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Role and Scope for RNs and LPNs

Scope of practice is based on the nurse's education, experience, competency, and the rules governing nursing. Practice must be consistent with current nursing standards. Nurses practicing in Iowa are responsible for understanding the rules and regulations. These regulations are in Iowa Code, Chapter 152 and Iowa Administrative Code, Chapter 6 for RN/LPN.

A registered nurse (RN) must perform the initial assessment. The initial assessment determines a patient’s baseline. From the data, the RN develops an initial nursing plan of care.

A licensed practical nurse (LPN) may not perform an initial assessment. Once the initial assessment and nursing plan of care is complete, LPNs may assist in the plan of care. The LPN can perform a patient history without RN supervision. The LPN is to communicate any change of a patient's status to the RN.

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LPN Functions

Individual facilities may require additional education and training. Regulation and facility policies and procedures will guide nurses in these practices. There must be documentation of competency kept in the nurse's personnel file. A LPN’s scope of practice and expansion of that scope is defined in Iowa Administrative Code, Chapter 6.

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Examples of LPN Tasks and Skills

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LPN Supervisory Course

Licensed practical nurses (LPNs) supervising in a facility may work under the supervision of the registered nurse. LPNs hired in long-term care to supervise must complete the supervisory course within 90 days of employment.

The Iowa Board of Nursing approved the supervisory course on 2/1/2017, which is online and accessible 24/7. The course is available at the National Healthcare Institute's Supervisory Course for Iowa's LPNs website. The licensee maintains their certificate documenting completion of the course. The following are not required to complete the supervisory course:

  • LPN's working in a supervisory role on or before October 6, 1982.
  • LPN's enrolled as a full-time student in a RN program scheduled to graduate within one year. The LPN is responsible to communicate to their educational status to their employer. The employer must track the completion of the RN coursework and RN licensure.

If the individual does not graduate from the RN program or who are not successful on RN-NCLEX they must take the supervisory course within 90 days. More information can be found on the NHI Online Supervisory Course page

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Expanded Intravenous Therapy Course for the LPN

Iowa Law and Administrative Rules allows the Licensed Practical Nurse (LPN) to perform IV therapy functions. The IV therapy course is currently offered by some Iowa Community College Continuing Education (CE) Departments and other Board approved CE providers. The IV Therapy course content is based on the latest standards of practice. The course is an application of both theory and practice related to IV therapy functions. Contact the individual CE providers for the availability and scheduling of the courses. The course must be offered by an approved Iowa Board of Nursing provider of nursing CE. Those providers who have access to the curriculum as of September 2021 are as follows:

  • Des Moines Area Community College, Des Moines - Provider #22
  • Hawkeye Community College, Cedar Falls - Provider #5
  • Health Education Center, Fort Dodge - Provider #10
  • Indian Hills Community College, Ottumwa - Provider #12
  • Iowa Health Care Association, West Des Moines - Provider #166
  • Iowa Lakes Community College, Emmetsburg - Provider #19
  • Iowa Western Community College, Council Bluffs - Provider #6
  • Kirkwood Community College, Cedar Rapids - Provider #30
  • North Iowa Area Community College, Mason City - Provider #3
  • Northeast Iowa Community College, Calmar - Provider #7
  • Southeastern Community College, West Burlington - Provider #24
  • Southwestern Community College, Creston - Provider #9
  • Western Iowa Tech Community College, Sioux City - Provider #21
  • Specialty Infusion Services, Omaha, NE - Provider #364
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Telehealth

Telehealth is the use of telecommunications and health technologies for providing healthcare. This may include telephonic, audio, video, remote monitoring, or mobile health devices. Nurses practicing telehealth are delivering services by electronic means. This is to gather information from a client and give advice based on assessment of the client. This is the practice of nursing and is the provision of patient care. The standard of care is the same as an in person setting. Nurses delivering care via telehealth must hold an active nursing license or multi-state license, in the state where the patient is located at the time of care

Telehealth License Requirements

Nurses providing telehealth services to a patient located in Iowa must hold an active license in Iowa or have a multi-state license. This care must follow Iowa nursing practice guidelines. This is not dependent on the employer's location nor whether there is compensation. Patients in transit may receive care via telephone as long as the patient is in transit and not residing in another state. You can view the list of compact states at the National Council of State Boards of Nursing, Inc. website

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Abandonment and Unethical Conduct

The Board rules do not define the term “abandonment.” The Board investigates unethical conduct as it relates to the nurse’s duty to the patient. Your conduct must ensure the safety and welfare of the patient or client.

Unethical conduct may include the following:

  • Failure to meet the minimum standards of nursing care and maintain professional decorum.
  • A licensee performing nursing services beyond their scope of practice.
  • Allowing another person to use your nursing license for any purpose.
  • Failing to follow board rules and regulations.
  • Improper delegation of nursing services, functions, or responsibilities.
  • Committing an act or omission which adversely affects the client or patient. This can include physical, psychosocial, emotional, or financial injury.
  • Engaging in sexual misconduct with patients or clients.
  • Failing to report to, or leaving, a nursing assignment without notifying a supervisor. This may qualify as abandonment.
  • Violating the confidentiality or privacy rights of the patient or client.
  • Discriminating against a patient or client because of age, sex, race, creed, illness, or economic or social status.
  • Failing to assess, accurately document, or report the status of a patient or client.
  • Misappropriating medications, property, supplies, or equipment of the patient, client, or agency. This may include:
    • Inappropriate use of prescription blanks.
    • Obtaining prescription medications under false pretenses.
  • Practicing nursing under the influence. This may include:
    • alcohol
    • illicit drugs
    • impairment from the use of prescribed medications
  • Involvement in the unauthorized manufacture, possession, distribution, or use of a controlled substance.
  • Pleading guilty to or being convicted of a misdemeanor or felony in any jurisdiction related to the practice of nursing.
  • Failing to report suspected wrongful acts or omissions committed by another licensee.
  • Failing to follow board order.
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Delegation

The delegation process must match the patients needs and circumstances. The delegatee's qualifications, resources and appropriate supervision must guide the task. The delegator must follow up on the delegated task.

Delegation Rules may be found in Iowa code under IAC 6.2(5)"c"

For more information, visit the National Council of State Board of Nursing (NCSBN) page on delegation.

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