The field of nursing is a constantly-growing field, with more layers of nursing professionals created as the health care system changes.
Nurses historically served as the middleman between patient and doctor, providing compassionate care and education to clients while the medical physician handled diagnosis and medication orders. But times have changed. Today, some nursing professionals are able to make medical diagnoses and order medication for patients, depending upon the education, training and certification they hold.
Here is an outline of nursing personnel ranked from jobs requiring the least amount of training and responsibilities to the greatest amount of training and responsibilities.
Nursing Aid / Nursing Assistant (not technically considered a ‘nurse’)
Certified Nurse Assistant (CNA) (certified, but not technically considered a ‘nurse’)
Doctor of Nursing Practice (DNP) (Certified Registered Nurse Anesthetists will need DNP after 2015)
What are the major differences in nurse status and job requirements for the various nurse categories? Starting at the lowest end of the scale, there are two categories of nurse assistants who are vital to the field of medical care but they are not technically considered ‘nurses’.
– do not hold a license, are not considered ‘nurses’ –
Nursing Aid / Nursing Assistant
Although not normally considered in the nursing echelon, nursing aids perform vital patient care in facilities such as nursing homes and long care facilities. A nursing aid has received on-the-job training in order to handle day to day routine nursing care.
Some of their duties include:
- Performing personal hygiene care for patients (cleaning and bathing)
- Helping patients use the toilet and dress
- Repositioning patients to prevent bed sores
- Assisting with transition from bed to wheelchair
- Relaying information to nurses
- Checking vital signs
- Serving meals and helping patients eat
A certified nursing assistant has obtained professional training resulting in certification. A CNA serves as the connection between the patients in a facility and the registered nurses assigned to their care, as the CNA spends more time with the patients and may notice changes in medical condition that need to be relayed to the registered nurse or other medical personnel in charge.
Typical duties of a CNA include:
- Taking vital signs on a regular basis, which includes blood pressure and temperature
- Charting vital signs and other information
- Rendering assistance with personal hygiene performance such as bathing or showering
- Repositioning the patient on a regular basis to prevent the development of bed sores
- Performing range of motion exercises with patients with limited mobility
The remainder of the descriptions regarding the differences between categories of nursing professionals will cover individuals who are ‘nurses’ in the field of nursing. Here is some information regarding the different levels of nurses, including their typical job responsibilities, limitations and duties.
Hierarchy of Nursing Professionals
LPNs are licensed practical nurses. LVNs are licensed vocational nurses, which is the designation given for the same position in California and Texas. These licensed professional work under the direction of another medical professional such as an RN or doctor. LPNs duties vary from state to state. In certain states, an LPN may give medication to a patient or even start an IV (intravenous drip). In other states they are not allowed to do this.
Typical duties include:
- Collecting information on patient history with appropriate charting
- Performing wound cleaning, care and changing of dressings
- Inserting catheters and performing catheter care as needed
- Providing ostomy care
Registered nurses are medical professionals who have received advanced education and training in the field of nursing and have passed a nursing exam in order to become licensed. They provide direct patient care and education to patients and their families, working with other medical professionals to ensure the patient received the best care possible. RNs provide major medical care to patients in settings that include medical offices, clinics, urgent care centers, hospitals, long term care facilities and more.
Typical duties include:
- Taking detailed patient medical history
- Administering medication orally, by syringe or through an IV
- Starting intravenous drips (IVs)
- Charting changes in patient’s medical condition
- Consulting with and making recommendations to the primary physician
- Operating specialized medical equipment such as monitors
- Providing other medical care to patient as deemed necessary
- Educating patient and family members about management of medical condition after patient returns home
Advanced Practice Registered Nurses refer to registered nurses with a Master’s degree who have met additional training requirements such as specific clinical practice. Some of the classifications that fall under this category include:
A Nurse practitioner has completed advanced training and educational requirements beyond that required for an RN.
Typical job duties include:
- Making medical diagnoses of illness
- Providing childhood vaccinations
- Conducting healthcare physicals
- Performing certain surgical procedures
- Developing treatment plan for illness
- Ordering lab work such as x-rays and blood work
- Prescribing certain medications
A certified nurse midwife assists women with all aspects of gynecological and obstetric care. They work in primary care offices, mid-wife practices and private settings.
Their duties include:
- Performing physical exams and prescribing medication
- Ordering lab tests
- Giving prenatal care
- Assisting mothers during labor and delivery of births that are low risk
- Providing education and medical care after birth as necessary
In cases where Caesarean section becomes necessary or the birth mother requires pain medication such as an epidural, the patient must be transferred to the care of a medical doctor.
Certified registered nurse anesthetists administer anesthesia to surgical patients and monitor patients post-surgery. CRNAs are now allowed to practice after receiving a Master’s degree as well as meeting other requirements, but the requirements are going to change in 2015 to require all new CRNAs to hold a DNP degree.
Typical job duties include:
- Taking detailed health history from patient prior to surgery
- Administering anesthesia during surgery
- Ensuring that patient handles anesthesia well during surgery
- Checking patient after surgery
DNP Doctor of Nursing Practice is a doctoral degree designed to prepare nursing professionals to perform more responsibilities within their job, actually making diagnoses in certain circumstances and setting up a course of treatment for patients. The DNP is not the same as the doctoral degree required for physicians. The DNP degree will be required of CRNAs beginning in 2015. Currently there is also a recommendation for implementation of a nationwide requirement that nurse practitioners be required to hold a DNP in order to enter into practice.
The field of nursing is wide open to anyone interested in becoming involved in providing caring and compassionate medical care to individuals suffering from medical illness, disease or infirmity. As the national population continues to rise, the need for medical professionals will necessarily rise, ensuring that nursing occupations will always be a viable option for someone interested in employment in the medical field.
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