AWHONN POSITION STATEMENT
The Use of Licensed Practice/
Official Position Statement of
the Association of Women’s
Health, Obstetric and
Neonatal Nurses
Association of Women’s
Health, Obstetric and
Neonatal Nurses
(AWHONN), 1800 M Street
NW, Suite 740 S,
Washington, DC 20036
Approved by the AWHONN
Board of Directors,
March 2023.
ª 2023 Association of Women’s Health, Obstetric and Neonatal Nurses. All rights reserved.
Requests for permission to use or reproduce should be directed to permissions@awhonn.org
Vocational Nurses in Clinical
Settings
Position
The Association of Women’s Health, Obstetric and
Neonatal Nurses (AWHONN) recognizes that
licensed practical nurses (LPNs), also known as
licensed vocational nurses (LVNs), can function as
supportive members of the health care team. In a
nursing care team that represents the collaboration of
varied skill sets, the well-trained LPN/LVN can be a
successful additional team member providing safe and
efficient patient care. The LPN/LVN should function
at their highest level of education, competency, and
scope of practice as defined by state regulations and
organizational policies. The professional registered
nurse (RN) is responsible for a comprehensive
assessment, planning, coordinating, and delivering
care and can delegate appropriate nursing care to
LPNs/LVNs caring for pregnant people and their
newborns.
Background
Over the centuries, nurses have been at the core of
health care services. However, demographics, disease,
health care structures, technological advances, and
conflict have shifted the focus of the attention of
nursing teams to meet the challenges of nursing
shortages, patient safety, and quality of care. To
mitigate these challenges, the health care team may
include advanced practice RNs (APRNs), RNs, LPNs/
LVNs, and assistive personnel (AWHONN, 2022a).
There are more than 900,000 LPNs/LVNs in the
United States (National Council of State Boards of
Nursing [NCSBN], 2021), who represent a slightly
more diverse workforce than their RN colleagues, with
LPNs/LVNs reporting demographics of 17.2% Black,
10% Hispanic/Latinx, and 69.5% White nurses
(Committee for Assessing Progress, 2016; Smiley
et al., 2021). Between 2015 and 2020, the percentage
of LPNs/LVNs employed in a nursing home/extended
care setting decreased as the percentage employed in
an acute care/hospital setting increased. The number
of LPNs/LVNs employed in women’s health,
obstetrics, and/or neonatology has remained steady
between 2015 and 2020, accounting for less than
3% of the LPN/LVN workforce (Smiley et al., 2021).
The LPN/LVN scope of practice requires appropriate
supervision by an RN, APRN, physician associate/
assistant, or physician to facilitate, coordinate, and
maintain compassionate, efficient, quality care and the
achievement of desired treatment outcomes (NCSBN,
2005b). Although the scope of practice for the LPN/
LVN has been lessened in acute care in recent years,
their role is integral to support the health care team
through task-driven responsibilities (MacLeod et al.,
2021).
The LPN/LVN is responsible for the knowledge
and skills necessary to provide nursing care
appropriate to the patient population served. As
United States nursing traditions and titles developed
throughout history, each state developed separate
training standards and regulations for LPNs/LVNs,
introducing challenges in creating a summative
position statement for all LPNs/LVNs throughout the
United States. This position statement attempts to
provide some common themes.
Educational Training and
Licensing
An LPN/LVN must graduate from an accredited LPN/
LVN program, which awards a certificate, diploma, or
degree upon successful completion. These academic
programs consist of several courses that focus on
nursing theory, clinical nursing techniques, and
procedures, with a strong focus on the anatomy and
physiology of body systems, communication,
interpersonal skills, and pharmacology. There is a
clinical rotation component in which they participate
in various patient care clinical settings. Each State
Board of Nursing requires LPN/LVN nursing program
graduates to pass the National Council Licensure
Examination for Practical Nurses (NCLEX-PN) to
apply for an LPN/LVN license. A nursing license gives
the individual permission to practice nursing, granted
by the state in which they met the requirements
(NCSBN, 2005b). When qualified LPNs/LVNs
participate in direct care, appropriate education and
supervision of them must be in place.
doi: 10.1016/j.nwh.2023.04.001; nwhjournal.org 1
AWHONN POSITION STATEMENT
The LPN/LVN in the Maternal/Child Acute
Care Setting
According to the NCSBN (2005b), the LPN/LVN scope of practice is
defined by each state’s Nursing Practice Act. LPNs/LVNs are
allowed in some states to delegate to and supervise LPNs/LVNs and
other assistive nonlicensed personnel (Corazzini et al., 2011).
Individual states set guidelines on the specific tasks permissible for
LPNs/LVNs. To address the duties the LVN/LPN may perform, it is
necessary to refer to the nursing process formulated as a framework
for the standards of practice of nurses in clinical care (Orlando,
1961). The nursing process comprises five steps: assessment,
diagnosis, planning, implementation, and evaluation (Toney-Butler &
Thayer, 2022). The scope of practice of the LPN/LVN asserts that
the LPN/LVN is only part of four of these five steps; the diagnosis
step is reserved for physicians, APRNs, and RNs (NCSBN, 2005a).
1. Assessment: In the assessment phase, the LPN/LVN practices
basic data collection used for assessment. They can collect
basic data, compare it against standard measures, and identify
any correlations with the findings. The main methods used to
collect data are health interviews, physical examination, and
observation.
2. Diagnosis: Although the LPN/LVN cannot determine a
nursing diagnosis, they assist the RN in determining the
problems and priority of the patient through prompt and
accurate communication of patient needs.
3. Planning: The LPN/LVN can collaborate in the planning
phase; care plans provide a course of direction for personalized
care tailored to an individual’s unique needs, subject to the
review and approval of the RN.
4. Implementation: During the implementation phase, the LPN/
LVN is expected to deliver the determined interventions per
the patient’s care plan, which the RN must determine. The
LPN/LVN applies communication skills for educating patients
and addressing patient and family concerns.
5. Evaluation: The LPN/LVN contributes to the evaluation of
individualized interventions related to the care plan or
treatment plan. The RN evaluates the progress toward the
goals/outcomes identified in the previous phases together with
the LPN/LVN, who can provide observations and suggestions
for the accomplishment of the plan of care.
AWHONN recommends that the roles and responsibilities of the
LPN/LVN be consistent with the state nurse practice act governing
the location where the LPN/LVN practices as well as consistent with
organizational policies and individual training and experience.
Depending on those factors, appropriate tasks may include but are
not limited to the following:
 Newborn care: collecting vital signs, performing glucose
testing, conducting phlebotomy and newborn screening,
facilitating skin-to-skin, providing parent/family education,
bathing the newborn, assisting with newborn feeding, and
introducing newborn education classes.
 Postpartum care: performing dressing changes, collecting
vital signs, performing glucose testing, removing or
inserting indwelling urinary catheters, using a bladder
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scanner, assisting with ambulation/fall prevention, activities
of daily living and prevention of infant drops, conducting
phlebotomy, providing perineal care, educating patient/
family, providing lactation and feeding education, and
discharge education.
 Labor, delivery, and recovery: collecting maternal vital
signs of a laboring patient, chaperoning during sensitive
examinations and treatments, performing glucose testing,
removing or inserting indwelling urinary catheters,
facilitating skin-to-skin during the golden hour, offering
assistive support during delivery, providing patient/family
education, assisting during emergency events, taking
patient histories, conducting phlebotomy, perineal care,
and assistance with ambulation.
The LPN/LVN in the Obstetric Surgical
Setting
According to the American Society of PeriAnesthesia Nurses (2018),
an LPN/LVN may not properly function independently in a Phase 1
postoperative area because care of these patients is the responsibility
of the RN. Phase 1 care is defined as “providing perianesthesia
nursing care to the patient in the immediate post-anesthesia period
and transitioning them to Phase 2 level of care” (American Society of
PeriAnesthesia Nurses, 2018, p. 7). Likewise, in a preoperative area
or in a Phase 2 postoperative care area, LPNs/LVNs may function
under the direction of an RN but may not perform postoperative
physical assessments. Nursing responsibilities in Phase 2 focus on
preparing the patient to be cared for at home by themselves or their
family/significant others. Preoperative and Phase 2 postoperative care
may be provided to patients having both obstetric and gynecologic
surgery in a labor and delivery unit or a women’s health operative
services area.
LPNs/LVNs may function as surgical technologists across the
United States, dependent on state board regulations, certification,
and health care facility policies (Association of Surgical
Technologists, 2013). According to the Association of periOperative
Registered Nurses (2020), LPNs/LVNs cannot function in the role of
a circulating nurse. LPNs/LVNs provide supportive assistance in the
operating room during emergencies, such as with quantitative blood
loss collection, facilitating skin-to-skin in the operating room, and
providing support to the patient and family members.
The LPN/LVN and Fetal Heart Rate
Monitoring
Caring for a pregnant person and fetus includes both initial and
ongoing assessments. Fetal heart monitoring is part of the assessment
in the ambulatory, antepartum, and intrapartum settings, regardless of
the chosen monitoring technique. Fetal heart monitoring is outside of
the scope of practice for the LPN/LVN (AWHONN, 2018).
Role of the Nurse
As acute care facilities examine staffing models and patient safety,
adding LPNs/LVNs to the acute care setting is a true collaboration
between nursing roles. Moore et al. (2019) discuss the need for

nurses to be given a clear understanding of the collaborative role of
practical nurses in acute care settings such as medical/surgical,
medical/oncology, and ICUs. To achieve a successful collaboration,
nursing staff need to understand the differences in their roles and
demonstrate respectful appreciation for each role.
In this collaborative role, the RN must understand that clinical
reasoning, nursing diagnostic judgment, and critical decision making
cannot be delegated to the LPN/LVN. Within the parameters of how
the state authority identifies delegation relative to a nursing
assignment, appropriate delegation should always involve the
transition of responsibility safely and consistently. According to the
NCSBN and the American Nurses Association joint statement on
delegation, the delegated responsibility must lie within the
parameters of the delegator’s authorized scope of practice under the
Nursing Practice Act (Cahill et al., 2021; NCSBN & American
Nurses Association, 2019). Additionally, the nurse staffing standards
published by AWHONN (2022b) and the American Academy of
Pediatrics and American College of Obstetricians and Gynecologists
(2017) assume that ancillary personnel can perform nonnursing
duties and provide support and comfort to perinatal patients, such as
being a chaperone during sensitive examinations and treatments.
Therefore, the addition of LPNs/LVNs to the staffing numbers does
not preclude requirements to meet staffing standards for RNs
(AWHONN, 2022b).
Recommendations
One element of an overall strategy to combat the nurse shortage is to
use LPNs/LVNs in maternal patient care settings (Jarrar et al., 2018)
according to their scope of practice. AWHONN is striving to build
workforce pipelines through innovative strategies that use LPNs/
LVNs to enhance positive patient outcomes, assist health care
organizational staffing needs, and ensure that quality maternity
nursing care is rendered. Nursing professional organizations, such as
the National Association of Licensed Practical Nurses, should
provide support through statements and resources to support the
integration of their members into acute care settings that may foster
a healthy work environment. Nurse leaders can be instrumental in
advocating for building staffing structures for the provision of optimal
care based on national, state, local, and organizational standards and
guidelines.
The addition of LPNs/LVNs to the nursing team also can provide
a more diversified workforce. Increasing nursing staff diversity is an
essential aspect in creating a more culturally competent patient
experience. As the demand increases for professional nurses,
educating and recruiting practical nurses opens a path for greater
diversity in nursing while maintaining and improving patient
outcomes (Jarrar et al., 2018).
Nurse leaders can review and revise policies to facilitate the ability
for the RN and LPN/LVN to collectively provide support and
coordinate the labor, delivery, recovery, and postpartum support
team. AWHONN supports the following:
 implementing policies on patient care that appropriately
identify the specific roles and responsibilities of the RN and
LPN/LVN and care that can be delegated to an LPN/LVN;
- 2023
AWHONN POSITION STATEMENT
 providing administrative support on incorporating LPNs/
LVNs into maternity care settings without impacting the
staffing standards for RNs;
 developing education for RNs on the delegation of
responsibilities for LPNs/LVNs;
 developing education for health care professionals on the
role and scope of practice of the LPN/LVN;
 incorporating LPNs/LVNs who have proper training into
the operating room as surgical technicians;
 facilitating the collaboration of the LPN/LVN role within
maternity code teams and emergency drills;
 creating specific tasks for LPNs/LVNs in maternity settings
as well as labor, delivery, postpartum, and newborn care
while following recommended standards and guidelines;
 promoting the use of LPNs/LVNs in maternity outpatient
care settings, with specific roles and responsibilities;
 providing annual LPN/LVN competency education based
on scope of practice and job responsibilities; and
 continuing research on the scope of practice for LPNs/
LVNs.
AWHONN Contextual Statement
Although the words “woman,” “women,” and “mother” and related
pronouns are used herein, AWHONN recognizes the existence of
diverse gender identities and acknowledges that not all individuals
who present for care self-identify as women or exclusively as women.
When referencing the published results of previous studies, terms
used by the original authors are retained for accuracy. To provide
appropriate, respectful, and sensitive care, the health care provider is
encouraged to always ask individuals what words they use to describe
themselves, their bodies, and their health care practices.
Acknowledgments
AWHONN gratefully acknowledges Barbara Mauger, DNP, RNC-
OB, NPD-BC, CLEC; Sue Ellen Abney-Roberts, DNP, RN-BC,
C-EFM, RNC-MNN, C-ONQS; Ruth Ochoa, DNP, RN, NEA-BC,
NPD-BC, RNC-OB; Jean Salera-Vieira, DNP, APRN-CNS, RNC;
and Karen Crowley, DNP, APRN-BC, WHNP, ANP, CNE, who
contributed to portions of this revised position statement. NWH
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