• There are many levels of nurses, each requiring certifications.Scrub Nurse image by Mary Beth Granger from Fotolia.com
  
  Nurses and home Health Aides (HHAs) are a vital part of the medical team. However many different levels of nurses and HHAs exists, each requiring their own certifications. These certifications are based upon the level of education and experience, and most states set the policies for certification. If a nurse or HHA works beyond her certification, then she is in violation of the applicable statutes, and risks losing her license or even prosecution.
  
  

Home Health Aide

• A Home Health Aide (HHA) is the lowest level of certification on the totem pole. According to the Department of Labor, HHA assist with housekeeping, bathing, and Activities of Daily Living (ADL). HHAs are authorized to provide housekeeping and personal services, but are generally not authorized to perform advanced medical procedures, such as taking vital signs or prescribing medications. A high school diploma is not needed to be a HHA, training is done by nurses or supervisors. Every state sets the criteria for certification and the the National Association for Home Care and Hospice (NAHC) offers national certification which some states may accept.
  
  

Certified Nurse Assistant

• Next up from a HHA is a Certified Nurse Aide (CNA) According to the Department of Labor, federal regulations are in place for certification, and states sets the criteria for registering a CNA into their databases. Some of the education needed is 75 hours of training from an approved program, and passing competency evaluations. Many states also perform background checks on CNAs before issuing a state license. Some of the duties include assisting with ADLs, bathing, and taking vital signs. CNAs however, are not authorized to administer medications, diagnose symptoms, or offer advice or prescriptions. These activities require higher levels of certification.
  
  

Licensed Practical Nurse

• Next up on the totem pole is the Licensed Practical Nurse, or LPN. The educational requirements of an LPN are a minimum of one year of training from an approved program, and passing the National Council of State Board of Nursing (NCLEX) NCLEX-PN exams. If all criteria is met, each state will issue a license to the LPN. In 1997, many states agreed to the NCLEX compact, which provided uniformity across the board for licensing, and many states have entered into reciprocity agreements with other states. Some duties of an LPN include taking vital signs, giving enemas, and assisting ADL activities. Other duties include giving injections and dressing wounds. LPNs are not authorized to do surgery, diagnose illness, or to prescribe medications.
  
  

Registered Nurse

• A Registered Nurse (RN) is the next level up. According to the department of labor, RNs have a minimum of an Associate's Degree in Nursing (ADN) from a regionally accredited college (see reference 5). Some progress to the Bachelor's Degree in Nursing Level (BSN). All must pass the NCLEX-RN exams. Each state maintains a registry, and well as the NCLEX. Some duties would include critical care in Intensive Care Units, and starting Intravenous fluids. RNs may supervise LPNs and lower certifications. They are not authorized to do surgery, nor to prescribe medications or to make diagnosis of illnesses.
  
  

Licensed Nurse Practitioner

• Licensed Nurse Practitoners (LNP) are the highest on the totem pole. They are almost doctors, and are licensed to diagnose symptoms, and to write prescriptions. According to the American Academy of Nurse Practitioners, they are first RNs with advanced medical training. An LNP must have a Master's Degree in Nursing (MSN) or higher to be eligible for licensing as a LNP by the state of residency practice. Many LNPs specialize as surgical assistants, or pediatric and family care. The next level up would be to obtain a Doctorate in Medicine (MD).