Registered nurse scope of practice is the set of duties an RN is legally authorized to perform, defined by each state’s Nurse Practice Act and the regulations of its Board of Nursing. In broad terms, you can independently assess patients, form nursing diagnoses, plan and evaluate care, delegate appropriately, and advocate for the people in your charge. You need a provider’s order to give medications or carry out specific treatments. You cannot make medical diagnoses, prescribe, or perform surgery. The exact edges shift from state to state, so the authoritative answer for your license is always the statute and regulations where you practice.
Where Your Scope Actually Comes From
Two layers of law define what you can do. The state legislature passes a Nurse Practice Act, which sets the broad rules for who may practice nursing and under what conditions. That Act then delegates authority to a state Board of Nursing to write more detailed regulations, issue licenses, investigate complaints, and discipline nurses who fall short.1StatPearls. Nursing Practice Act
When a question comes up about whether a specific task is within your scope, the answer lives in those two sources together, not in facility policy or informal custom. Facility policy can be stricter than the law, never looser. If your employer asks you to do something that falls outside your state’s scope, doing it is still a violation, and the Board can discipline you for it regardless of who instructed you.
What You Can Do on Your Own Judgment
The independent core of nursing is the nursing process, and none of it requires a physician’s order.
Assessment comes first: gathering physical and psychological data through examination, interview, and record review. From that data you identify nursing diagnoses, which are distinct from medical diagnoses. A physician diagnoses pneumonia. A nurse diagnoses “impaired gas exchange” or “activity intolerance” and builds a care plan around those functional problems.
The plan sets interventions you can carry out on your own authority: patient education, repositioning schedules, non-pharmacologic pain strategies, skin care, mobility work, emotional support. Evaluation closes the loop, asking whether the interventions are actually working and adjusting when they are not.
Advocacy runs through all of it. Questioning a discharge that looks premature, making sure a patient understands they can refuse treatment, raising a safety concern up the chain — these are part of your professional role, not optional extras. They flow from your own education and judgment.
What You Can Do Only With an Order
Administering medications, performing specific treatments, and running diagnostic tests all require an order from a physician, nurse practitioner, or other authorized prescriber. “Dependent” is the technical word for these tasks, but it does not mean mechanical.
You have an independent legal duty to verify every medication order before you act on it: right patient, right drug, right dose, right route, right time. If anything looks off, you are expected to question it. Following a prescriber’s order blindly is not a defense when a patient is harmed. The standard practice is that nurses should not carry out an order without first seeking clarification from either the pharmacy or the prescriber whenever a question arises about interpretation, the medication itself, or the dose.2National Center for Biotechnology Information. Nursing Rights of Medication Administration
Executing a harmful order can create legal liability for you no matter who wrote it. Document the task once completed, and report adverse reactions to the provider promptly. In healthcare there is a long-standing principle that if it was not charted, it was not done, and the medical record is the primary evidence of what you did.
What You Can Delegate, and What Stays With You
RNs regularly assign tasks to Licensed Practical Nurses and unlicensed assistive personnel such as nursing aides. Delegation is part of the job, but you can delegate a task without delegating clinical judgment, and you remain legally accountable for the outcome.
The National Council of State Boards of Nursing lays out five criteria for safe delegation:3National Council of State Boards of Nursing. National Guidelines for Nursing Delegation
- Right task, meaning the activity is appropriate to delegate for this specific patient.
- Right circumstances, meaning the setting, resources, and patient condition allow for safe completion.
- Right person, meaning the individual has the training and competency to perform it.
- Right direction, meaning your instructions are clear and include the objective, limits, and expectations.
- Right supervision, meaning you monitor progress, step in when needed, and give feedback.
Tasks typically delegated to aides include routine vital signs, help with bathing, and collecting basic data that does not require professional interpretation. Confirm the person understands what you are asking, and follow up. Inadequate supervision is one of the more common paths to a negligence finding.4National Council of State Boards of Nursing. Delegation
What RNs Cannot Do
Certain high-risk functions are reserved for providers with different training. As an RN, you cannot make a formal medical diagnosis, prescribe medications, or perform surgical procedures. Only Advanced Practice Registered Nurses with the right certification, and in some states a collaborative agreement with a physician, are authorized to diagnose and prescribe.
Crossing those lines is treated as practicing medicine without a license, which is a criminal offense in every state. Depending on the jurisdiction and the severity of the violation — including whether a patient was harmed — the charge can be a misdemeanor or a felony, carrying fines and potential jail time. The Board of Nursing can and often does pursue permanent revocation of the license alongside any criminal case. Scope violations of this kind sit among the most career-ending mistakes a nurse can make.
Abandonment Versus Refusing an Assignment
One of the most misunderstood areas is where refusal ends and abandonment begins. Abandonment occurs after you have accepted responsibility for a patient and then leave without arranging for continued care and without reasonable notice. Once you have taken the handoff and established a nurse-patient relationship, walking away exposes you to Board discipline.
Refusing an assignment before you accept it is a different situation. If you have not yet taken responsibility for the patient, declining because you lack the training, because staffing is dangerously inadequate, or because the task would compromise safety is generally not treated as abandonment. Many states also specify that refusing mandatory overtime does not constitute abandonment. Timing is what matters. Before you accept, you have options. After you accept, you have obligations. If you truly must leave after accepting, notify your supervisor immediately, document the reasons in detail, and stay until a qualified replacement is in place.
Mandatory Reporting as Part of Your Scope
Every state designates registered nurses as mandatory reporters with a legal duty to report suspected abuse or neglect of vulnerable populations. The covered groups and reporting procedures vary, but the duty typically extends to children, elderly adults, and people with disabilities.5National Center for Biotechnology Information. Mandatory Reporting Laws Some states add intimate partner violence and abuse of dependent adults.
Reportable mistreatment generally covers physical abuse, sexual abuse, emotional abuse, neglect (physical, medical, or nutritional), and financial exploitation.5National Center for Biotechnology Information. Mandatory Reporting Laws Nurses are also required to report certain infectious diseases and public health threats to state and local health departments, with the specific list set by jurisdiction and usually tracking the CDC’s recommended reporting list.
The trigger for reporting is suspicion, not proof. You do not need to investigate or confirm abuse before filing. Waiting for certainty is itself a violation. Facilities often have internal procedures, but the legal duty sits on you individually, whether or not your employer has a policy.
You are also expected to report colleagues whose practice appears compromised by substance misuse, mental health conditions, fatigue, or other factors that put patients at risk. Many Nurse Practice Acts treat failure to report impaired practice as a disciplinable offense in its own right. Good-faith reports should be protected from retaliation, though the strength of those protections depends on the state.
Practicing in More Than One State
If you want to work across state lines, the Nurse Licensure Compact matters. As of 2026, 43 jurisdictions participate.6Nurse Licensure Compact. Home A multistate license issued by your home state lets you practice in any other compact state without obtaining a separate license there.
Eligibility turns on your primary state of residence, determined by where you hold a driver’s license, where you are registered to vote, and what state you declare on your federal tax return.7Nurse Licensure Compact. How It Works Property ownership is not a factor. You can only have one primary state of residence, and it must be a compact member for you to hold a multistate license.
Telehealth follows the same logic. You must be licensed in the state where the patient is located at the time of service. A multistate license covers that automatically for patients in other compact states. For patients in non-compact states, you need that state’s individual license. Military spouses who keep residency in a compact state can practice under their multistate license wherever the family is stationed.8Nurse Licensure Compact. Nurses and the NLC
Important boundary: the compact does not expand what you are clinically allowed to do. You practice under the Nurse Practice Act of the state where the patient is located. If that state’s scope is narrower than your home state’s, follow the narrower rules.
Keeping the License That Carries Your Scope
Nursing licenses are not permanent. Most states use a two-year renewal cycle, requiring a fee and a set number of continuing education contact hours. Biennial renewal fees generally run from roughly $40 to nearly $200 depending on the state. Working on an expired license is unlicensed practice and can trigger Board discipline even when the lapse is an honest oversight.
Continuing education requirements typically run from about 12 to 36 contact hours per cycle. Roughly ten states currently have no formal CE requirement for RNs, though employers in those states often set their own training expectations. Several states mandate hours on specific topics within the total, with common subjects including human trafficking recognition, medical error prevention, opioid prescribing risks, and cultural competency. Mandated-topic hours count toward your total rather than adding to it, but missing a required topic can hold up renewal even when your total is sufficient. Check your Board’s current requirements well before your deadline, because specifics change more often than most nurses expect.