Q: My mom is in the hospital recovering from heart surgery. Her care has been good [other than a bedsore which was successfully treated] but it has been an “Alphabet City” in her room. I know that her nurse is an RN, but what does CNA, LPN, PA, NP, and WOCN stand for and what are their jobs?
A: A hospital stay can be confusing and at times frustrating especially when it seems that everyone walks into the room with a stethoscope draped around their neck. Your mom is being seen by a variety of health care professionals with varying degrees of education and significant differences in the nature of the care they are permitted to deliver. The specifics can vary from state to state but are closely aligned. In New York for example, by way of educational and training requirements, the rungs up the ladder are CNA [Certified Nursing Assistant], LPN [Licensed Practical Nurse], RN [Registered Nurse], WOCN [Wound Care Nurse], PA [Physicians Assistant] and NP [Nurse Practitioner].
Everyone treating your mom must wear an identification badge with their name and professional title displayed. It's the job of the CNA to assist the RN or LPN with her day-to-day activities such as bathing, dressing, eating, and toileting. The LPN also works under the direction of the RN or medical staff and may give medications, record vital signs and, with additional training, administer IV therapy. The LPN’s “scope of practice” is greater than the CNA but less than the RN. Of course, an RN is the mainstay of nursing practice. The RN assesses patients, identifies complications, intervenes on their own or with the other members of your mother’s health team for additional treatment, helps coordinate her care, administers medications, and performs all routine nursing services. The WOCN is an RN who is also certified in “wound and ostomy care.” (The WOCN would have been requested by the RN to see your mother for treatment of her bedsore.) A PA is usually someone who has worked in a health area such as a paramedic, lab tech, or ambulance emergency medicine and has then taken graduate courses in order to obtain PA certification. A PA must work under the supervision of a physician and may examine, diagnose, and treat. The NP starts off as an RN who then obtains a graduate degree as a Nurse Practitioner. Like a PA, the NP may diagnose and treat illnesses but it only needs to be “in collaboration” with a physician, and in a specifically designated specialty, which in your mom’s case could be Adult Care, or perhaps Gerontology.
Our best advice: ask questions, understand the answers, and be an advocate for your mom, if needed.