# Different types of nurses?



## Jim37F (Jun 17, 2013)

What's the difference between all the different types of nurses? I.e. RN, LVN, Clinical Nurse Specialist, Discharge Planner, etc? What's their scope of practice, general duties, where they're generally found, etc. is there a "pecking order" in terms of level of care (for example I know a Paramedic is higher than an AEMT, which is higher than an EMT-B and so on)

While I'm at it, where does a Physicians Assistant rank? And is there a difference between a Doctor and a Physician?


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## DesertMedic66 (Jun 17, 2013)

I'm sure there are member here who will be able to answer your questions (some members here are nurses), you may want to try:

http://allnurses.com/


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## Akulahawk (Jun 17, 2013)

Jim37F said:


> What's the difference between all the different types of nurses? I.e. RN, LVN, Clinical Nurse Specialist, Discharge Planner, etc? What's their scope of practice, general duties, where they're generally found, etc. is there a "pecking order" in terms of level of care (for example I know a Paramedic is higher than an AEMT, which is higher than an EMT-B and so on)
> 
> While I'm at it, where does a Physicians Assistant rank? And is there a difference between a Doctor and a Physician?


The Nursing pecking order is:

RN 
LVN 
CNA 


Discharge Planners, Clinical Nurse Specialists, and so on all have their own scopes of practice and they're trained specifically for those jobs after they've completed RN school. Each type of RN has their own scope of practice and what that is depends upon the training/education they've had. For instance, an ICU nurse may be allowed to do more things than a Med/Surg nurse because of the education received during their unit orientation. A discharge planner RN may not have started a line or given  meds in YEARS but would know all the facilities that are willing to take patients with a certain insurance provider and for what reasons. 

The RN can do the admission assessments, can push meds, hang blood, hang antibiotics, and so on. They can supervise LVN's and CNA's. They have the widest scope of the nurse levels. The LVN/LPN is a lower level and may be allowed to start IV's, hang blood with an RN, but may not be allowed to hang antibiotics or any other piggyback med. Primarily they "collect data" and actually can do MOST of what an RN does, but there are just some things that only an RN can do. A CNA does a LOT of the basic grunt-work of nursing. Bed changes, bed baths, toileting, vital sign collection, feeding, and so on. Each level can do the duties of the levels below, so an RN can do all the things a CNA can do... but a good CNA can make an RN's or LVN's life so much easier.

The PA is a "mid level" provider, as is a Nurse Practitioner. They fit between the Physician and the Nurse. PA's are completely dependent upon the Physician for their OK to work, though the level of supervision may vary. The NP _may_ be independent or _may_ be required to have a collaborative agreement with a Physician. This is state-dependent. The NP is also going to be very specialized, where the PA is more of a generalist but can still get more training in a specific area. 

As said before, go to HTTP://allnurses.com for MUCH more specific info about what each level of RN does and how all the specialties fit together.


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## JPINFV (Jun 17, 2013)

"Doctor" is an education title that in healthcare is generally limited to doctoral level providers with unrestricted licenses in their field (medical doctors can practice all of medicine, dentists can practice all of dentistry, etc). A "physician" is the proper term for a medical doctor. Historically, a surgeon was not considered to be a "physician," but physicians and surgeons have converged over the past 100 or so years. 

Physician assistants and nurse practitioners fall into the category of "mid-level providers." They provide medical care under a limited scope of practice when compared to physicians, but a greater and more independent level than other health care providers. Whether supervision/collaboration (same thing) should be required of mid-levels (specifically NPs) or not is a rather contentious issue in healthcare.


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## MountainMedic (Jun 18, 2013)

Take note that a CNA isn't a nurse, but a "certified nurse's aid." It's fairly analogous to an EMT-B tech working in an ER. Out east we had CNAs, out west we have EMT-B techs. I feel like the "tech" title commands more respect.


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## Bullets (Jun 18, 2013)

JPINFV said:


> "Doctor" is an education title that in healthcare is generally limited to doctoral level providers with unrestricted licenses in their field (medical doctors can practice all of medicine, dentists can practice all of dentistry, etc). A "physician" is the proper term for a medical doctor. Historically, a surgeon was not considered to be a "physician," but physicians and surgeons have converged over the past 100 or so years.



This especially confuses our newer employees, there are a few senior nurses who are educational doctors, so i jokingly call them Doctor when i see them even though they are RNs


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## VFlutter (Jun 18, 2013)

Another topic that can be confusing is the various Masters of Nursing degrees and Advanced Practice roles. Not all MSNs are Nurse practitioners.

For example a Clinical Nurse Specialist is a RN who holds a MSN that focuses on clinical education, evidence based practice, and research. They do not have prescriptive authority or any advanced clinical privileges. 

The term "Nurse Practitioner" or "APRN" is thrown around loosely but there are many differences. A Family Nurse Practitioner is going to have a different scope of practice and training than an Acute Care Nurse Practitioner. And a CRNA, although technically an APRN, is totally different from the others.


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## Brandon O (Jun 18, 2013)

JPINFV said:


> "Doctor" is an education title that in healthcare is generally limited to doctoral level providers with unrestricted licenses in their field (medical doctors can practice all of medicine, dentists can practice all of dentistry, etc). A "physician" is the proper term for a medical doctor.



And both for reasons of form (cf: only one "captain" on a ship) and reasons of clarity, the only people calling themselves (or letting others call them) "doctor" in a healthcare setting, unless it's otherwise patently obvious, should be medical doctors.


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## JPINFV (Jun 19, 2013)

Brandon Oto said:


> And both for reasons of form (cf: only one "captain" on a ship) and reasons of clarity, the only people calling themselves (or letting others call them) "doctor" in a healthcare setting, unless it's otherwise patently obvious, should be medical doctors.



I'll say that it really depends on level of authority. For example, I don't have a problem with a podiatrist calling himself a "doctor" when admitting and operating on foot cases. Of course podiatrists are much closer in terms of legal scope, liability, and education to physicians than advance practice nurses are.


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## Brandon O (Jun 19, 2013)

JPINFV said:


> I'll say that it really depends on level of authority. For example, I don't have a problem with a podiatrist calling himself a "doctor" when admitting and operating on foot cases. Of course podiatrists are much closer in terms of legal scope, liability, and education to physicians than advance practice nurses are.



Yeah... for a "doc equivalent" (DO of course, or yer dentist, podiatrist, etc) I think it's appropriate, except in the odd situation where it might cause actual confusion (the dentist responds with the trauma team!).

But a nurse with a PhD in English literature letting anybody call them "doctor" inside hospital walls... that's fraud in my eyes.


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## mycrofft (Jun 20, 2013)

JPINFV said:


> I'll say that it really depends on level of authority. For example, I don't have a problem with a podiatrist calling himself a "doctor" when admitting and operating on foot cases. Of course podiatrists are much closer in terms of legal scope, liability, and education to physicians than advance practice nurses are.



Had a bystander who said he was a doctor have an accident  victim lie down (well, scrunch down) in the back seat of a 66 Mustang because she had a headache. She started c/o neck pain and we had to extricate her from that back seat. The doctor was a podiatrist.


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## Arovetli (Jun 20, 2013)

mycrofft said:


> Had a bystander who said he was a doctor have an accident  victim lie down (well, scrunch down) in the back seat of a 66 Mustang because she had a headache. She started c/o neck pain and we had to extricate her from that back seat. The doctor was a podiatrist.



i feel sorry for the beautiful car.


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## mycrofft (Jun 20, 2013)

CNA's do not equate to EMT's in nearly any way except being dedicated to patient care and concern. 

RNs working under protocols or following orders can use data to make decisions. They can be held accountable for following some sorts of orders rather than questioning them. LVNs or LPNs can perform many technical aspects of care even sometimes per their own protocol, but they cannot make decisions and are harder to sue. CNA's follow orders and report to the RN if something doesn't add up. Employers will try to use LVNs as RNs and RNs as everything that costs more. RNs often like the additional duties and "job enrichment" and wind up being anything from case managers to advice nurses to helicopter caregivers to  basic floor care to managing an entire facility. We're like silicone and duct tape, go anywhere and try to fix anything, cheaper.


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## broken stretcher (Jul 13, 2013)

Well theres cute nurses, theres ugly nurses, skinny nurses, fat nurses, big booty nurses, *****y nurses, and nice nurses, nurses who love ems providers, and nurses who think we all have the IQ of a plastic fork.


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## VFlutter (Jul 13, 2013)

broken stretcher said:


> Well theres cute nurses, theres ugly nurses, skinny nurses, fat nurses, big booty nurses, *****y nurses, and nice nurses, nurses who love ems providers, and nurses who think we all have the IQ of a plastic fork.



Iz a cute nurse?!? :wub:


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## DesertMedic66 (Jul 13, 2013)

Chase said:


> Iz a cute nurse?!? :wub:


Yes, yes you are :rofl:


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## Jim37F (Jul 25, 2013)

Is there any difference between a CCTRN and a MICN?


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## VFlutter (Jul 25, 2013)

Jim37F said:


> Is there any difference between a CCTRN and a MICN?



Critical care transport nurse and Mobile ICU nurses are pretty much the same thing just two different classes/certifications.


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## usalsfyre (Jul 25, 2013)

Chase said:


> Critical care transport nurse and Mobile ICU nurses are pretty much the same thing just two different classes/certifications.



Depending on the jurisdiction there is VAST, VAST difference...


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## hogwiley (Jul 25, 2013)

I'll add that although LPNs/LVNs are the lowest rung on the nursing pecking order(unless you count CNAs), they still usually have more medical education than even a Paramedic, at least in most of the programs I've seen. 

At the Community College I go to the requirements for being admitted to the LPN program are almost the same as the RN program, and are well above the requirements for the Paramedic Program, and lasts the same amount of time as the Medic program (3 semesters). 

That's not to say Paramedics and LPNs are equivalent, as their roles are radically different.


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## Jim37F (Jul 25, 2013)

usalsfyre said:


> Depending on the jurisdiction there is VAST, VAST difference...



Ok because I've noticed that in the LA County protocols they tend to refer to being for either EMTs, Paramedics or MICNs, but most of the nurses I've worked with are CCTRNs


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## Akulahawk (Jul 26, 2013)

Jim37F said:


> Ok because I've noticed that in the LA County protocols they tend to refer to being for either EMTs, Paramedics or MICNs, but most of the nurses I've worked with are CCTRNs


MICN is a nurse that's been working in the ED for about 2 years and has decided to pursue the certification. Here in California, MICNs are usually the people that the Paramedics talk to at a Base Hospital to get Base Hospital Orders from. That's different from getting an order directly from a Base Hospital Physician. While they can go into the field, they may NOT give medical direction to a Paramedic. They aren't ICU nurses that go into the field. Despite the "Mobile" part of the title, MICNs normally only do a day or two of field observation every couple years, and typically stay in the ED otherwise, so they really aren't all that mobile.

A CCT-RN is (usually) an ICU nurse that's worked in the ICU for at least 2 years and is able to provide care to a patient during transport between medical facilities. Sometimes the CCT-RN is an ED Nurse that is knowledgeable enough to provide care during interfacility transport. The CCT-RN does not deal with giving care orders to a Paramedic in the same way that a MICN does, and may not actually know what a Paramedic can do. 

At least in California, there really is a vast difference between the two. 

Also, Nurses (even MICNs) normally don't count as EMT providers on an ambulance, at least as far as EMSA staffing is concerned. A CCT-RN ambulance must have 2 EMTs on board. If the RN is also certified as an EMT, that counts as the 2nd EMT. Go figure... :wacko:


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## Jambi (Jul 26, 2013)

For some reason I keep thinking of this while reading through all this.  No, I'm not comparing nurses to hippies, it's just the terms, names, and arguments of definition going on

http://www.southparkstudios.com/clips/103809/hippie-infestation


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## Jim37F (Jul 26, 2013)

Akulahawk said:


> .
> 
> Also, Nurses (even MICNs) normally don't count as EMT providers on an ambulance, at least as far as EMSA staffing is concerned. A CCT-RN ambulance must have 2 EMTs on board. If the RN is also certified as an EMT, that counts as the 2nd EMT. Go figure... :wacko:



Yeah all our CCT units have two EMTs plus the nurse, but my shift is a new one so we don't even have a permanent nurse assigned yet (go figure)


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