The Different Levels Of Nursing

Interview with a Certified Nursing Assistant (CNA)

Q. How did you become interested in becoming a CNA?"

My first job out of high school was an entry-level patient care technician at a retirement home. I enjoyed working with the patient residents and wanted to help them more. So the facility trained me and paid for my CNA license.

Q. What does a typical day at work look like for you?

The duties of a CNA depend on where you work (nursing home, rehab center, hospital, etc.), what shift you work (morning vs. evening), and what your state department of health permits.

For day shift, after clocking in, the CNA receives their assignment and briefly reviews the patient's care plan for any pertinent information. Then they assist with patient care, such as helping patients out of bed, dressing, grooming, and feeding. Morning vital signs are also collected at this time, as well as how much the patient ate, and the results reported to the nurse for documentation.

After lunch, the CNA assists with activities, such as range of motion, or helps transport patients to therapy or other procedures. The CNA also stocks medical supplies, changes linens, provides ice water, and answers patient call lights. Different hospitals and facilities will have unique requirements and responsibilities for their CNAs. Essentially, CNAs help perform critical tasks that ensure patients are well-cared-for and safe during their hospital stay.

Q. What are the benefits of being a CNA?

Working as a CNA is a very important role among the healthcare team. One of the biggest advantages of being a CNA is the autonomy. If you enjoy caring for others, keeping a clean environment, and building relationships among your coworkers and patients — all with less than six months of training — then being a CNA is a fantastic option.

Q. What are the challenges of being a CNA?

You need to be able to physically handle people, as well as work with different equipment such as mobility aids, wheelchairs, and therapy beds. You also need to be in decent shape and be able to stay on your feet for long periods of time. Being a CNA is a physically demanding job that requires lifting, pushing, and pulling several patients a day while ensuring proper body mechanics and patient safety.

Q. What advice would you give to students interested in becoming a CNA?

Make a list and visit the resident care facilities and hospitals in your area to inquire about job openings and requirements. Decide where you would like to see yourself working and if there are opportunities for growth and career advancement. It's also important to consider the distance of the facility from home and what the commute would be like during the times you arrive and leave.

Interview with a Licensed Practical Nurse (LPN)

Nicholas McGowan is a registered LPN, you can read more about his background in his bio above.

Q. How did you become interested in becoming an LPN?

After working as a CNA, I wanted to understand more about the health of my patients and provide more advanced care for them. An LPN was the next option. I enrolled in a local community college program, and after one year, I earned my license to be an LPN.

Q. What does a typical day at work look like for you?

Depending on the facility you practice at (clinic, rehab center, long-term care, sub-acute, or hospital), the job duties vary. After clocking in, the LPN gets their patient assignment and reviews the patient's chart and plan of care after receiving a report from the previous shift.

The LPN then conducts patient rounds by checking vital signs and giving morning medications. Advanced procedures such as tracheostomy care, suctioning, and wound care are all performed by the LPN. Some states permit LPNs to start IVs and hang fluids with an advanced IV certification. In the afternoon, the LPN follows up on lab results and any new physician orders for treatment or medication. At the end of the shift, the LPN ensures the patients' plan of care is met and provides a report to the oncoming shift.

Q. What are the benefits of being an LPN?

LPNs enjoy greater autonomy and flexibility in caring for patients. If you want to learn more about the human body, illness, and treatment, as well as provide more advanced care for your patients without going to school for over three years, then becoming an LPN is a great option. Depending on your state, you can earn extra certifications to provide advanced treatment, as well as earn competitive wages and benefits.

Q. What are the challenges of being an LPN?

You need to be able to recognize if a patient is deteriorating and communicate effectively with your colleagues. There is an escalation process, and the patient depends on the LPN to respond well to situations that require critical thinking and communication. This can be a struggle for nurses who don't work well with a team.

Q. What advice would you give to students interested in becoming an LPN?

Make sure you leave yourself opportunity for career advancement. In some states, the pay differential between LPNs and RNs is very large, with the only difference being six more months of school for an RN license. For some who are on a strict timeline and a tight budget, six months might seem like a long time. But for the majority, six months goes quickly when you consider the differences over the lifetime of your career. Nonetheless, if you find a fulfilling role at a facility where LPNs are valued, highly regarded, and well-compensated, you'll never have to "work" a day in your life!

Interview with a Registered Nurse (RN)

Q. How did you become interested in becoming an RN?

My grandmother, Bettie Short, was a nurse, and she inspired me to become one. Her first career was being a homemaker, and after raising her children, she went to nursing school.

Q. What does a typical day at work look like for you?

I have worked in varied clinical settings, and right now I am working in telehealth. A typical day for me includes monitoring a panel of patients with chronic health conditions to help manage these conditions better and prevent hospitalizations. I often review blood pressure, heart rate, weight, and oxygen saturation, amongst other things. Based on trends and abnormalities, I will contact the patient to assess their condition and their physician for follow-up interventions. Trust me, there is never a dull moment, and I enjoy every minute of it.

Q. What are the benefits of being an RN?

The benefits of being an RN are endless. Besides being in the top-ranked trusted profession, you have the option to travel as a nurse, become an entrepreneur, become certified in a specialty, advance in your career and education, and have job security.

Q. What are the challenges of being an RN?

The biggest challenges of being an RN are the physical demands, emotional burnout, inflexible schedules, and long work hours. Plus, at some point, every nurse feels unappreciated by their coworkers and employers.

Q. What advice would you give to students interested in becoming an RN?

To become an RN, I would advise interested students first to seek nursing schools they would be interested in attending. Learn more about their admission criteria, prerequisites, and program requirements. Preparing for nursing school is just as important as attending nursing school.

During nursing school, time management is a priority. Connect with your peers and instructors, be a sponge at clinical learning as much as you can, and never be afraid to ask questions. If you encounter any detours along this journey, that's ok; keep going.

Interview with an Advanced Practice Registered Nurse (APRN)

Q. How did you become interested in becoming an APRN?

I was always interested in becoming an APRN, but was unsure if it was a good fit since my initial long-term goals did not align with the role of an APRN. At the time, I was not an entrepreneur and really did not know what path I was going to take. I initially thought I wanted to be a chief nursing officer (CNO), but soon realized that was not the best position. I ultimately wanted to leave the hospital setting and work within the community.

Eventually, I started a permanent makeup studio, and an opportunity presented itself for me to open a MedSpa. Although I could open a MedSpa under my nurses' licence with a collaborative physician as my medical director in the state of California, I felt it would be ideal if I obtained my advanced degree as well.

Q. What does a typical day at work look like for you?

As a MedSpa owner, it is definitely not the daily life of a typical APRN. As an entrepreneur, there is a lot of time spent working on the business. For example, it is my responsibility to make sure business financial goals are met, support the team, train the team, and see patients.

On any given day, I see approximately 10-15 patients, and I like to work as a clinician within the business about 3-4 days a week. I have colleagues who work in primary care, and they approximate about 30-40 patients per day, just to give a rough comparison. The upside to that is that they can go to work and not think about the operations of the business; unfortunately, I do not have that luxury.

Q. What are the benefits of being an APRN?

Interview with a Nurse Practitioner (NP)

Q. How did you become interested in becoming an NP?

I became interested in learning about nurse practitioners at the same time that I learned about ecstasy, a club drug also known as "molly." At the time, the concerns of overdosing on ecstasy were similar to the concerns we have about opioids today. Many institutions were forced to address these concerns on college campuses as a form of prevention, and my school's NP facilitated a campus town hall meeting on ecstasy during my sophomore year.

Coming up as a first-generation American, I was only given three options as targeted professions: doctor (physician), lawyer, and engineer. I was on track for my biology/pre-medicine degree, and then this town hall meeting introduced me to another option.

I wanted to learn more about NPs and how they were able to function in the role of a physician without being one. This NP was knowledgeable and spoke with us at a level we could understand as young adults. Luckily, she was married to my chemistry professor, which opened up an opportunity for me to further build my relationship with her. This rapport developed into a mentorship, and I began to volunteer at the student health center to learn all that I could about the day in the life of an NP.

Q. What does a typical day at work look like for you?

I typically begin my day the night before to ensure that the next day I am in a productive mental space for the unexpected, such as procedures or walk-ins. I start with reviewing my appointment calendar to see the various chief complaints for the day. They're also called "patients concern" or "chief concern."

As an FNP, I primarily care for and treat common conditions such as colds, high blood pressure (hypertension), diabetes (diabetes mellitus), and obesity and conduct preventative exams. My patient load and duration of visits depend on the reason for the visits. On average, if there are little to no preventative visits (a review of one's overall health) scheduled, I see 25-30 patients in a day.

For patient visits that are follow-ups, I review their charts from the previous visit or more depending on the level of care they require. For new patients, I review their questionnaires to learn a little about them before I meet them. This practice mentally prepares me for the next day.

The day of the visit, I meet with my nurse to discuss the plan for that day and lay out what tools, tests, or referrals I anticipate for each patient. Of course, what the patient shares, what I assess, and what I decide during the visit may be different from what I anticipate. Then we proceed with seeing the patients for the day. I document the visit and submit prescriptions via e-scripts as I go because it is impossible to remember everything throughout a busy day to document those important details later.

Depending on the visit type and the patient's questions, a visit can last 10-45 minutes. I am intentional about ending each visit with their questions answered. Having patient education handouts ready is a good way to ensure this when you have a full day.

When it comes to self-care, I go to bed early to get at least eight hours of rest so I can be the best for my patients the next day. I bring my lunch to work so I can get the most out of my break, as there is no time to leave the practice to get lunch and come back. I prefer not to work through my breaks to avoid becoming burnt out in the long run.

Q. What are the benefits of being an NP?

The benefits of being an NP are individualized and can vary from the rewarding salary to the impact you have on someone's life. The salary allows me to invest in building a business while living comfortably. It is also a bonus to the pleasure I get helping others become actively involved in the care and witnessing their transformations. I enjoy the flexibility of time so I can also focus on being a wife, a mother, and working on my personal goals.

Q. What are the challenges of being an NP?

The three biggest challenges for today's NP are transitioning into practice, educating the public on the roles of NPs, and finding a collaborative physician.

In any field, transitioning from a student to a professional is challenging because there is a lack of confidence, even though you can do the job. It is even more challenging for NPs because healthcare involves life or death. Although NPs can do many tasks similar to physicians, they have fewer hours of training in doing the same thing, which increases their risk for malpractice. To avoid mishaps, more and more NPs are applying to residencies to get additional training and boost their confidence as new providers. Other new NPs seek out mentors as support during their transition.

Nurse practitioners are master- or doctorate-prepared registered nurses that assess, diagnose, prescribe, treat, order some diagnostic tests, refer, and evaluate patient care. Today, NPs are known as the nation's primary care providers of choice. There are over 290,000 NPs, mostly practicing as family nurse practitioners. Yet, many patients have never experienced receiving care involving an NP. Continuous education provided by NPs at the beginning of their visits with patients is one way to introduce their role. Another way is for practices to introduce new NPs through a newsletter, including the list of services the NP can provide.

Many states require NPs to practice with a collaborative agreement. A collaborative agreement is an agreement between a physician and NP with the same specialty. A collaborative physician does not have to be on-site or actively engage in the patient's care. The challenge is that there has been an exponential growth of NPs entering the workforce in the past ten years, and there are not enough physicians to serve as a collaborative.

Each state has a limitation on the amount of NPs a physician can have an agreement with. For instance, in the state of Georgia, the ratio of one collaborative physician to NPs is 1-to-4. In addition, it is good practice to enter into agreements with physicians you already have a relationship with. Some NPs may not have physicians of the same speciality in their professional network.

Q. What advice would you give to students interested in becoming an NP?

I would advise students to start working towards becoming an NP before you start NP school. This includes shadowing or volunteering with an NP at a local practice to get a feel for what the role will feel like for you. This saves you time and tuition money. It is also important to mention that there isn't an exact formula for becoming an NP, but there are questions students must have an answer to before embarking on the journey, such as:

• Did you do your research (whether it's interviewing an NP or reading credible resources)?
• Did you ask the right questions before deciding on an NP specialty?
• Is this a good time in your life to endure the rigor of a program?
• How will you pay for NP school?
• Do you plan to work full-time?
• What do you plan to do in the next five years with your NP degree?

Becoming an NP was one of the best decisions I made and I hope my experience inspired you to join this rewarding profession.