LPN Scope of Practice in Maryland: Delegation, IVs, and Limits

The LPN scope of practice in Maryland is defined by one hard rule and a long list of tasks that flow from it: a Licensed Practical Nurse may practice only in a team relationship with at least one other licensed health professional who is not an LPN, and within that team the LPN administers prescribed treatments and medications, monitors patients, performs wound care, manages catheters, keeps records, and may teach or supervise other staff for tasks that match the LPN’s training.¹ Some tasks are reserved to licensed nurses and cannot be handed off, and some higher-acuity work requires additional training or direct RN supervision.

The Team Relationship Requirement

Everything else about the license sits on top of this rule. Title 8 of the Health Occupations Article authorizes an LPN to practice practical nursing only in a team relationship with at least one licensed health professional who is not an LPN.¹ In most settings that other professional is a registered nurse or a physician.

This is not a facility policy or a staffing preference. It is a licensure condition. An LPN working without that team relationship in place is practicing outside the scope of the license, regardless of the setting or how competent the LPN is at the underlying task.

What LPNs Are Authorized to Do

Within the team structure, an LPN in Maryland may:

Administer treatments and medications ordered by a prescriber authorized to write them
Monitor patient health and document findings
Perform wound care
Manage catheters
Maintain patient records
Teach and supervise other staff, provided the tasks match the LPN’s education and demonstrated competencies¹

Practicing under any name other than the one on your license is a violation of state law, even if the underlying work is inside your scope.¹

Medications, IV Lines, and Infusion Therapy

Medication administration is where the rules get granular. Four medication tasks must be performed by a licensed nurse and cannot be delegated to a certified nursing assistant or unlicensed aide: calculating medication doses, giving injections, administering medications through a tube inserted into a body cavity, and administering IV medications.² An LPN can perform them; unlicensed staff supervised by an LPN cannot.

Infusion therapy in Maryland works in tiers tied to training. After finishing a specialized infusion therapy education program, an LPN may independently perform a defined set of tasks on midclavicular, central venous catheter (CVC), PICC, and implanted port lines:

Calculating and adjusting flow rates, including on a pump
Changing dressings on insertion sites and changing injection caps and administration sets
Flushing lines and converting between continuous and intermittent infusions
Observing and reporting on insertion sites and signs of adverse reactions

Two higher-acuity activities require direct RN supervision on top of the training. Under the direct supervision of an RN who has completed a comprehensive patient assessment, an LPN with the appropriate training may administer total parenteral nutrition (TPN) and hang pharmacy-prepared medication solutions through central lines. A second specialized program is the prerequisite for administering non-vesicant chemotherapy and antiviral agents, which also requires direct RN supervision and adherence to the facility’s written protocols.³

For controlled substances, federal rules stack on top of state ones. An LPN working in a hospital or institution registered with the DEA may administer controlled substances under that institution’s registration, provided the LPN is authorized under Maryland law and acts within the scope of employment. LPNs cannot prescribe controlled substances and cannot call in oral prescriptions for Schedule II drugs on a practitioner’s behalf, even in emergencies. Prescribing generally is not part of the LPN license in Maryland.

What Cannot Be Delegated by an LPN

Delegation flows in one direction: an LPN may hand certain tasks to certified nursing assistants, medication technicians, or unlicensed personnel, but only when doing so does not jeopardize the patient’s welfare. When an LPN delegates, the LPN must instruct the person, direct the work, evaluate performance on an ongoing basis, and step in to correct problems. If the delegated task is being performed incompetently, the LPN must stop the person and notify the RN leading the nursing team.⁴ The responsibility stays with the delegating nurse.

Certain core functions cannot be delegated by anyone, including an LPN, because they require nursing judgment:

The initial nursing assessment on admission, shift change, transfer, or discharge
Developing a nursing diagnosis
Establishing nursing care goals
Developing the care plan
Evaluating a patient’s progress²

These stay with a licensed nurse. Some of them, in practice, are RN-led rather than LPN-led work; either way, they never move down the chain to unlicensed staff.

The Right and Duty to Refuse Tasks Outside Your Scope

Maryland’s standards of professional performance give an LPN both the right and the responsibility to refuse any nursing act that exceeds the LPN’s education, capabilities, clinical competency, or scope of practice.⁴ Agreeing to perform a task you are not trained for exposes you and the patient to risk, and the Board treats it as a scope violation regardless of who told you to do it. A physician’s order, a supervisor’s instruction, and staffing pressure do not expand what your license allows.

The same performance standards require an LPN to communicate observations of actions by other healthcare providers that could jeopardize patient safety to the supervising RN.⁴ Reporting up is part of the role, not optional.

Consequences of Practicing Outside Scope

The Maryland Board of Nursing publishes sanctioning guidelines that tie categories of misconduct to ranges of penalties. Criminal conduct, sexual offenses, and controlled substance diversion each have their own tiers, with monetary penalties ranging from $1,000 to $5,000 for licensees depending on the category and the presence of patient harm, and sanctions running from a reprimand through probation, suspension, and revocation.⁵ Scope-of-practice violations are handled through the same disciplinary framework.

Board discipline is not the end of the exposure. Negligence or malpractice can lead to civil litigation for damages caused to a patient, and criminal charges are possible in cases involving intentional harm, fraud, or drug diversion. Federal law also requires state licensing authorities to report adverse licensure actions against healthcare practitioners to the National Practitioner Data Bank within 30 calendar days.⁶ Once an action is in the NPDB, future employers and licensing boards in other states see it during background queries. A Board cannot make a reportable action confidential by relabeling it, so a Maryland discipline record follows the license across state lines.

The practical takeaway is narrow. Know the team-relationship rule, know which medication and infusion tasks require additional training or direct RN supervision, know which functions never leave the licensed nurse, and refuse anything outside those lines in writing when you can.

1
Maryland General Assembly. Maryland Health Occupations Code 8-311 – Licensed Practical Nursing
2
Maryland Department of Human Services. COMAR 10.27.11 Delegation of Nursing Functions
3
Library of Maryland Regulations. COMAR 10.27.20.05 – Infusion Therapy Acts – LPN
4
Cornell Law Institute. Maryland Code of Regulations 10.27.10.03 – Standards of Professional Performance
5
Library of Maryland Regulations. COMAR 10.27.26.07 – Sanctioning Guidelines
6
NPDB. NPDB Guidebook – Chapter E: Reports Overview