Many registered nurses (RNs) claim that their pre-nursing experience in healthcare was a tremendous benefit to them performing well in nursing school, passing the NCLEX-RN and easing into the nursing profession. There are many solid choices of entry-level roles for those who are considering a career as a Registered Nurse and need a stepping-stone plan that includes working in healthcare while enduring prerequisite courses and nursing school. Two common roles are that of the Certified Nursing Aide/Assistant (CNA) or Licensed Practical (or Vocational) Nurse (LPN or LVN). However, of these two pathways to becoming a thriving RN, which one is the best?

Certified Nursing Assistants are healthcare team members who are trained to provide basic care for patients' activities of daily living (ADL) such as bathing and grooming. CNAs are also trained in how to measure vital signs like blood pressure, temperature, pulse, and respiration. As part of the healthcare team, the CNA's scope of employment is designed to provide support to the RN and LPN staff by assisting patients with tasks such as getting to the bathroom, walking in the hallways, answering call lights, refreshing bedside water and assisting patients with eating.

RELATED: CNA Classes & Programs

CNAs are certified by the state in which they work after completing a state-approved training program and passing a two-part exam that includes written and practical testing. The cost of a CNA program ranges from free to $2,000 depending on the location program details. The 240-hour curriculum and coursework for nursing assistants is monitored by the Commission on Collegiate Nursing Education (CCNE) and may include:

  • Communication Skills
  • Professionalism Skills
  • Medical/Surgical Asepsis
  • Body Mechanics
  • Resident Rights
  • Rehabilitation Care
  • Restorative Care
  • Emergency Procedures
  • Catastrophe Prevention
  • Patient Care Skills
  • Death and Dying
  • Vital Signs
  • Resident Care Procedures
  • Weights and Measures
  • Nutrition
  • Observation and Charting

Once certified, CNAs work in a variety of settings including home health, in-home support services, hospitals, long-term care facilities, and rehabilitation facilities. The average median annual salary for nursing assistants in 2018 was $ 28,530 with a job growth rate expected to increase around 9% each year, according to the United States Bureau of Labor Statistics. Considering a commitment of 6 weeks of full-time coursework and a salary range that continues to improve each year, the CNA route to becoming an RN can be a quick and affordable option.

Licensed Practical Nurses (also referred to as Licensed Vocational Nurses in some states) are required to have additional training and coursework that is more in-depth than that of a CNA. LPNs are healthcare team members who have their own scope of practice that is separate from the RN, and they cannot practice independently without clinician or RN oversight. The LPN's role can be task-oriented such as performing wound care, inserting a urinary catheter, administering medications (except for intravenous in most states) or collecting lab specimens. LPNs can also be in charge of multiple patients who are medically stable in a long-term care facility and execute the plan of care created by RNs, nurse practitioners, or physicians. Since the LPN has less training in complex medical issues, their scope of practice is limited to basic assessment and reporting skills.

LPNs are licensed in the state in which they practice after completing an accredited LPN program and passing the NCLEX-PN exam. Programs for LPN students will vary depending on the area and individual programs. For example, courses taught through an adult learning format where no college credit is awarded are typically less expensive than LPN programs at a technical school that also earn the student an associate of science (AS) degree. Students can complete LPN school in as little as 12-18 months which includes classroom didactic training and can cost anywhere from $4,000 to $20,000 depending on the program. Courses for the LPN program (regulated by the Accreditation Commission for Education in Nursing) include what is learned in the CNA course as well as:

  • Fundamentals of Nursing
  • Human Biology
  • English Composition
  • Microbiology
  • Pharmacology and Drug Calculation
  • Nutrition and Diet Therapy
  • Introduction to Psychology
  • History of Nursing
  • LPN Scope of Practice
  • Overcoming Barriers to Therapeutic Communication

Once licensed, LPNs can work in any healthcare setting such as hospitals, emergency rooms, outpatient clinics, home health, and long-term care or rehabilitation facilities. The average salary for an LPN varies by state and region, but according to the Bureau of Labor and Statistics, LPNs earned a median wage of $46,240 in 2018 and is expected to grow by 11% in the next 10 years.


Amanda Bucceri Androus, RN, BSN
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