care management.
What Nurses Cannot Delegate
Understanding what nurses can do also means understanding what they must do personally and cannot hand off to nursing assistants or medical assistants. Under Washington state law, which reflects principles common across most states, RNs may delegate basic tasks like blood pressure monitoring, personal care, and glucose testing to certified nursing assistants. But they cannot delegate medication administration by injection (with the exception of insulin in some settings), sterile procedures, or central line maintenance. Any task requiring nursing judgment, or any act that involves piercing or severing tissue, stays with the licensed nurse.
Before delegating anything, the RN is legally responsible for evaluating whether the assistant is competent to perform the task, confirming the delegation is appropriate for that patient’s situation, and supervising the outcome. The accountability never transfers. If something goes wrong with a delegated task, the nurse who delegated it shares responsibility.
Why Scope of Practice Varies by State
Every state has its own Nurse Practice Act, and these laws create real differences in what nurses at each level can do depending on where they work. An NP in one state may practice completely independently, while the same NP across the state line needs a collaborative agreement with a physician. An RN in one facility may suture lacerations in the emergency department while an RN at a different hospital in the same state may not, depending on facility policy and the nurse’s documented training.
State boards of nursing publish scope-of-practice decision trees and comparison charts to help nurses determine whether a specific procedure falls within their authority. The general framework is consistent: your license level sets the ceiling, your state’s Nurse Practice Act defines the legal boundaries within that ceiling, your employer’s policies may narrow it further, and your individual training and competency determine what you should actually perform.