RN vs LPN vs CNA: Duties, Training, Pay and Which Path Fits You

Walk onto any nursing unit and you'll see three kinds of nursing staff working side by side: certified nursing assistants, licensed practical nurses and registered nurses. To patients and families they can look almost identical, since everyone wears scrubs and everyone is busy. But the three roles differ a lot in what each person is allowed to do, how long they trained, how much responsibility they carry and what they earn.

If you're deciding where to start in nursing, or whether it's worth going back to school for the next step, this guide lays out the differences honestly. We cover daily duties, education, licensing, typical work settings, pay and the bridge programs that let you move up without starting over.

The short version

Exact rules about what each role may do are set by each state's board of nursing and by each employer's policies. Treat the descriptions below as typical, not universal.

Certified Nursing Assistant (CNA)

What CNAs do on shift

CNAs provide the hands-on personal care that keeps patients safe, clean and comfortable. A typical shift includes helping residents bathe, dress, eat and use the bathroom. CNAs reposition bed-bound patients to prevent pressure injuries, help people walk and transfer, take vital signs, measure intake and output, and answer call lights. They also tell the nurse when something seems off.

That last part is underrated. CNAs often spend more time with each patient than anyone else on the team, so they're frequently the first to notice when a resident is more confused than usual, isn't eating, or is breathing differently. Good CNAs catch problems early.

Training and certification

Federal rules require nurse aide training programs to include at least 75 hours, with at least 16 hours of supervised practical training. Many states require more. Programs are offered by community colleges, technical schools, the Red Cross in some areas, and nursing homes themselves. Some facilities will pay for your training in exchange for a work commitment. After the course you pass a state competency exam, usually a written or oral test plus a hands-on skills demonstration. Then you're listed on your state's nurse aide registry.

Who it suits

CNA work is the fastest way into healthcare and an honest test of whether you like patient care. It's physically demanding and the pay is modest, but the experience counts heavily if you later apply to LPN or RN programs. Many nursing schools give credit or preference to applicants with CNA experience.

Licensed Practical Nurse (LPN) / Licensed Vocational Nurse (LVN)

LPN and LVN are the same role with different names. California and Texas use "LVN," and most other states use "LPN."

What LPNs do on shift

LPNs provide direct nursing care under the direction of an RN or physician. Depending on the state and setting, that commonly includes:

• Giving oral, topical and injectable medications
• Wound care and dressing changes
• Monitoring patients and reporting changes
• Inserting and caring for urinary catheters, and caring for tracheostomies and feeding tubes
• Collecting specimens
• Documenting care
• Supervising CNAs, especially in long-term care

Where LPN scope usually stops: LPNs generally contribute to patient assessments but don't carry final responsibility for the comprehensive initial assessment or the nursing care plan. IV therapy is where state rules vary the most. Some states let LPNs start IVs and hang certain fluids after extra certification, while others restrict IV pushes or blood products entirely. If you're an LPN moving states, read the new state's rules before your first shift.

Training and licensing

Practical nursing programs typically run about 12 to 18 months full time at community colleges and technical schools. They combine classroom study (anatomy, pharmacology, nursing fundamentals) with supervised clinical rotations. Graduates take the NCLEX-PN and apply for a license with their state board.

Where LPNs work

Skilled nursing facilities and long-term care are the biggest employers of LPNs. There, LPNs often run a hall or a medication cart and lead a team of CNAs. Home health, rehab centers, physician offices, correctional facilities and some hospitals hire LPNs as well. Hospital roles for LPNs have become less common in many regions, so if your goal is acute care, plan for the RN step.

Registered Nurse (RN)

What RNs do on shift

RNs carry the broadest scope and the most accountability. On top of everything above, RNs perform full patient assessments and build and update the nursing care plan. They give IV medications, including high-risk drugs, manage complex patients, and coordinate with physicians, therapists and case managers. RNs also educate patients and families, and supervise LPNs and CNAs. When a patient's condition changes, the RN is usually the one who puts the picture together and decides what happens next.

ADN vs BSN

There are two main routes to an RN license. An Associate Degree in Nursing (ADN) takes about two years and is often the faster, cheaper option. A Bachelor of Science in Nursing (BSN) takes about four years, or less through accelerated programs if you already hold a degree. Both lead to the same NCLEX-RN exam and the same license.

The difference shows up in hiring. Many hospitals, especially larger systems and those pursuing Magnet recognition, prefer or require a BSN for new hires. Some hire ADN nurses on the condition that they finish a BSN within a set number of years. Leadership, public health and advanced practice roles (nurse practitioner, CRNA, nurse midwife) build on a BSN.

Where RNs work

RNs work almost everywhere: hospitals across every specialty, nursing homes as charge nurses and directors of nursing, home health and hospice, outpatient surgery centers, schools, clinics, insurance companies, telehealth and travel nursing. That range of options is one of the strongest arguments for becoming an RN.

How the three roles work together on a real shift

It's easier to see the differences in action. Picture a 30-resident hall in a skilled nursing facility on a day shift. Two CNAs split the residents. They get people up, washed and dressed, help with breakfast, take morning vital signs and turn residents who can't move themselves. They also report anything unusual to the nurse. Maybe a resident who normally feeds herself suddenly can't hold a spoon, or someone's legs look more swollen than yesterday.

The LPN runs the medication pass for the hall. They also change dressings, check blood sugars, give insulin and document what they've done. When a CNA flags the resident who can't hold her spoon, the LPN checks on her, gathers vital signs and details, and calls the RN supervisor.

The RN assesses the resident, recognizes possible signs of a stroke, calls the physician and arranges transfer to the hospital. Afterward the RN updates the care plan and talks with the family. Each person did their part, and the outcome depended on all three.

How pay compares

Pay follows responsibility. In the US Bureau of Labor Statistics' recent national data, RN median pay has been well above $80,000 a year. LPN/LVN median pay has been around $60,000, and nursing assistants have earned well under $45,000. Actual pay depends heavily on the state, the city, the setting, shift differentials and experience. A night-shift CNA in a high-cost metro can out-earn a day-shift LPN in a rural area. For current figures in your area, check the Occupational Outlook Handbook and state wage data at bls.gov, and compare that with the salary ranges on real job postings near you.

Two more things affect what you take home. One is overtime and differentials: nights, weekends and holidays often add a few dollars an hour. The other is flexible work such as per diem shifts or travel contracts, which typically pay more per hour in exchange for fewer benefits or less stability.

Moving up: CNA → LPN → RN

You don't have to start over to move up. Nursing has some of the clearest career ladders in any field:

• CNA to LPN. Your CNA experience makes you a stronger applicant. Many people keep working CNA shifts on weekends while in LPN school.
• LPN to RN bridge programs. These give credit for your LPN education and experience, often shortening an ADN to around a year of study. LPN-to-BSN bridges exist too.
• RN to BSN. Many RN-to-BSN programs are online and designed for working nurses, and some employers offer tuition help.

Many facilities, especially nursing homes and health systems with workforce shortages, offer tuition reimbursement or "earn while you learn" programs. Ask about them in interviews. A facility that will pay for your next credential is worth more than a slightly higher hourly rate somewhere that won't.

Which path is right for you?

Choose CNA if you want to start working in healthcare within weeks, want to test whether patient care suits you, or need income while you prepare for nursing school.

Choose LPN if you want a licensed nursing role in about a year, enjoy long-term care, rehab or home health, and like the idea of bridging to RN later while earning a nurse's wage.

Choose RN if you want the widest range of jobs, the highest earning potential of the three, and options like travel nursing, specialty certifications, leadership or advanced practice down the road.

Whichever level you're at today, there's demand for your skills. Browse CNA jobs, LPN jobs or RN jobs, or create a free profile so facilities hiring in your area can find you.