Level 1 vs. Level 2 Nursing Care in Tennessee: Scope, Education, and Regulation

Tennessee's Two-Tier Nursing Model

Level 1 Nursing Care – Licensed Practical Nurse (LPN)

• Scope: Basic nursing tasks under RN/physician direction.
• Tasks: Vital signs, oral/IM/subQ meds, wound care, ADL assistance, catheter care, data collection.
• Education: 12–18 month diploma/certificate program.
• Licensure: NCLEX-PN.
• Supervision: Required—RN or physician must be accessible.

Level 2 Nursing Care – Registered Nurse (RN)

• Scope: Independent nursing process (assess, diagnose, plan, implement, evaluate).
• Tasks: All LPN tasks + IV starts, IV push meds, blood admin, complex wound care, respiratory therapy, care planning, teaching, delegation, triage.
• Education: ADN (2–3 yrs) or BSN (4 yrs).
• Licensure: NCLEX-RN.
• Autonomy: Practices independently within Nurse Practice Act.

Key Differences Summary

Aspect	LPN (Level 1)	RN (Level 2)
Assessment	Data collection	Comprehensive nursing assessment
Care Planning	Contributes	Develops/updates
IV Therapy	Limited (maintenance only, with cert)	Full (initiation, titration, blood)
Delegation	Receives delegation	Delegates to LPN/UAP
Critical Thinking	Task-oriented	Complex clinical judgment

Patient Assignment

• Stable, predictable needs → LPN appropriate.
• Unstable, complex, unpredictable → RN required.
• Facility policies and acuity tools guide staffing.