Question: I work at [state agency] and we have questions about specific assessment activities allowed by an RN as opposed to an LPN. I have a provider question about a portion of the MDS that is a comprehensive assessment that I believe should be covered as assessment activity under the Board rules but would like to have the opportunity to discuss with a board staff member what the process entails to make sure we are in agreement before I answer the provider.
Response: Thank you for contacting the MBON with a question about assessment roles of RN v. LPN. It is not the role of MBON staff to offer legal interpretations and suggest decisions for various questions and scenarios posed. Particularly when the situation is hypothetical, it can be even more dangerous for staff to provide input and opinions that could be misconstrued. These types of conversations may then morph into statements being attributed to MBON that inadvertently are interpreted as "law" or with the force of regulation, when, in fact, it is no more than an opinion. That is why we must point you back to the NPA and COMAR.
In this case, I refer you to the Nurse Practice Act where it defines the scope of practice for APRN, RN, and LPN. Without considering any specific situations or scenarios, I would suggest that it is not the "assessment activity" that is differentiated under the various scopes of practice, but what decisions and interventions may be made based on the assessment. For example, all three levels of nursing licensure (LPN, RN, APRN) can perform a neurological assessment, but how one would be able to interpret and synthesize the findings, what interventions could be selected, and what level of nursing diagnosis and care planning could be made are very different. Also, the level of accountability is different, i.e., an APRN would be held to higher standard than either LPN or RN.
Further, CMS and the Joint Commission each have their own rules and regulations on "who can do what" that may need to be followed, so that even if the Maryland NPA implied a certain level of assessment or assessment activity is within the scope of an LPN, it could be that it is disallowed by federal regulations or agency policy. The prudent nurse must take all of this into account when making decisions about who is best suited to complete which portions of an assessment.