Scope of Practice Decision Tree

Determining Your Scope of Practice Decision Tree

Please click here for a PDF version of the Scope of Practice Decision Tree to use
when determining whether an act is within your scope of practice.

Nursing Roles and Responsibilities
as specified in Nevada Revised Statutes (NRS 632)
and Nevada Administrative Code (NAC 632)

 

REGISTERED NURSE

LICENSED PRACTICAL NURSE

NURSING ASSISTANT

ASSESSMENT
Independent, dependent and interdependentfunctions 

Assesses and evaluates health status of groups and individuals:

collect objective and subjective data

analyze, report and record data

validate, refine and modify data

At the direction of RN, APN, licensedphysician, licensed physician assistant, or licensed dentist 

Contributes to assessment of health status by:

collecting, reporting, and recording objective and subjective data

observation of conditions or change in condition

signs and symptoms of deviation from normal health status

At the direction and under the supervision of RN or LPN 

Collects data related to health status by collecting. reporting and recording basic objective and subjective data

Observes for change in health status and signs and symptoms or deviations from normal health status

IDENTIFICATION OF HEALTH CARE PROBLEMS
Utilizes all data to identify and document health care problems Assists in formulating lists of needs/problems Provides basic information which licensed nurses use in making lists of problems and needs
ESTABLISHMENT
Collaborates with patient, family, significant others and health team to: 

identify present and predicted needs

establish short and long term goals

set realistic and measurable goals

Contributes to setting realistic and measurable goals by identifying major short and long term goals Provides basic information regarding the patient which assists the licensed nurse in setting goals
PLANNING A STRATEGY OF CARE
Develops a written care plan to include: 

cultural, ethnic, spiritual aspects and decisions regarding treatment

measures to support human functions and maintain hygiene, comfort and safe environment

educational and counseling needs to promote, maintain, restore health

community resources for continued care

priority needs

Reviews and revises care plan as necessary

Participates in development of written care plan 

Recognizes, understands, respects cultural, spiritual, religious issues, beliefs, needs and rights to choice

Assists in identification of measures to maintain hygiene and comfort

Supports human functions

Maintains environment conducive to well-being

Provides health teaching

Participates in identification of priorities

Contributes to the development and revision of the plan of care by providing basic information regarding the patient which assists the licensed nurse in the development and revision of the plan of care 

Provides total personal care or assists patient with ADLs, encourages self-care

IMPLEMENTING STRATEGY OF CARE

Initiates and assists with delegating and assigning care

Verifies medical orders for accuracy, proper authorization, and documented contraindications

Administers prescribed medications and IV therapy

Provides education and counseling

Documents interventions and responses

Communicates interventions and responses

Makes judgments, decisions and modifies care

Assists patient with ADLs, encourages self-care 

Provides direct nursing care, comfort measures, emotional support to patients whose condition is stable or predictable

Provides care to patient whose condition is complex or unstable under direct supervision of RN

Assists with rehabilitation - ROM, alignment, body mechanics

Provides environment conducive to safety and health

Carries out functions taught in approved PN program

Executes orders of APN, PA, doctor, or dentist based on knowledge of cause and effect of order after verifying accuracy

Administers prescribed treatment and medication

Performs selected IV therapy functions under the supervision of RN

Assists in patient teaching

Documents interventions and responses

Communicates interventions and responses when patient condition is stable or predictable

Provides physical care, comfort measures, emotional support to patient whose condition is stable or predictable 

Assists with basic restorative nursing, bladder training

Provides a safe and healthy environment

Provides functions taught in approved nursing assistant programs

Completes basic duties assigned by a licensed nurse

Repeats patient teaching instructions as given by the licensed nurse

Documents and communicates completion of assigned duties and patient responses

DELEGATION AND SUPERVISION OF NURSING CARE
Delegates to and assists staff in implementing care 

Delegates/assigns duties as specified in rules and regulations

Considers complexity of care, educational preparations and facility policies when delegating or assigning care

Remains responsible for the acts delegated or assigned

N/A N/A
MAINTAINING SAFE AND EFFECTIVE CARE
Maintains safe environment 

Institutes standard procedures to stabilize patient's condition or prevent serious complications in emergency situations

Acts as patient advocate

Consults with RN and others and seeks guidance as necessary 

Initiates standard emergency procedures until RN or doctor is available

Applies principles of asepsis and infection control

With proper training serves as a scrub nurse in operating room

Participates in development revision and implementation of policies and procedures

Seeks guidance from a licensed nurse as necessary 

Performs CPR when necessary

Follows principles of asepsis and infection control

Shares pertinent information with a licensed nurse

EVALUATING RESPONSES TO INTERVENTIONS
Utilizes identified goals to: 

determine data to be collected to evaluate outcome of care

document and communicate evaluation data

evaluate responses of individuals and groups to nursing interventions

use evaluation data to reassess patient status, modify problems, prescribe changes in nursing interventions and revise care plans

Documents and communicates outcomes of care given 

Assists with collection of evaluation data

Contributes to modification of strategy of care

Documents and communicates patient responses 

Assists with collection of data

TEACHING THEORY AND PRACTICE OF NURSING
Teaches nursing theory in educational programs when qualified by education and experience 

Assists personnel/students who are supervised to develop and maintain competency

Teaches and exemplifies nursing practice based upon knowledge,  skills and abilities

N/A N/A
MANAGING PRACTICE OF NURSING
Gives direct, individualized care or assigns functions according to education and demonstrated competence 

Supervises persons to whom nursing functions are delegated or assigned

Provides leadership in formulating. interpreting, implementing and evaluating nursing care  objectives and policies

Functions as circulating nurse in operating room

Directs and evaluates quality of nursing services

Evaluates nursing personnel

Assigns duties to auxiliary workers as specified in rules and regulations 

Assists auxiliary workers to carry out assigned care

Supervises auxiliary workers to whom care is assigned

N/A
COLLABORATING WITH OTHER HEALTH PROFESSIONALS
Communicates significant changes in patient status 

Consults as necessary to meet needs

Shares pertinent information Shares pertinent information
ADDITIONAL DUTIES IN AREA OF SPECIALIZATION
Meets the requirements of NAC 632.225 

additional duties are within the authorized scope of practice

follows written policies and procedures approved by medical staff, nursing and agency administration

completes Board-approved comprehensive program including supervised clinical OR documents completion of such from another state OR can provide evidence of previously acquired additional knowledge/skill/ability

maintains evidence (both RN and employer) of original documentation and demonstration of acquired knowledge/skill/ability

verification of continued competency via recertification or annual evaluation

The requirements for special CE are outlined in NAC 632.340

Meets the requirements of NAC 632.242 

additional duties are within scope of practice

follows written policies and procedures approved by medical staff, nursing, and administration

completes Board-approved comprehensive program including supervised clinical OR documents completion of such from another state OR can provide evidence of previously acquired additional knowledge/skill/ability

maintains evidence (both LPN and employer) of original documentation and demonstration of acquired knowledge/ skill/ability

verification of continued competency via recertification or annual evaluation

The requirements of special CE are outlined in NAC 632.340

N/A