How a CNA's Scope of Practice Differ from an LPN's

Maybe you are one those who want to pursue a nursing career right out of high school. Or perhaps you earned a few college credits and you want to achieve your goal of becoming a nurse. You also might want to start studying soon and earn that nursing degree as quickly as possible. If that's the case, then enrolling in a certified nursing assistant (CNA) or a licensed practical nursing (LPN) program would suit you best. These degrees can be finished in a short period of time and remain the fastest way to enter the nursing profession. You already know that CNAs and LPNs are valuable members of the health care team, otherwise why would they be present in practically all settings? Both CNAs and LPNs seem to have the same skill sets at first glance. But, do they really perform the same tasks? Before finding out the difference in their scopes of practice, let us define first what is a CNA and an LPN.

What is a CNA?

Depending on the place of work, CNAs can be referred to as nursing assistants, nursing aides, patient care technicians, or unlicensed assistive personnel. Don't be confused, they are the same type of health care workers. They have to complete no less than 75 hours of basic nursing theory and clinical practice before they are eligible for certification by the state board of nursing. CNAs are not nurses per se, but they do basic nursing tasks. When you visit a long-term care facility, chances are you get to see a lot of CNAs around.

What is an LPN?

LPNs, also called licensed vocational nurses (LVNs), need to complete one to two years of nursing studies. If you feel like the educational preparation of CNAs is not enough and you want to have a basic qualification as a nurse, then an LPN program is right for you. LPNs are required to study anatomy, medical-surgical nursing, obstetric nursing, and pharmacology, aside from completing the clinical component. They need to pass the NCLEX-PN for licensure. Most LPNs nowadays are found in nursing homes, community clinics and hospitals. To give you a clear idea of the differences in the scope of practice between CNAs and LPNs, please read on.

Scope of Practice: What's the Difference?

CNAs perform basic and routine tasks needed for the daily functioning of patients. They are the ones who usually take care of the more mundane but important activities of the patient like bathing, grooming, ambulating, turning, feeding, toileting, and the like. CNAs are in constant contact with the patient to assist them with these activities of daily living (ADLs). They also perform repetitive tasks such as monitoring vital signs, recording intake and output, and collecting specimen and lab samples.

In some states and facilities, CNAs are legally allowed to perform phlebotomy, take ECGs, and assist in treatments and procedures. Take note, however, that CNAs must be supervised by the LPN or registered nurse (RN) at all times when performing nursing tasks. When a task is delegated to the CNA, he or she must make sure that the task is under the scope of practice before accepting. This is to ensure responsibility and accountability. We don't want the hassle of lawsuits stemming from negligence and malpractice.

So, what are the limitations of CNAs? One thing is that CNAs should not perform a complete assessment. Only RNs can assess and LPNs can collect data. CNAs assess patients to a very limited extent and they should always report their observations to LPNs or RNs. Another no-no for CNAs is performing invasive procedures such as inserting or removing tubes and catheters, administering food through tubes, and tracheal suctioning. They are likewise prohibited from administering blood products and medications, including oxygen. Unlike LPNs, CNAs are never allowed to take verbal orders from physicians. But can experienced CNAs supervise new LPNs? No. LPNs ALWAYS supervise CNAs and NEVER the other way around. There are always exceptions out there, but it pays to know the general restrictions of the CNA's scope of practice.

What about LPNs? The crucial thing to remember is that LPNs can do all the tasks that CNAs can perform, and additionally, they can perform invasive procedures. So, LPNs may perform routine bedside nursing tasks themselves such as assisting in hygiene, dressing, feeding and ambulation. Assisting in range of motion exercises also falls under the responsibilities of LPNs. The invasive tasks they are allowed to do include suctioning, changing dressings, catheterization, enemas, taking laboratory samples and administering oral, intradermal, subcutaneous and intramuscular medications. They are supervised by the RN in doing these activities. A task can be delegated by LPNs to CNAs but they must provide guidance and supervision. An LPN makes sure that the CNA knows exactly what he or she is going to do, and directs the CNA while doing the procedure. LPNs in turn are guided and supervised by RNs and physicians.

Now, have you figured out the basic differences between the CNA and LPN scopes of practice? You must have determined by now that CNAs are more limited when compared to LPNs. But that does not make them any less valuable than LPNs. They just have different roles. CNAs focus on rendering routine and basic tasks for the daily functioning of patients such as performing ADLs. They are under the direction and supervision of the LPN or RN. The LPN meanwhile can perform all the tasks that CNAs do. But by virtue of their education and nursing license, they are permitted to perform more invasive tasks.

While laws and regulations specify the distinction between CNA and LPN practice, in reality they may overlap in certain situations because they are both oriented toward the technical side of nursing. You can make the choice between going for a CNA or an LPN degree and certification. Both are considered quick paths to the nursing profession. If you don't mind doing routine work and love to interact with patients often at the bedside, then a CNA or LPN career is an excellent choice.

J.G. Enriquez has worked as a nurse for 4 years. He writes articles about nursing careers for BrainTrack.com.