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Nursing is a practice discipline where competence resides in the use of specific knowledge, skills, and clinical judgment to meet patients' and families' healthcare needs.1 The American Nurses Association defines nursing as "the protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities and populations."2(p7),3(p6) The licensed practical nurse (LPN), also called a licensed vocational nurse (LVN), plays an important and valuable role in the nursing care of all patients, including those with life-limiting illness.4


Historically, nursing has experienced periods of oversupply and undersupply. In periods of short supply, efforts to create a nurse extender position to perform some of the work typically done by the registered nurse (RN) precipitated the development of the LPN/LVN role.5 In 2005, there were approximately 710,000 LPNs/LVNs in the United States.6


Hospice and palliative LPN/LVN practices within the guidelines of individual state boards of nursing and provides evidenced-based physical, emotional, psychosocial, and spiritual care under the direction of an RN.7 The nursing care supports a collaborative process that promotes comfort to patients and families experiencing life-limiting illness. The LPNs/LVNs assist the RN by providing the necessary treatments, education, and documentation consistent with the plan of care. They are an important part of the interdisciplinary team and provide excellent information to the team that is ultimately responsible for the plan of care. The LPN/LVN participates in monitoring symptoms and changes and reports these changes to the RN in charge of the patient's care. In essence, the RN is responsible for the act of assessment, and the LPN/LVN is responsible for observing, monitoring, and reporting his/her observations.4



This is the position of the HPNA Board of Directors:


* Licensed practical nurses/LVNs are an important member of the team and assist the professional nurse in providing nursing care that is critical to achieving the patients', families', and communities' goals of care in palliative care.


* Organizations need to clearly understand the differences and similarities between LPN/LVN and RN education and training, as well as the nursing functions that remain the responsibility of the RN.


* Persons developing policies, procedures, and protocols ensure that the role of the LPN/LVN in palliative care is consistent with individual state nurse practice acts, the Statement on the Scope and Standards of Hospice and Palliative Licensed Practice/Vocational Nursing Practice, and Professional Competencies for the Hospice and Palliative Licensed Practice/Vocational Nurse.




Palliative care. The goal of palliative care is to prevent and relieve suffering and support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies. Palliative care is both a philosophy of care and an organized, highly structured system of delivering care. Palliative care expands traditional disease-model medical treatments to include the goals of enhancing quality of life for the patient and family, optimizing function, helping with decision making, and providing opportunities for personal growth.8(p3)


Evidence-based practice. This refers to practice that is based on research, clinical expertise, and patient preferences that guide decisions about the healthcare of individual patients. Evidence-based nursing practice stresses the use of research findings, quality improvement data (as appropriate), other operational and evaluation data, the consensus of recognized experts, and affirmed experience to substantiate practice.9


Licensed practical/vocational nurse. An LPN/LVN is not an RN. The term registered nurse is the practice of "professional nursing."1 Becoming an LPN/LVN requires 12 to 14 months of post-high-school formal training program and supervised clinical instruction that focuses on the fundamental aspects of nursing care.1 Once the training is complete, the graduate is required to pass a licensing examination for "practical nursing."6


Approved by the HPNA Board of Directors


October 2008


Developed by:


Susan Cox, RN, MSN, CHPN


Beth Werner, RN, ABA, CHPN


This position statement reflects the bioethics standards or best available clinical evidence at the time of writing or revisions.


To obtain copies of HPNA Position Statements, contact the National Office at:


Penn Center West One, Suite 229, Pittsburgh, PA 15276


Phone: (412) 787-9301


Fax: (412) 787-9305


Web site:




1. Murray MA. A question of evidence: decision-making in palliative care nursing. Int J Palliat Nurs. 2008;14(1):45-47. [Context Link]


2. American Nurses Association. Nursing: Scope and Standards of Practice. Washington, DC:; 2004. [Context Link]


3. American Nurses Association. Nursing's Social Policy Statement. 2nd ed. Washington, DC:; 2003. [Context Link]


4. The National Federation of Licensed Practical Nurses. The education. Accessed June 25, 2008. [Context Link]


5. Kerfoot KM. Role redesign: what has it accomplished? J Issues Nurs [serial online]; 2007;2. Accessed June 14, 2008. [Context Link]


6. American Nurses Association. About nursing. Accessed June 16, 2008. [Context Link]


7. Dahlin C, Glass E, eds. Hospice and Palliative Nursing: Scope and Standards of Practice. Hospice and Palliative Nurses Association and American Nurses Association. Silver Spring, MD: 2007. [Context Link]


8. National Consensus Project. Clinical Practice Guidelines for Quality Palliative Care Executive Summary. Pittsburgh, PA: National Consensus Project; 2004:2. [Context Link]


9. Goode C, Krugman M. Evidenced-based practice: a tool for clinical and managerial decision making. In: Dochterman J, eds. Current Issues in Nursing. St Louis, MO: Mosby; 2001:60-68. [Context Link]