Focused vs. Comprehensive Assessment
The Licensed Practical/Vocation Nurse (LPN/LVN) is a highly valuable member of the medical care team. By partnering with Registered Nurses, Certified Nurse Assistants (CNAs) or Patient Care Technicians (PCTs), the LPN/LVN can perform a wide range of patient-care duties in many clinical settings. While the Registered Nurse (RN) has a wider scope of practice and is responsible for more comprehensive patient assessments and duties, the LPN/LVN is able to conduct focused assessments to determine the health status of patients. How does the comprehensive assessment compare to the focused assessment, and when is either appropriate?
The National Council of State Boards of Nursing recommends that the Licensed Practical/Vocational Nurse has a directed scope of practice under the supervision of an RN, Advanced Practice Nurse (APRN), licensed physician or other care provider who is authorized by the state. The LPN/LVN’s practice falls under an established set of nursing standards that are set by the state’s Board of Nursing (BON). Although variations occur from state to state, it is generally accepted that the LPN/LVN provides professional services such as collecting and reporting patient data, conducting a focused assessment of the patient’s health status, performing direct patient care such as wound care, procedures and assistance with activities of daily living, providing health information to patients and families, participating and contributing to the plan of care, delegating and assigning interventions related to the plan of care and collaborating with the health care team.
The Registered Nurse, by comparison, is able to perform all of the LPN/LVN services with additional responsibilities such as performing a comprehensive assessment, establishing a nursing diagnosis, setting goals and prescribing nursing interventions to meet health care needs, evaluating the response to interventions and care plans, designing and implementing patient-specific education programs and ensuring that safe care is being rendered by all staff.
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Many states are hesitant to use the term “assessment” when related to the LPN/LVN practice, choosing to describe the actual duties and tasks that fall within the scope of practice. Regardless of the terms used, the focused assessment is “an appraisal of an individual’s status and situation at hand, contributing to comprehensive assessment by the RN, supporting ongoing data collection and deciding who needs to be informed of the information and when to inform.” For example, the LPN/LVN assigned to a set of patients can conduct a focused assessment of the vital signs, heart rate, breath sounds, etc. and report any abnormal findings to the RN or other licensed clinical provider for a more comprehensive assessment to be done. Many organizations choose to have the LPN/LVN administer treatments and medications while the RN is responsible for the assessment on all patients.
For the RN, the comprehensive nursing assessment includes a more extensive data collection for not only individual patients, but families, groups and the communities they serve. The RN is responsible for anticipating alterations in conditions as well as emergent changes in a patient’s health status, plus any variations to previous conditions. A comprehensive assessment also includes evaluating the impact of all nursing care, implementing nursing diagnoses and interventions and evaluating the need for any changes to those interventions. For departments or units with complex patients requiring frequent interventions, organizations may choose to staff only RNs, or only assign stable patients to the LPN/LVN. Outpatient clinics, such as a Urologist’s office, may hire an LPN/LVN to provide patients vasectomy information that has been created by RNs or other clinicians.
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There is a myriad of nursing roles available to Licensed Practical/Vocational Nurses. A care team that includes skilled LPN/VNs can provide a professional depth and breadth of care for any organization. Effective utilization of these nurses is essential to combat the RN labor shortage and offer safe and competent care to patients that is well within the LPN/NV scope of practice.