When a patient enters the healthcare setting, he often encounters both registered nurses (RNs) and licensed practical nurses (LPNs). Each of these nurses has her own set of responsibilities, including patient assessments. While each state has different laws regarding scope of practice, some basic principles apply to patient assessments conducted in the United States.
In the hospital, psychiatric and home health settings, a registered nurse conducts the initial patient assessment. This usually includes taking a medical history and performing a comprehensive physical examination. Based on that information, the RN creates a care plan that later RNs and LPNs work from. LPNs then conduct focused assessments as part of patient care--reporting changes to the physician or RN. Typically, a hospital patient on a medical floor will be assessed by an RN at the beginning of each shift. After this, some of the patient's assessments may be conducted by an LPN.
Registered nurses are qualified to perform critical assessments of patients, such as those that occur in intensive care units and coronary care units. RNs are also routinely responsible for suicidal patients. In contrast, licensed practical nurses are authorized to assess patients who are medically stable. LPNs are seldom found in ICUs; they are more likely to be caring for patients on medical/surgical floors or in nursing homes. The Colorado Board of Nursing specifies that LPNs are qualified to care for patients who have "predictable outcomes."
RNs generally conduct more complex assessments than LPNs. RNs are often qualified to interpret assessment findings that are beyond the scope of the LPN, such as EKG interpretation. The registered nurse has had more education in the interpretation of heart sounds and lung sounds as well as other specific assessment skills. The Oklahoma Board of Nursing explains that RNs are responsible for assessing the health status of individuals and analyzing that information while LPNs "contribute" to the assessment of the health status 1.
Both registered nurses and licensed practical nurses may perform specific assessments, such as mental status or nutritional assessments. Typically, the RN performs the first specific assessment and the LPN then monitors the patient for changes.
RNs are qualified to assess patients for suicidal risk in the psychiatric hospital. Both RNs and LPNs assess most patients, while assessments of patients who are deemed potentially dangerous to staff or patients are often deferred to the registered nurse.
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