{
  "source": "Cooked Index — occupational AI risk register",
  "page": "https://cookedindex.com/jobs/licensed-practical-and-licensed-vocational-nurses/",
  "methodology": "https://cookedindex.com/methodology",
  "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.",
  "scored_at": "2026-08-11",
  "model": "claude-opus-5",
  "occupation": {
    "title": "Licensed Practical and Licensed Vocational Nurses",
    "soc_code": "29-2061",
    "category": "Healthcare",
    "us_employment": 648410,
    "median_annual_wage": 64400
  },
  "verdict": "SAFE",
  "risk_resistance": 73,
  "contested": false,
  "near_boundary": false,
  "dimensions": {
    "task_resistance": 15,
    "embodiment": 18,
    "liability_shield": 15,
    "trust_premium": 15,
    "judgment_accountability": 10
  },
  "reasoning": {
    "task_resistance": "At 15, the shift is dominated by tasks no software can perform — wound irrigation and packing, IM and subcutaneous injections, Foley insertion, ostomy care, glucose checks, two-person transfers — but it isn't 18 because MAR reconciliation, MDS-adjacent documentation, prior-auth forms, and shift-change reporting are genuine hours of the day and are exactly what language models eat first.",
    "embodiment": "An 18 reflects a body that must be within arm's reach of another body in an uncontrolled setting: turning a 240-lb resident on a fall-risk mattress, catching a combative dementia patient mid-slide, palpating for a vein, smelling a wound before you see it — the 2 points held back only because a slice of LPN work is now telehealth triage and clinic phone follow-up.",
    "liability_shield": "15 is right because your NCLEX-PN license and state board number are attached to every med you push and every entry you sign, and a diversion or wrong-dose error goes to your license, not just your employer's — but it sits below the 18-20 band because your scope is defined and supervised by the RN or physician who writes the orders, so you carry accountability without independent authority.",
    "trust_premium": "In long-term care you are the person a resident sees three shifts a week for two years, and families call asking for you by name because you noticed the appetite change first; 15 rather than 19 because agency staffing, high turnover, and rotating floor assignments mean the institution, not the individual, is often what the patient is stuck with.",
    "judgment_accountability": "10 fits the reality that you decide when a change in mentation, output, or skin color warrants escalating to the RN or calling the family — real triage discretion under time pressure — but the definitive calls on diagnosis, med changes, and code status belong to others, and much of your day runs on standing orders, care plans, and protocol."
  },
  "rationale": "The core of this job — administering injections and oral meds, changing dressings, inserting catheters, taking vitals, repositioning and bathing residents, feeding, monitoring for skin breakdown — happens with hands on a human body in nursing homes and clinics, where robotics is nowhere close. AI will absorb the charting, care-plan documentation, shift-report summaries, and insurance paperwork that eat a real share of the shift, which changes the day but not the headcount. State licensure and personal accountability for medication administration keep a credentialed human in the loop; note that this is a regulatory shield, and scope-of-practice rules can be rewritten.",
  "outlook": "Demand keeps climbing with an aging population in nursing homes and home health; expect documentation load to shrink and bedside hours per shift to rise.",
  "what_would_raise_it": {
    "levers": [
      {
        "dimension": "liability_shield",
        "change": "Federal enforcement of the CMS minimum staffing rule for long-term care (2024 final rule, 42 CFR 483.35 — 3.48 total nursing HPRD with specific RN/aide floors) plus state-level licensed-nurse ratio laws that count LPN hours specifically; also state board rules that bar unlicensed or AI-directed medication administration in assisted living. Watch state nurse practice act revisions that explicitly name the licensed nurse as accountable for verifying AI-generated med reconciliation or fall-risk flags.",
        "plausibility": "plausible",
        "would_add": 3
      },
      {
        "dimension": "judgment_accountability",
        "change": "Task-mix shift: once charting, MDS/care-plan documentation and prior-auth paperwork are absorbed by AI, the residual shift is assessment, deterioration recognition and escalation calls. This rises further if facilities formalize LPN 'charge nurse' roles in SNFs with documented authority to escalate to the on-call provider, and if AI early-warning systems (sepsis, fall, skin-breakdown alerts) are deployed with a licensed nurse required to adjudicate each alert — the pattern already emerging with Epic Deterioration Index workflows.",
        "plausibility": "already happening",
        "would_add": 4
      },
      {
        "dimension": "task_resistance",
        "change": "Acuity shift in nursing homes: as lower-acuity residents move to home-based and remote-monitoring care, the on-site caseload concentrates into complex wound care, trach/vent, IV therapy, and behavioral dementia care — tasks with no automation path. Watch state expansions of LPN scope to IV push and central line care (already permitted in several states).",
        "plausibility": "plausible",
        "would_add": 2
      },
      {
        "dimension": "trust_premium",
        "change": "Narrow route only: private-duty and hospice home-care markets where families pay out of pocket and explicitly contract for a named human at the bedside. This does not extend to institutional LTC, where the payer is Medicaid and buyers do not choose the nurse.",
        "plausibility": "plausible",
        "would_add": 1
      }
    ],
    "ceiling_note": "Already 73 and near the practical ceiling on embodiment. The realistic risk direction is downward, not upward: scope-of-practice deregulation letting medication aides or AI-supervised unlicensed staff administer meds would cut liability_shield fast, and institutional payers give this occupation almost no trust premium to build on."
  },
  "adjudication": null,
  "employment_history": {
    "points": [
      {
        "y": 2017,
        "emp": 702700,
        "wage": 45030
      },
      {
        "y": 2018,
        "emp": 701690,
        "wage": 46240
      },
      {
        "y": 2019,
        "emp": 697510,
        "wage": 47480
      },
      {
        "y": 2020,
        "emp": 676440,
        "wage": 48820
      },
      {
        "y": 2021,
        "emp": 641240,
        "wage": 48070
      },
      {
        "y": 2022,
        "emp": 632020,
        "wage": 54620
      },
      {
        "y": 2023,
        "emp": 630250,
        "wage": 59730
      },
      {
        "y": 2024,
        "emp": 632430,
        "wage": 62340
      },
      {
        "y": 2025,
        "emp": 648410,
        "wage": 64400
      }
    ],
    "from": 2017,
    "to": 2025,
    "change_pct": -7.7,
    "comparable_from": 2019,
    "spans_soc_revision": true
  },
  "pivots": [],
  "license": "https://cookedindex.com/terms"
}