We are often asked questions about the Scope of Practice within the nursing profession in New York.
 

Information from the Office of Professions website was used to answer questions 1-4.

1.  Q: What are the three distinct licenses within nursing in New York State, and how are they defined?
      A: A Registered Professional Nurse (RN) may:

• diagnose and treat a patient’s unique responses to diagnosed health problems;
• perform health assessments to identify new symptoms of possibly undiagnosed conditions or complications
• teach and counsel patients about maintenance of health and prevention of illness or complications;
• execute medical regimens as prescribed by licensed physicians, dentists, nurse practitioners, physician assistants, and podiatrists, and,
• contribute as members of an interdisciplinary health care team and as consultants on health-related committees to plan and implement the health care needs of consumers.

A Licensed Practical Nurse (LPN) provides skilled nursing care tasks and procedures under the direction of an RN, physician, or other authorized health care provider.

A Nurse Practitioner (NP) is an RN who has earned a separate license as an NP through additional education and experience in a distinct specialty area of practice. Nurse practitioners may diagnose, treat, and prescribe for a patient’s condition that falls within their specialty area of practice. 

2.  Q: How do I know what falls within my legal scope of practice?
      A: For school nursing-related questions, please contact us at the Center. For other nursing practice concerns, contact the NYS Board for Nursing by email: nursebd@mail.nysed.gov, by phone: 518-474-3817 ext. 120, or by mail: NY State Education Department, 89 Washington Avenue - Education Building, State Board for Nursing, Second Floor, West Wing, Albany, NY 12234.

3.   Q: Can a licensed practical nurse (LPN) practice independently?
       A: No, the New York State Education Law § 6902 requires LPNs to practice under the direction of an RN, clinical nurse specialist, NP, physician, dentist, PA, specialist assistant, podiatrist, or midwife (“directing practitioner”). The directing practitioner must provide an appropriate degree of direction to the LPN, determined by the patient care needs and the skill and ability of the LPN. In most cases, the directing practitioner must be on-premises when LPNs provide nursing care.
The directing practitioner does not necessarily have to be on-premises to direct an LPN where:

1. the LPN has demonstrated competence to meet the nursing care needs of the LPN’s patients;
2. the LPN’s patients are highly unlikely to require personal intervention by the directing practitioner; and
3. the directing practitioner is available to direct the LPN by phone and can personally intervene within 15 minutes to ensure timely/appropriate care.

The directing practitioner remains ultimately responsible for providing appropriate direction by phone or in-person to ensure patient or client safety. LPNs must practice under the direction of a directing practitioner even if the LPN has been issued an "Independent Medicaid Provider Number" by the New York State Department of Health. The "Independent Medicaid Provider Number" merely allows the LPN to be paid for Medicaid services provided by the LPN; it doesn’t authorize the LPN to practice independently. (Updated FAQ-NYSED) 

4.   Q: Can a licensed practical nurse (LPN) be supervised by an unlicensed person?
       A: No, only a licensed physician, nurse practitioner, midwife, podiatrist, dentist, physician assistant, specialist assistant, clinical nurse specialist, or registered professional nurse may direct the nursing practice of an LPN. Other persons not legally allowed to supervise professional nursing practice may supervise non-clinical matters, i.e., attendance, dress codes, unpaid leave.

Resources for questions the information below are embedded in each Q&A. 

5.   Q: Who is permitted to perform the required screenings in school? 
       A: Education Law Section 905 states: The director of school health services of each school district shall conduct screening examinations of vision, hearing, and scoliosis of all students at such times and as defined in the regulations of the commissioner, and at any time deemed necessary. However, Education Law Section 902 allows schools to employ an RN and other *health professionals to assist the medical director with the duties as outlined in Education Law Section 901, in compliance with each such health professional's practice act. Schools are encouraged to consult with their legal counsel if they have additional questions. Resources: Education Law Sections 901, 902, and 905, and Vision, Hearing, and Scoliosis Screenings guidelines on the Screenings resource page.

*Section 902 defines "health professionals" as persons duly licensed to practice a health profession pursuant to applicable law, including but not limited to physicians, RNs, NPs, and PAs.

6.   Q: Is an LPN allowed to complete screenings "under the direction" of an RN?
       A: LPNs can perform vision and hearing screenings under the direction of an RN if appropriately trained and can document the results of those screenings. LPNs are not to conduct scoliosis screenings as the LPN scope of practice does not include assessment. Resources: Education Law Sections 901, 902, and 905, and Vision, Hearing, and Scoliosis Screenings guidelines on the Screenings resource page.

7.   Q: What is the role of the school nurse in preparing for school emergencies?
       A: The Registered Professional Nurse has a vital role in emergency planning and management. School nurses should assess potential emergency risks in the school environment, develop student specific emergency response plans and emergency care plans for students with known health conditions, and assess the effectiveness of preparation through emergency training and practice activities. See the Guidelines for Managing Emergency Health Care and Communicable Disease in Schools (NYSED 10/22, Updated 11/2023) for detailed information. 

8.   Q: Is the school nurse responsible for the care of school district employees?
       A: Whether a school nurse is responsible for providing care for ill and/or injured school staff members should be outlined in the school nurse’s employment contract and job description. The school/district should have a policy and procedure in place related to the school nurse caring for school staff. If not specifically outlined, the nurse should only provide care to staff in the case of an emergency. Please contact the Center with additional questions. 

9.  Q: Can LPNs be expected to carry out the professional duties of a school nurse?
      A: No, the scope of practice of the RN and LPN is not interchangeable. The RN is the professional nurse in school settings who may independently, within the scope of practice of the Registered Professional Nurse, triage, assess students, interpret clinical data, develop nursing care plans, and make decisions regarding nursing care. Resources: Use of Licensed Practical Nurses and the Term “School Nurse” in School Settings on the Nursing Roles | Practice | Services resource page.

10. Q: If an LPN works outside of their scope of practice, would that action affect the RN's license?
       A: Ultimately, the LPNs are licensed individuals who are held to be responsible for knowing and practicing within their own scope of practice. An LPN works "under the direction of" an RN. Prior to delegating a health activity or task, the RN is responsible for ensuring the task is within the LPN's scope of practice, is appropriate to delegate, and the LPN has the proper training. Resource: Office of Professions and Office of Professions Part 29 Unprofessional Conduct

11. Q: In a school setting, could an unlicensed person perform tracheostomy suctioning on a student?
       A: No, only an RN, an LPN with the appropriate training, or the student's parent/guardian may perform tracheostomy suctioning in the school setting. Resource: Guidelines for Determining a Student with a Disability's Need for a One-to-One Nurse (NYSED 1/2019)

Page Updated 7/2/26