CNA, CMT, LPN/LVN, RN: who does what on the floor

On any shift in a long-term care building, residents are cared for by a team with different training, licenses, and responsibilities. Knowing who does what helps clinicians understand where they fit, and it helps facilities post the right role for the work that actually needs doing.

One caveat before we start: scope of practice is set by each state, mainly through its nursing laws and board of nursing, and facilities can add their own policies on top. What follows is the typical picture. Always check your state's rules and your facility's policies for specifics.

CNA: Certified Nursing Assistant

CNAs provide much of the hands-on, day-to-day care residents receive. Typical duties include:

• Helping residents bathe, dress, groom, eat, and use the bathroom
• Repositioning, transfers, and help walking
• Taking vital signs and recording intake, output, and other observations
• Answering call lights and keeping residents safe and comfortable
• Noticing changes, like a resident who's suddenly more confused, isn't eating, or has a new skin issue, and reporting them to the nurse

Training path: a state-approved nurse aide training program, followed by a competency exam. People who pass are listed on the state's nurse aide registry.

Because CNAs spend the most time with residents, they're often the first to notice that something is off.

CMT / Med Aide: Certified Medication Technician or Aide

A CMT, also called a certified medication aide or medication assistant (and "Med Tech" on our site), is typically a certified nursing assistant who has completed additional state-approved training in giving medications and passed a state exam.

Where the role is allowed, med aides generally give routine, scheduled medications by the routes their state permits, under a licensed nurse's supervision. Decisions that call for a nursing assessment stay with the nurse.

This is the role with the most state-to-state variation. Not every state recognizes it, and the states that do set their own rules on training, which settings can use med aides, and which medications and tasks are allowed. Facilities should confirm what their state permits before building a med pass around a med aide.

LPN / LVN: Licensed Practical or Vocational Nurse

LPN and LVN are the same license with different names. California and Texas use "licensed vocational nurse"; other states use "licensed practical nurse."

In long-term care, an LPN/LVN is often the nurse for a hall or unit. Typical duties include:

• Giving medications, including many that aides can't
• Treatments and wound care
• Monitoring residents and reporting changes in condition
• Documentation
• Directing CNAs and med aides on the unit, where state rules allow

LPNs/LVNs generally work under the direction of an RN, physician, or other provider. They gather information and contribute to assessments, but in most states the comprehensive assessment and the care plan belong to the RN.

Training path: a state-approved practical nursing program, often offered through community colleges and technical schools, followed by the NCLEX-PN exam and licensure by the state board of nursing.

RN: Registered Nurse

RNs have the broadest scope of the four. In long-term care, an RN might work as a charge nurse or unit manager, supervise a shift, or lead the nursing department. Typical responsibilities include:

• Comprehensive assessments and care planning
• Admissions and significant changes in a resident's condition
• Communicating with physicians and other providers
• Supervising and delegating to LPNs/LVNs, med aides, and CNAs
• Tasks the state reserves for registered nurses

Training path: an associate or bachelor's degree in nursing (a few diploma programs still exist), followed by the NCLEX-RN exam and licensure by the state board of nursing.

How the roles work together

Picture a typical hall. CNAs handle personal care and are the eyes and ears at the bedside. A med aide, where allowed, takes the routine med pass so the nurse's time goes to treatments, assessments, and residents who need closer attention. The LPN/LVN runs the hall: medications, treatments, documentation, and first response when something changes. The RN oversees the bigger picture: assessments, care plans, admissions, and escalation to providers.

Information flows up, and direction flows down. The system works best when everyone feels comfortable speaking up, including a PRN clinician who is new to the building and may notice something the regular team has grown used to.

For facilities: which role should you post?

Start with the work, not the title. What does the shift actually involve?

• Short on hands-on care? Post a CNA.
• Need help with a routine med pass? A med aide may be an option if your state allows it in your setting. If not, post an LPN/LVN or RN.
• Need a nurse to run a hall, do treatments, or give medications a med aide can't? Post an LPN/LVN, within your state's scope.
• Admissions, assessments, supervision, or anything reserved for RNs? Post an RN.

Your state's rules and your own policies come first. When in doubt, post the role that covers every task the shift might require.

Find the right fit

NurseStat staffs all four roles in skilled nursing and long-term care, assisted living and memory care, home health, hospice and palliative care, behavioral health, and rehabilitation and post-acute settings. Clinicians can learn more on the For Clinicians page. Facilities can start with For Facilities or contact us.