Common Misconceptions About CNAs and LPNs

Some people get the impression that a certified nursing assistant (CNA) and a licensed practical nurse (LPN) are second-rate senior caregivers. Sandy Pellegrine strongly disagrees. Sandy and her husband, Jim, co-own Right at Home in Foxborough, Massachusetts, a senior care agency that serves communities southwest of Boston. Having worked as a CNA and an LPN, Sandy is quick to applaud both challenging healthcare jobs.

“I’ve heard people say, ‘Oh, I’m just an aide,’” says Sandy. “And my response is, ‘You are not just an aide. You are the real hands-on person who regularly get to see and know the care clients. Your job is important. Because without you, many seniors would not be able to age in place right at home.’”

The Pellegrines opened their Right at Home office in 2007 when Sandy was working as a CNA at a local hospital emergency room. The fast-paced ER work included transporting patients for diagnostic tests, cleaning patients, and restocking rooms. As she has served in multiple roles in healthcare and home care over the years, Sandy would like to help debunk misconceptions about CNAs and LPNs.

Misconceptions About CNAs

You’re in a low-level job and do little work.

“As a CNA, you have to love people and you have to want to help people,” says Sandy. “You are not going to get rich working as a CNA — you are really there to work with people at their worst moments and to try to make things better for them. The work is more fulfilling and rewarding than monetary.” Although a CNA is not the highest-paid position in the healthcare field, the work brings flexibility in hours and allows for learning the ropes and further study to pursue a nursing license or degree.

And the workload? The care shift can vary depending on the client’s health condition and care needs, whether working at a hospital, care facility or private home.

"People often choose to be a CNA to serve people,” Sandy says. “It’s not because they tried and failed nursing school. From a training perspective, the attendants, aides and CNAs can start a new career in a relatively short amount of time."

You become a CNA because you can’t become a nurse.

“People often choose to be a CNA to serve people,” Sandy says. “It’s not because they tried and failed nursing school. From a training perspective, the attendants, aides and CNAs can start a new career in a relatively short amount of time.” CNA applicants must have a GED or high school diploma before starting specific CNA classroom and clinical training. Depending on state requirements, the CNA student completes an 8- to 16-week course to earn a CNA certification. A CNA focuses more on the medical aspect in caregiving, and a personal care attendant (PCA) or home health aide (HHA) concentrates more on the tasks for home management, such as cooking or basic household upkeep.

CNAs are involved in the direct care of individuals, including bathing, dressing, feeding, toileting, and reporting observations of a care client’s physical symptoms and behavior. Assisting with personal hygiene is only a small part of a CNA’s work. “Because our aides and CNAs handle the day-to-day care, they are the eyes and ears, and they work to make sure clients can stay in their home,” Sandy emphasizes.

You basically clean up people when they vomit or soil themselves.

CNAs are involved in the direct care of individuals, including bathing, dressing, feeding, toileting, and reporting observations of a care client’s physical symptoms and behavior. Assisting with personal hygiene is only a small part of a CNA’s work. “Because our aides and CNAs handle the day-to-day care, they are the eyes and ears, and they work to make sure clients can stay in their home,” Sandy emphasizes.

You are a nurse and responsible for ongoing care decisions.

CNAs are not nurses and remain under the ongoing supervision of licensed practical nurses or registered nurses. CNAs assist nurses and physicians who are legally responsible for the medical care of their patients.

Misconceptions About LPNs

You are not a real nurse.

Licensed practical nurses, also known as licensed vocational nurses, attend nursing school for typically one to two years before passing an academic skills test and a state nursing board licensure exam. LPNs do not have a bachelor’s degree in nursing like a registered nurse (RN), but LPNs are still dedicated and accomplished nurses. “LPNs may not have as much schooling on the theory behind some health conditions, but I think with experience, LPNs learn to see the whole picture,” explains Sandy, who serves as one of two LPNs with Right at Home.

You can’t do most things a registered nurse can.

While an LPN is under the supervision of registered nurses or physicians, an LPN completes many of the same job responsibilities as an RN, depending on the regulations in each state. Common LPN tasks include taking vital signs, administering medicine or injections, changing bandages, inserting catheters, and reporting status updates. Also, LPNs and RNs are there to be a listening ear and to lend emotional support to their care recipients and their families, an important aspect for all patient situations.

“To have a good home health/home care agency, there has to be a good balance of responsibilities and a good team,” Sandy adds. “Everyone has to work together to make it work well. The most rewarding things for all of us are the people we care for and knowing that we are making a difference in their lives. Many of our clients would not be able to stay home if aides, CNAs and nurses were not there together helping.”

*Further information regarding the nursing hierarchy:
An LPN in the U.S. generally works under the direction of an RN. But, as regulations vary, the Nurse Practice Act offers a complete picture of the hierarchy of healthcare professionals in all 50 U.S. states.

The Nurse Journal ranks RNs next in the healthcare hierarchy after physicians. RNs can diagnose and treat patients, but LPNs cannot. However, many experienced LPNs have obtained the experience and training to identify a patient's condition. LPNs are healthcare professionals who are vital to patient care.