Every state has a Nurse Practice Act (NPA) — the state law that defines who can practice nursing, what nursing practice means, and what each license level is authorized to do. NPAs are administered by the State Board of Nursing. The NPA is the primary legal authority on scope of practice — above any employer policy, physician order, or personal belief about what a nurse "should" be able to do. If an employer policy conflicts with your state's NPA, the NPA governs.
Key principle: Nurse Practice Acts create a scope of practice that represents the maximum outer boundary of what a licensed nurse may do. Individual employers may restrict this scope further (for example, a hospital may restrict nurses from performing certain procedures without additional certification even if the NPA permits it), but employers cannot legally expand nurses' practice beyond the NPA boundary.
| License | Training | Core Scope | Supervision Requirement |
|---|---|---|---|
| CNA (Certified Nursing Assistant) | 75–150 hours; state-approved training program; NNAAP exam | Activities of daily living (bathing, grooming, dressing, feeding, ambulation assistance); vital signs; reporting observations to licensed nurses. Cannot perform assessments, administer medications, or carry out nursing interventions. | Must work under direct supervision of licensed nurse (RN or LPN); cannot function independently |
| LPN/LVN (Licensed Practical/Vocational Nurse) | 12–18 months; NCLEX-PN exam | Contributions to data collection and basic assessments; administering medications per physician/NP orders; routine care procedures; IV medication administration VARIES by state (some states permit LPNs to administer IV meds; others prohibit it entirely or require additional certification); wound care; patient education under RN supervision. | Works under supervision of RN, physician, or dentist; scope varies significantly by state — some states have expanded LPN scope substantially, others remain very restrictive. Always verify your state's specific LPN scope. |
| RN (Registered Nurse) | 2-year ADN or 4-year BSN; NCLEX-RN exam | Full nursing process: assessment, nursing diagnosis, planning, implementation, evaluation. Initiation and management of all nursing interventions within scope. Medication administration including IV. Delegation to LPNs and CNAs. Patient and family education. Coordination of care across disciplines. | Functions independently within scope; may practice without direct supervision in most settings; collaborates with (but is not supervised by) physicians in most clinical contexts |
| APRN (Advanced Practice RN: NP, CNS, CNM, CRNA) | Master's or doctoral degree; national certification; state APRN licensure | Diagnosis and treatment of illness and injury within population focus; prescribing medications including controlled substances (Schedule II–V); ordering and interpreting diagnostic tests; initiating and managing treatments independently; providing anesthesia (CRNAs). Scope varies by APRN role and state practice authority. | Full practice authority states: practice fully independently, no physician supervision or collaboration required. Reduced/restricted practice states: require physician collaboration agreement or supervision. 27 states + DC now have full practice authority for NPs (as of 2026). |
Independent nursing functions are interventions that nurses initiate based on their own clinical assessment and judgment without requiring a physician or provider order. These actions are within nursing's autonomous scope of practice. Examples: repositioning a patient for pressure injury prevention; applying ice to a bruise; elevating the head of the bed for a patient with dyspnea; providing emotional support and therapeutic communication; teaching a patient coping strategies; implementing safety measures for a fall-risk patient; assessing and documenting physical findings.
Dependent nursing functions require a physician or provider order before the nurse may implement them. Examples: administering medications; initiating IV fluids; performing procedures (arterial line insertion, bladder catheterization in many settings); ordering laboratory tests (in most RN roles; APRNs with prescriptive authority can order diagnostics independently).
Collaborative/interdependent functions are carried out jointly with other healthcare team members — care planning conferences, discharge planning, palliative care discussions. No single profession "owns" these functions; they require coordination.
Delegation is the transfer of a nursing task to another person while retaining accountability for the outcome. RNs may delegate specific tasks to LPNs and CNAs, but the RN cannot delegate the nursing process itself — assessment, nursing diagnosis, care planning, and evaluation cannot be delegated. Only the implementation of specific delegated tasks can be transferred.
The Five Rights of Delegation (NCSBN framework, the standard used on NCLEX):
Right Task: Is this task appropriate to delegate? The task must be: routine (not requiring ongoing nursing judgment), predictable outcome, minimal risk to a specific patient, and within the scope of the delegate. Tasks requiring frequent assessment or nursing judgment are NOT delegatable.
Right Circumstance: Is the patient's condition stable and appropriate for this task to be delegated? A patient who was stable an hour ago may not be stable now. Delegation appropriateness is assessed at the moment of delegation, not at admission.
Right Person: Is the delegate competent, trained, and legally authorized to perform this task? CNA competency, LPN scope, and individual licensee training history must all be verified. You cannot delegate to someone outside their scope just because you are short-staffed.
Right Direction/Communication: Did you give clear, specific instructions — what to do, when, how, and what to report back? Vague delegation ("just keep an eye on her") is inadequate. Specific delegation names what to observe, what threshold triggers a report back, and what the expected outcome is.
Right Supervision/Evaluation: Are you following up to verify that the delegated task was performed correctly and that the patient's condition remains stable? Delegation does not end at the handoff — the delegating RN remains accountable for the outcome and must verify completion.
Initial nursing assessment and nursing diagnosis; planning the nursing care plan; patient teaching that requires nursing judgment about patient readiness and comprehension; IV medication administration (in most states, CNAs may not administer any medications); inserting nasogastric tubes; central line care and assessment; telephone orders from physicians (must be received by a licensed nurse); interpretation of cardiac rhythms requiring intervention; changing sterile wound dressings (varies by facility policy — some delegate simple wound care to CNAs under supervision); administering blood or blood products.
Full practice authority (FPA) means an APRN is legally permitted to evaluate patients, diagnose, order and interpret tests, and prescribe medications — including controlled substances — without a required physician collaboration agreement or supervision agreement. As of 2026, 27 states and the District of Columbia have enacted full practice authority for NPs. In restricted and reduced practice states, NPs must maintain a collaboration or supervisory agreement with a physician, which creates both regulatory and professional barriers to fully independent practice. Nurses planning to practice as NPs in independent or rural settings should verify their state's current practice authority status, as this has been an area of active legislative change.
Related guides: Nursing delegation guide | NCLEX strategies | Nursing prioritization | NP specialty comparison
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