Code blue response has tightened considerably since the AHA's 2020 CPR and ECC guidelines pushed team-based resuscitation into every accredited facility, and licensed practical nurses are now written into those response protocols in ways that were informal a decade ago. When a patient goes unresponsive and pulseless, the team assembles within 60 to 90 seconds, and the LPN at the bedside is usually the one who called it.
What happens next isn't improvisation. State boards, facility policy, and AHA algorithms each define what a licensed practical nurse can compress, document, hand off, or assist with, and those boundaries hold even when the room is chaotic. The gap between what LPNs are trained to do and what they're legally permitted to do varies sharply by state, and that gap is where most of the confusion lives.
The 6 Code Blue Team Roles and Where LPNs Fit In
The American Heart Association's ACLS framework organizes code blue response around six clearly defined positions. Each role carries specific responsibilities, and the team must include at least one member with advanced cardiac life support training. Where an LPN fits into this structure depends on facility policy and state scope of practice rules, but several positions are realistic entry points for a prepared LPN.
| Role | Typical Team Member | Core Responsibilities | LPN Involvement |
|---|---|---|---|
| Team Leader | ACLS-trained clinician, often a physician or advanced practice provider | Assigns roles, rotates team members, makes treatment decisions, and provides real-time feedback to the rest of the team during resuscitation | Not an LPN role. This position requires ACLS certification and advanced clinical authority that falls outside LPN scope of practice. |
| Compressor (Position 1) | ACLS-trained provider designated for chest compressions | Assesses the patient, places the backboard and defibrillator pads when the crash cart arrives, and performs high-quality chest compressions per ACLS guidelines, rotating out to prevent fatigue | LPNs with current BLS certification can perform chest compressions. Many facilities assign LPNs to this role, especially for the initial minutes before the full code team arrives. |
| Monitor and Defibrillator Operator (Position 2) | ACLS-trained provider assigned to the AED, monitor, or defibrillator | Brings and operates the defibrillator or AED, rotates with the compressor, positions the monitor where the entire team can see it, and supports rhythm analysis | Generally reserved for ACLS-certified providers. An LPN may assist by retrieving the crash cart or applying defibrillator pads, but operating the device typically requires ACLS training and facility authorization. |
| Airway Manager (Position 3) | ACLS provider assigned to the airway position | Opens and maintains the airway, provides bag-mask ventilation, delivers high-flow oxygen, suctions the airway, inserts basic airway adjuncts, and assists with advanced airway procedures | LPNs trained in BLS can deliver bag-mask ventilation and apply oxygen. Inserting advanced airway devices or assisting with intubation is outside LPN scope unless specific state regulations and facility policy permit it under direct supervision. |
| Recorder (Position 5) | Designated code team member responsible for documentation | Records the time of every intervention and medication given, announces when the next dose or action is due, and documents the frequency and duration of any interruptions in compressions | This is one of the most common code blue roles for LPNs. It requires sharp attention to detail but does not involve advanced clinical decision-making, making it well matched to LPN training. Facility protocols often assign nurses, without specifying RN or LPN, to this position. |
| Medication and IV Access Provider (Position 6) | ACLS-trained provider, often designated as the Medication RN in hospital protocols | Initiates IV or IO access, prepares and labels medications from the crash cart, and administers drugs as ordered by the team leader | LPN eligibility varies significantly. Some hospital protocols designate this as a Medication RN role, restricting it to registered nurses. In facilities and states where LPNs are authorized to administer IV push medications, an LPN may prepare medications and hand them off or administer them under direct RN or physician supervision. |
LPN Scope of Practice During a Code: What's Allowed, What's Not
Not every code blue task is open to every nurse. The table below breaks down what LPNs and LVNs can and cannot do during a cardiac arrest across eight states, based on each state board of nursing's published scope of practice rules as of 2026. Notice that chest compressions and basic life support are universally permitted, while IV push medications and advanced airway interventions are restricted almost everywhere. Facility policy and documented competency training can further narrow (but rarely expand) what is listed here.
| State | Compressions and BLS Tasks | Medication Administration | Airway and Intubation | Key Restriction |
|---|---|---|---|---|
| California | Permitted. LVNs may use a manual resuscitation device and perform cardiopulmonary resuscitation at the basic life support level; they may respond to and intervene in life-threatening emergencies. | IV-certified LVNs may start peripheral IVs and superimpose IV solutions (electrolytes, blood products, nutrients), but have no statutory authority to administer IV push medications or any agent via a central line. | Outside LVN scope. Endotracheal intubation and ventilator management are reserved for Respiratory Care Practitioners. | LVNs cannot perform tracheal suctioning, cuff inflation or deflation, tracheostomy tube replacement, or manipulate invasive or non-invasive ventilators. |
| Texas | Permitted. LVNs must initiate CPR in the absence of a clear DNR order as part of their duty to provide basic nursing care in emergencies. | LVNs may not perform IV therapy, including IV push medications, until they complete a post-licensure validation course; even then, specific IV push drugs require facility policy authorization. | Not addressed in board guidance as an LVN function; considered outside scope. | LVNs cannot legally determine or pronounce death and therefore cannot decide to withhold CPR. IV push, IV drip, and IV piggyback medication authority is explicitly dependent on facility policy and validation training. |
| New York | Permitted under direction of an RN or other directing practitioner. Performing basic CPR is within LPN scope when the nurse is competent and directed. | LPNs may not administer any drugs or solutions by IV push other than saline or heparin flushes for IV access patency. | Outside LPN scope. Endotracheal intubation is not listed among LPN functions under Education Law Article 139 and is reserved for higher-licensed providers. | LPNs may not access or flush venous chest or arm port central lines, may not deliver IV therapy through central devices, and may not administer therapeutic IV push medications. |
| Florida | Permitted. Basic life support, including chest compressions and AED use, is within LPN scope when trained. | IV-certified LPNs may not perform IV push medications other than heparin and saline flushes, even under direct supervision; therapeutic IV pushes are prohibited. | Not addressed as an LPN function; considered outside scope. | LPNs may not initiate blood products, mix IV solutions, administer chemotherapy or investigational drugs, or deliver IV push medications beyond heparin or saline flushes. |
| Ohio | Permitted. Chest compressions and AED use fall within supportive care under Ohio Revised Code when the LPN is trained and directed. | LPNs may inject heparin or normal saline to flush an intermittent infusion device or heparin lock; all other IV push medications are prohibited. | Not addressed as an LPN function; considered outside scope. | Ohio law explicitly prohibits LPNs from injecting medication via a direct intravenous route except heparin or saline flushes for intermittent devices. |
| Pennsylvania | Permitted. CPR (adult, infant, and child) is listed as within LPN scope when the nurse is trained. | LPNs are prohibited from administering medications via push or bolus route during IV therapy, including in emergencies. | Not addressed as an LPN function; considered outside scope. | IV-trained LPNs may administer IV fluids and maintain blood and parenteral nutrition under RN or provider direction, but may not give push or bolus medications or titrate IV medications. |
| Georgia | Permitted. Basic emergency care including CPR is within LPN supportive care scope when supervised and the nurse has documented competency. | LPNs may administer IV fluids, nutrient therapies, and medications under supervision with a valid individualized order; however, IV push medications are generally considered outside LPN scope in most settings. | Not addressed as an LPN function; advanced airway interventions are typically restricted. | Activities must be consistent with the nurse practice act, supervision requirements, and documented competency; high-risk code medications and advanced airway interventions remain restricted for LPNs. |
| Illinois | Permitted. Basic life support tasks are within LPN scope when trained and directed. | Illinois Administrative Code explicitly prohibits LPNs from administering medications via IV push or administering heparin in heparin locks. | Not addressed as an LPN function; considered outside scope. | LPNs may not administer chemotherapeutic agents, start or add blood or blood components, or give any medication via IV push. Illinois is notably the only state in this sample that also restricts heparin lock flushes. |
In a Code Blue, an LPN is indispensable at the bedside but bounded by state law. You can compress a chest, log every intervention, and hand off the crash cart, yet the orders and the airway belong to someone else.
Step-By-Step: The LPN Code Blue Checklist
This checklist synthesizes the team roles and scope-of-practice guidance covered in earlier sections into a single, chronological action sequence. Print it, laminate it, and review it before every mock code drill.
CPR, Airway, and Equipment Tasks LPNs Perform
During a code blue, LPNs carry out hands-on resuscitation tasks that directly affect whether a patient survives. These duties center on chest compressions, ventilation support, equipment management, and assisting with advanced interventions. Each task has specific performance standards rooted in current American Heart Association guidelines.
Chest Compressions
High-quality CPR is the single most important intervention in cardiac arrest, and LPNs are frequently the ones delivering it. The current AHA targets for adult compressions are a rate of 100 to 120 per minute at a depth of at least 2 inches but no more than 2.4 inches.1 Full chest recoil between compressions is essential. Because fatigue degrades compression quality in as little as two minutes, code teams rotate compressors on a regular cycle. LPNs should expect to be swapped in and out and must maintain technique each time they step onto the chest.
Bag-Valve-Mask Ventilation
Before an advanced airway is placed, the standard adult compression-to-ventilation ratio is 30:2.2 That means 30 compressions followed by a brief pause for 2 breaths delivered via bag-valve-mask. LPNs assigned to ventilation need to form a tight seal, watch for visible chest rise, and avoid over-ventilation, which can impair cardiac output. Once an advanced airway such as an endotracheal tube or supraglottic device is in place, the protocol shifts: compressions become continuous4 and ventilations are delivered asynchronously at 1 breath every 6 seconds, or about 10 breaths per minute.23
AED and Defibrillator Assistance
When you hear "AED assist" or "defibrillator assist" in an LPN's assignment, the role typically involves retrieving the device, applying pads to the patient's chest, and ensuring leads are connected. The decision to analyze the rhythm and deliver the shock rests with the code team leader or the ACLS-certified provider directing the resuscitation. LPNs support the process, but they do not independently interpret rhythms or order energy levels.
Crash Cart and Equipment Retrieval
LPNs are commonly responsible for bringing the crash cart to the bedside, breaking the seal, and organizing supplies so the team can access medications, IV supplies, and airway adjuncts without delay. Knowing the cart layout before a code happens is not optional. Many facilities assign LPNs to periodic crash cart checks specifically because familiarity under calm conditions translates to speed under pressure.
Intubation: Where LPNs Stand
Endotracheal intubation is an advanced airway procedure. Authorization to intubate is governed by state licensure, facility policy, and individual credentialing rather than by a single national rule. In practice, intubation is performed by physicians, advanced practice providers, respiratory therapists, or specially credentialed RNs. LPNs do not intubate. Their role during intubation is to hand equipment, maintain suction readiness, and continue compressions until the provider secures the airway.
Documentation and the Recorder Role
Compressions and airway management draw every eye during a code, but the clipboard in the corner carries just as much weight once the room clears. An LPN who is barred from pushing meds or managing the airway can still be the most valuable person on the team by running the record.
What the Recorder Tracks
The recorder's job is to build a real-time, minute-by-minute account of the resuscitation. That means logging the exact time compressions start and stop, every rhythm check and its result, each medication given with dose and route, defibrillation attempts and joules delivered, and the timing of any airway intervention. Nothing gets written from memory after the fact. The recorder calls out timestamps loudly enough for the team leader to hear, which keeps the whole code synchronized to the two-minute cycle AHA protocols require.
Why LPNs Often Fill This Seat
Because the recorder role is documentation, not direct treatment, it frequently falls to an LPN even in facilities that restrict LPN involvement in pushing code meds or leading compressions. It is one of the clearest ways an LPN contributes meaningfully to a code without stepping outside scope. Some facilities pair the LPN with a scribe or second recorder for high-acuity codes, but a single trained LPN can usually manage the log solo if oriented properly.
Common Pitfalls
- Missed timestamps: A rhythm check or med given without a logged time creates a gap that is hard to reconstruct later and can raise questions during review.
- Incomplete med logs: Missing the route, dose, or the name of who administered a drug weakens the record's legal and clinical value.
- Unclear handoff notes: A recorder who doesn't summarize the sequence clearly for the receiving unit or physician leaves gaps that slow post-code care decisions.
From Code Sheet to Chart
The paper or digital code record doesn't end when the patient is stabilized or the code is called. It feeds directly into the post-event debrief, where the team reviews timing, roles, and response quality, and it becomes part of the permanent chart. An accurate, well-timed record protects the patient's continuity of care and protects every clinician in the room.
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How LPN Code Blue Duties Vary by Setting
An LPN's role during a code blue shifts significantly depending on the care environment. Staffing levels, available equipment, proximity of physicians, and facility policies all shape what an LPN is expected to do, and how quickly advanced help arrives. The comparison below breaks down four common settings so you can see where LPN responsibilities expand and where they narrow.
| Setting | Typical LPN Role During a Code | Who Else Is Present | Common Tasks | Key Considerations |
|---|---|---|---|---|
| Acute Care Hospital (Inpatient) | Supports the multidisciplinary code team by performing BLS tasks, managing logistics, and documenting events | RNs, physicians, anesthesiologists, respiratory therapists, security, and administration all converge at the bedside | Initiates CPR, checks pulse and respirations, starts IV lines (if IV certified), administers oxygen, draws blood, obtains bedside glucose, gathers supplies, records code events, assists with transport, and provides family support | Cannot push IV medications but may start IV infusions when certified. The large team allows the LPN to focus on BLS, monitoring, and equipment so advanced practitioners handle intubation and medication administration. |
| Emergency Department | Functions as a member of the ED team under direct RN supervision, responding to code blue and other emergency codes while balancing routine patient care | RNs lead nursing interventions, physicians direct the code, and additional ED staff respond per departmental protocol | Observes vital signs, monitors patient status, assists caregivers with procedures, delegates to and supervises unlicensed assistive personnel, and responds to multiple emergency codes (blue, red, and others) | Scope is defined by department policy and RN direction. The fast pace means the LPN must shift rapidly between ongoing care duties and emergency response, requiring strong prioritization skills. |
| Skilled Nursing Facility (Long Term Care) | Often the first licensed clinician to recognize cardiac or respiratory arrest, initiate CPR, and activate the facility's rapid response or code blue system | An RN must be on duty per policy, but staffing ratios are lower; physicians are typically reached by phone or arrive after activation | Recognizes arrest, begins CPR immediately, activates the code blue or rapid response system, and responds to unit or patient crises efficiently | In some organizations, orientation and many skilled care activities are the same for RNs and LPNs. However, policy still requires an RN on duty, and competency distinctions apply to higher risk procedures such as wound VAC management or PICC line care. |
| Outpatient Clinic (e.g., Cardiology) | Integrates code blue protocol into routine ambulatory workflows, activating emergency response when an arrest or collapse occurs in the clinic | Rapid response teams in outpatient settings are typically nurse led by RNs or advanced practice nurses; physicians may be on site or nearby | Performs clinic nursing care, administers medications within scope, documents care, maintains safety protocols, and follows the designated code blue procedure when an emergency arises | Outpatient settings lack continuous inpatient monitoring, so the LPN must stay alert for sudden deterioration. Code events are rarer here, making ongoing drill participation and protocol review especially important. |
An RN's verbal order during a code still has to fit the LPN's scope of practice. The urgency of a code does not expand what an LPN is legally allowed to do.
Delegation, RN Supervision, and Liability Considerations
How Real-Time Delegation Works
During a code, the RN or physician leading the resuscitation delegates tasks on the fly, but that delegation isn't unlimited. The NCSBN Delegation Guidelines are clear: an RN can only hand off a task that matches the delegatee's scope of practice, demonstrated competence, and the stability of the situation at that moment. The delegating RN also remains accountable for the outcome. That means if you're asked to grab the crash cart, apply pads, or run compressions, that's appropriate delegation. If you're asked to interpret a rhythm strip and decide on the next intervention, that crosses into nursing judgment territory that boards in states like North Carolina and Rhode Island specifically classify as non-delegable.
An Order Doesn't Expand Your Scope
A common misconception is that an RN's verbal order during a code somehow authorizes an LPN to step outside CNA vs LPN vs RN scope of practice. It doesn't. Texas Board of Nursing guidance lists medication administration decisions, nursing assessments, care plan formulation, and evaluation of client response as non-delegable regardless of who's asking. An order from a supervising RN can direct you to perform a task that's already within your scope faster or with more urgency, but it cannot legally convert an RN-only task into something you're now permitted to do. If a task requires ongoing assessment, interpretation, or independent clinical decision-making, no order changes that.
Documentation Habits That Protect You
After a code, documentation gets scrutinized. Chart exactly what you did, who directed it, and when. If you administered a medication under direct RN supervision within your scope, note that supervision. If you were assigned recorder duties, timestamp interventions as they happen rather than reconstructing afterward. The ANA Code of Ethics Provision 4.4 underscores that both the delegating nurse and the delegatee carry responsibility for the quality of care performed, so your documentation should reflect competence, not guesswork.
Declining a Task Outside Your Scope
If you're asked mid-code to do something outside LPN scope, such as pushing a high-alert medication independently or making a triage call on the next intervention, say so immediately and clearly: "That's outside my scope, I can hand that off or assist another way." This isn't insubordination. NCSBN's position on delegation makes clear that a delegatee cannot further delegate a task, and accepting a task you're not licensed or competent to perform creates exposure for both you and the RN who assigned it.1 Most experienced code teams respect a quick, confident redirect far more than a hesitant attempt at something outside your training.
Texas Board of Nursing: A State-By-State Example
Preparing for Code Blue Scenarios: NCLEX-PN and Clinical Training
Code blue readiness is one of the few LPN competencies where classroom theory and clinical exposure rarely line up, which is why simulation has become the workhorse of practical nursing programs. The 2026 NCLEX-PN test plan, in effect from April 1, 2026 through March 31, 2029, gives you a clear map of what the exam expects, and mock code drills give you the muscle memory the exam cannot test directly.1
Where Code Blue Content Lives on the NCLEX-PN
The test plan organizes content into four Client Needs categories.1 Code blue and CPR content maps most directly to Physiological Adaptation under Physiological Integrity, where the plan explicitly lists Medical Emergencies and the ability to respond and intervene in a client life-threatening situation such as cardiopulmonary resuscitation.2 Broader emergency response planning, including identifying nursing and assistive personnel roles during internal and external disasters, sits under Safety and Infection Prevention and Control within Safe and Effective Care Environment.2 NCSBN also measures clinical judgment through case study items and stand-alone items, so expect scenario-based questions that ask you to prioritize actions during a deteriorating patient event.1
Simulation and Mock Codes
LPN/LVN clinical rotations rarely guarantee live code exposure. You may spend an entire preceptorship without hearing an overhead page, which means simulation labs and mock code drills are where most LPN students actually build competence during LPN school. Ask your program how often it runs full-team mock codes with a manikin, defibrillator trainer, and assigned recorder role.
Study Habits That Translate
- BLS algorithms: Review the current AHA adult and pediatric BLS sequences until compression rate, depth, and ventilation ratios are automatic.
- Crash cart familiarization: Walk the cart drawer by drawer on your clinical unit so you can hand off supplies without hunting.
- Recorder practice: Run mock documentation using a code sheet, timing each intervention and medication as if the event were real.
Those three habits, paired with NCLEX-PN case study review, close the gap simulation was designed to fill.
A Code Blue is a coordinated cardiac arrest response, and an LPN's role in it is not improvised. The duties are specific and scope-bound: high-quality compressions, documentation, equipment support, and assistive tasks under RN or physician direction. Laws and facility policies vary, so verify your state board's rules and your employer's code policy before relying on memory. Keep BLS certification current, and use an LPN refresher course to rehearse mock codes until the sequence feels automatic. When the alarm sounds, preparation does more than clarify your scope. It lets you act with the steady, practiced confidence that helps the whole team work faster.
