Roles and Responsibilities

NAPNES (2007) issued the following statement of responsibilities required for practice as an LPN/LVN:

•Demonstrate professional behaviors of accountability and professionalism according to the legal and ethical standards for a competent licensed practical/vocational nurse.
•Effectively communicate with patients, significant support person(s), and members of the interdisciplinary health care team incorporating interpersonal and therapeutic communication skills.
•Collect holistic assessment data from multiple sources, communicate the data to appropriate health care providers, and evaluate patient responses to interventions.
•Collaborate with the registered nurse or other members of the health care team to organize and incorporate assessment data to plan/revise patient care and actions based on established nursing diagnoses, nursing protocols, and assessment and evaluation data.
•Demonstrate a caring and empathic approach to the safe, therapeutic, and individualized care of each patient.

Box 1-3 Nursing Conditions in the Past

The following job description was given to floor nurses by a hospital in 1887.
In addition to caring for your 50 patients, each nurse will follow these regulations:

•Daily sweep and mop the floors of your ward, dust the patient’s furniture and windowsills. Maintain an even temperature in your ward by bringing in a scuttle of coal for the day’s business.
•Light is important to observe the patient’s condition. Therefore, each day fill kerosene lamps, clean chimneys, and trim wicks. Wash the windows once a week.
•The nurse’s notes are important in aiding the physician’s work. Make your pens carefully; you may whittle nibs to your individual taste.
•Each nurse on day duty will report every day at 7 AM and leave at 8 PM, except on the Sabbath, on which day you will be off from 12 noon to 2 PM.
•Graduate nurses in good standing with the director of nurses will be given an evening off each week for courting purposes or two evenings a week if you go regularly to church.
•Each nurse should lay aside from each payday a goodly sum of her earnings for her benefits during her declining years so that she will not become a burden. For example, if you earn $30 a month, you should set aside $15.
•Any nurse who smokes, uses liquor in any form, gets her hair done at a beauty shop, or frequents dance halls will give the director of nurses good reason to suspect her worth, intentions, and integrity.
•The nurse who performs her labors and serves her patients and doctors without fault for 5 years will be given an increase of 5 cents a day, providing there are no hospital debts outstanding.

It is interesting to compare current practical and vocational nursing tasks with those that were expected in 1887. Practical and vocational nursing has indeed come a long way.

From Hill SS, Howlett HA: Success in practical/vocational nursing: From student to leader, ed 7, St. Louis, 2013, Saunders.

•Implement patient care, at the direction of a registered nurse, licensed physician or dentist through performance of nursing interventions or directing aspects of care, as appropriate, to UAP.

LPN/LVNs are required to be aware of the content of the nurse practice act of the state in which they are employed. The role of the LPN/LVN is found in this law, and the law differs from state to state.
A major criterion in differentiating between the roles of the RN and the LPN/LVN is the level of independence for the practice activities. The LPN/LVN never functions independently. LPN/LVNs provide care in basic and complex situations under the general supervision of an RN or physician. They are responsible for functioning safely and are accountable for their actions.
LPN/LVNs function interdependently when they offer input to the RN about the effectiveness of care or offer suggestions to improve the patient’s care. Because LPN/LVNs provide actual care at the bedside in acute care situations, the data collected during the giving of care are valuable in determining whether progress is being made to meet patient goals.

Practical and vocational nursing is an exciting challenging career that provides an opportunity to care for others while receiving personal satisfaction. The focus is on bedside and personal care of patients in a variety of settings. Performance in a responsible and accountable manner calls for knowledge, skill, and expertise.