Registered Nurse (RN) and Certified Nursing Assistant (CNA) Comparison

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How does working as a registered nurse (RN) compare to working as a certified nursing assistant (CNA)? Having worked as both, I can give somewhat of a comparison. However, of course working as either can be vastly different depending on where you work.

Pay  Already a CNA?  Duty  Responsibility  Nurse Practice Act  Thoughts?

Pay Differences

Let's just get this one out of the way. Yes, nurses typically get paid more. But money isn't everything and shouldn't be the ultimate determining factor. In fact, if you are looking to the medical field in order to make a quick buck, you're looking in the wrong place. We earn every penny we make and many argue that we don't get paid enough.

How much more? It varies greatly depending on where you work. The difference is typically significant. You will more than likely earn over twice as much working as a nurse as you would working as an assistant and that's just the base pay. Shift differentials, overtime, and float pay is also significantly higher.

If pay wasn't a factor, which would I prefer? This is such a difficult question that I still haven't decided on a particular stance. I will say that nursing is much more stressful, at least mentally. CNA work is more physical. I have had overwhelmingly demanding shifts working as both.

Are You Already a CNA?

Should you become a nurse if you are already a CNA? The short answer would be absolutely but it depends on the person. If you enjoy your work and plan to be in the medical field for many years to come, I would say go for it. The amount of schooling required, although extensive and stressful, is well worth it in the long run.

If you ask some CNA's, they will tell you that they wouldn't want to work as a nurse for various reasons. Nurses often say the same about working as a CNA. Each role isn't for everyone, although nurses should be willing to do any and all CNA work as needed. Failing to do so can cause controversy in the workplace.

Duty Differences

Nurses have to tamper with lots of medications, needles, and every type of wound imaginable. If you have a fear of dealing with any of these, you will have issues. Although some people can overcome this fear if their desire is strong enough. It is also your duty, to do the majority of the charting. You typically have to do an assessment at least once a shift if not multiple times a shift.

As a CNA, you still have to deal with every bodily fluid imaginable such as urine, feces, blood, emesis, etc. If you can't handle such things, it would be next to impossible to work as either. You have to have somewhat of a strong stomach. You can't be gagging and making disgusted looks in front of your patients. You have to stay professional.

Responsibility Differences

The biggest differentiator between the two is the responsibility factor. There are many more ways for a nurse to make a mistake. Many things regarding patients can fall back on their nurses. Their life is in your hands and one mistake can take it from them. Just typing that makes me shudder but it's the truth. I have definitely been more stressed since I became an RN.

If the CNA makes a mistake, it falls back on the nurse, even if they weren't in the room. It becomes the nurses mistake. They are responsible for what the CNA does and doesn't do. They are the ones who has to make sure the job is done right. That's why nurses are supposed to delegate to the CNA.

That's not to say CNAs don't have any responsibilities. They can get into heaps of legal trouble just like nurses. They can still go to court, get sued, and of course get fired too. The difference is that the nurse has more responsibility regarding their patients.

The CNA relays information to the RN. They do not make judgement calls. If something needs to be changed regarding the patient's care, it is the RN's responsibility to make that change. The assistant simply follows commands and alerts the nurse if they recognize a change in the patient's status. If a change in care needs to be made, the RN is responsible for relaying the message and making sure the change is performed correctly.

Excerpt from the Nurse Practice Act

"Practice of a certified nursing assistant (CNA) means providing care and assisting persons with tasks relating to the activities of daily living. Such tasks are those associated with personal care, maintaining mobility, nutrition and hydration, toileting and elimination, assistive devices, safety and cleanliness, data gathering, reporting abnormal signs and symptoms, postmortem care, patient socialization and reality orientation, end-of-life care, cardiopulmonary resuscitation (CPR) and emergency care, residents' or patients' rights, documentation of nursing-assistant services, and other tasks that a certified nurse assistant may perform after training beyond that required for initial certification and upon validation of competence in that skill by a registered nurse (RN). This subsection does not restrict the ability of any person who is otherwise trained and educated from performing such tasks."

What does this mean exactly? In simple terms, it means a CNA can be trained to do certain tasks by the RN even if they weren't initially trained to perform that task. The catch is that the nurse has to provide appropriate training and the assistant has to feel comfortable doing it. The task can't be too complex requiring judgement or independent thinking. When in doubt, the CNA should receive clarification before performing the task.

What are your Thoughts?

What similarities and differences did I miss? Are you an RN, CNA, or neither? If you are one, how long have you been working? Which do you prefer to work as? What advice would you give someone who is thinking about joining the medical field? Let me know in the comments below.

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