Alphabet Soup…NP’s, RN’s, LPN’s, CNA’s

hospitalI have noticed that some health care providers reverse their name badges, we can’t know their names or their job responsibilities.. During a 9 month period I stayed at 3 hospitals and two nursing homes, I tried to be responsible about who were the providers of healthcare and assistance. I learned to ask, “Who are you and what do you do here?”. Most badges have an alphabet soup of letters. This what they mean and what we should expect they provide us. Perhaps this will be useful for those of us with elderly parents or a spouse who needs rehab therapy.


Most* Nurse practitioners (NP), also called Advanced Practice Nurses (APN) have completed a registered nursing degree as a part of a bachelors degree, plus a masters degree. In addition, many now seek a doctorate level degree.

(*Not all NPs do have these degrees. In some states, NPs were licensed prior to these degree requirements, and were therefore “grandfathered,” meaning, they did not have to complete them.)

An NP may be certified in a specialty area, such as family health, oncology, or pediatrics. Nurse practitioners are clinicians, not unlike a physician who may have his or her own practice. He or she can serve as a patient’s regular healthcare provider, and may diagnose, order tests, develop treatment plans and write prescriptions.

Most NPs work in collaboration with a physician, which is usually required by the state they work in. They are accredited through several organizations, including the American Academy of Nurse Practitioners. Be sure you don’t confuse nurse practitioners with nurses. Their work with patients may be very different.

The nursing home/rehab I stayed at used a NP several days a week with a MD visiting once a week.


RNA registered nurse is a nurse who has graduated from a nursing program usually receiving an Associates degree and has passed a national licensing exam to obtain a nursing license An RN’s scope of practice is determined by local legislation governing nurses, and usually regulated by a professional body or council.

Registered nurses are employed in a wide variety of professional settings, often specializing in their field of practice. They may be responsible for supervising care delivered by other healthcare workers including enrolled nurses licensed practical nurses, unlicensed assistive personnel, nursing students, and less-experienced RNs.

Registered nurses must usually meet a minimum practice hours requirement and undertake continuing education in order to maintain their registration. Furthermore, there is often a requirement that an RN remain free from serious criminal convictions.

The RN’s at the nursing home/rehab I stayed at mostly gave out the meds and didn’t do much more then that except for the Wound Nurse who help residents with wound care.


You can often find LPN training programs at technical schools or community colleges, although some might be located at high schools or hospitals. Training generally involves a combination of traditional class work, such as biology and pharmacology, along with supervised clinical instruction. A person can generally become an LPN with two years of training; all U.S state and territorial boards also require passage of the exam.

Often, they provide basic bedside care. Many LPNs measure and record vital signs such as weight, height, temperature, blood pressure, pulse, and respiratory rate. They also prepare and give injections, enemas, catheters, monitor wounds, and give alcohol rubs, massages. To help keep patients comfortable, they assist with bathing, dressing, and personal hygiene, moving in bed, standing, and walking. They might also feed patients who need help eating. Experienced LPNs may supervise nursing assistants and aides, and other LPNs.

As part of their work, LPNs collect samples for testing, perform routine laboratory tests, and record food and fluid intake and output. They clean and monitor medical equipment. Sometimes, they help physicians and registered nurses perform tests and procedures. Some LPNs help to deliver, care for, and feed infants.

LPNs also monitor their patients and report adverse reactions to medications or treatments. LPNs gather information from patients, including their health history and how they are currently feeling. They may use this information to complete insurance forms, pre-authorizations, and referrals, and they share information with registered nurses and doctors to help determine the best course of care for a patient. LPNs often teach family members how to care for a relative or teach patients about good health habits.

The LPN’s at the nursing home/rehab I stayed at also mostly gave out the meds and didn’t do much more then that.


CNAMost training programs for CNA’s (Certified Nurse Assistants) do not last more than one year and are offered at a wide variety of institutions, including career schools, community colleges, hospitals, nursing homes & even high schools. Program lengths vary but average one year. Prerequisites for entry are typically a high school diploma or equivalent. After passing the examination, the candidate is added to his or her state’s nurse aide registry and is eligible to be hired on as a Certified Nursing Assistant.

Certified Nursing Assistants work very closely with their patients. Many times the patient is either elderly or chronically ill; both cases need consistent, long-term care. The usual work environment is either a hospital or a home, either private or health-related. They provide basic medical care and work directly under the supervision of doctors and registered nurses. The tasks listed below make up the majority of what you can expect to be doing on a day-to-day basis.

Working for certified home health or hospice agencies to support and comfort terminally ill patients and their families. Enabling disabled, chronically ill or challenged patients to live in the comfort of their own homes instead of healthcare facilities. Providing light housekeeping, shopping and meal preparation for elderly, infirm and shut-in patients. Helping developmentally or intellectually disabled clients learn self-care skills and providing employment support.

Certified Nursing Assistant Job Duties:

  • Provides patients’ personal hygiene by giving bedpans, urinals, baths, backrubs, shampoos, and shaves; assisting with travel to the bathroom; helping with showers and baths.
  • Provides for activities of daily living by assisting with serving meals, feeding patients as necessary; ambulating, turning, and positioning patients; providing fresh water and nourishment between meals.
  • Provides adjunct care by administering enemas, douches, nonsterile dressings, surgical preps, ice packs, heat treatments, sitz and therapeutic baths; applying restraints.
  • Maintains patient stability by checking vital signs and weight; testing urine; recording intake and output information.
  • Provides patient comfort by utilizing resources and materials; transporting patients; answering patients’ call lights and requests; reporting observations of the patient to nursing supervisor.
  • Documents actions by completing forms, reports, logs, and records.

The CNA’s at the Christian Care Center Rehab/Nursing home were God’s Angels on Earth. They made living tolerable for the elderly, disabled, stroke, and diabetic/other amputees. The CNA’s and UAP’s at the VA Medical Centers in Nashville and Murfreesboro are “lazy clods”


Unlicensed assistive personnel (UAP) is a class of paraprofessionals who assist individuals with physical disabilities, mental impairments, and other health care needs with their activities of daily living (ADLs) and provide bedside care — including basic nursing procedures — all under the supervision of a registered nurse, licensed practical nurse or other health care professional. They provide care for patients in hospitals, residents of nursing facilities, clients in private homes, and others in need of their services due to effects of old age or disability. UAPs, by definition, do not hold a license or other mandatory professional requirements for practice, though many hold various certifications.

UAP’s do many of CNA tasks.

The facilities and food at West Meade Place Nursing Home were superior to that of the Christian Care Center at 2501 River Road. But….the Physical and Occupational therapists who worked with the patients were not fully licensed but were what are called PTA’s (Physical Therapy Assistant) or OTA’s who finished a program at a Community College while licensed PT’s hold Doctorate degrees from schools like Belmont University.

Certified occupational therapists (OT) typically hold Masters or Doctoral degrees in occupational therapy from an ACOTE accredited institution.

To practice in the United States, occupational therapists must receive a master’s degree and pass a licensing examination to become certified by the National Board for Certification in Occupational Therapy (NBCOT). Occupation Therapy Assistants (OTA) usually hold an Associates degree from a community college.

Almost all inpatient therapy I received was by a PTA or OTA while the PT’s and OT’s held administrative / supervisor positions. I usually saw a licensed PT or OT during an initial evaluation, otherwise they were in an office cubicle or roaming the therapy area.

Here is how I rank the hospitals I stayed at.

  1. Centennial was the best
  2. St Thomas was OK
  3. Veterans Affairs Medical Center (VAMC)-Nashville was a distant third but worst food than the Murfreesboro VAMC.
  4. Veterans Affairs Medical Center (VAMC)-Murfreesboro was dangerous.  I was infected with MRSA and was treated for pneumonia with continuous antibiotic IV’s and respiratory therapy for 7 days  in their Acute Care ward. In military parlance, I had dodged a bullet. I was virtually ignored by the caregivers. PT and OT was substandard. I twice fell to the floor, supposedly being assisted by a staff member, the second time my prosthetic hip was shattered in three pieces while the titanium ball joint pressed my sciatic nerve flat for six days until I could receive surgery to replace the broken hip. I was then sent to a nursing home under a VA contract.

cccRiverRdHard work and great therapy at the nursing/rehab facility by a licensed Physical Therapist and a military trained Occupational Therapist restored my physical condition to the point where I returned home to my lovely and very patient wife.


If He Knew He Would Live This Long…….


This gallery contains 2 photos.

A friend recently told me; “If I knew I would live this long I would have taken better care of my body.” I agree with him because of my own experiences. Viet Nam injuries along with a motorcycle wreck while riding … Continue reading

A Subject We Usually Don’t Talk About

Last month I had my right shoulder joint replaced. A serious but a somewhat routine surgery,  except for a complication I faced, I am right handed and additional arthritis prevents me from reaching behind myself with my left arm. Toileting becomes difficult when the only arm I can use is locked in an immobilizer sling tied to my body.UltraSlingII3

I made test trials with various options prior to surgery and was unhappy with the results.  There simply had to be a better, cleaner way. My travels throughout the world proved that there is more than one way to skin a cat….or clean a behind!

Homes and hotels in most countries in Europe, Latin America and Japan have bathrooms equipped with either a bidet, or in Japan, specially equipped toilets and seats.%UseBidetaByCountry

Bidets are hardly used at all in the U.S. while most hotel rooms in Europe had a bidet and commode like this:Bidet and CommodeSome hotel bathrooms even post instructions for use:BidetCorrectUse

My visits to Japan surprised me with the many variations of toilet equipment which allowed cleaning with a water stream and even air drying after a water cleanse, they include electronic controls….. BidetJapanControls

So….I was left with the question; what can I do to retain my dignity and take care of my own toileting? I discussed this problem with an Occupational Therapist. The Occupational Therapist equipped me with two choices, both required I attach toilet paper to a stick to poke between my legs and wipe with a scrubbing motion. Each device held the toilet paper differently but both had a release mechanism to drop the soiled paper into the toilet. The routine was; attach clean paper, scrub, release, attach fresh paper, etc. etc. etc…no better choices were offered.



I was not happy with any of these options. Unfortunately there was not enough room to install an additional bidet unit, or time and money enough to buy and have a plumber install a Japanese Deluxe toilet.

Just what could I do?

After a great deal of searching on the internet I found a number of portable products, most attached to the cold water supply to the toilet tank, all had spray attachments suitable for female hygiene use but not good for use for toileting. Finally I found something  that looked like it would do the job….it is called HydraWand.



I ordered it, installed it in five minutes. It was a portable device that worked as well as any bidet I used in hotels throughout Europe, Japan, Korea and Hong Kong. The faucet attachment allows me to control the water temperature for total comfort. I will use this even after my arm is out of the sling because it is far superior to toilet paper and every bit as good, if not better, than the bidets found outside the United States.

I sure wish we had something like this in the outhouses we used in Vietnam.BidetOuthouseVietNam

How Pete Saved $29.95 per Month

I have recently returned from a very rewarding meeting with Tim Takacs. He has an Elder Law Practice and Life Care Planning Operation with a staff of 9 specialists including:

  • Office Manager
  • Office Assistant
  • Assoc. Lawyer
  • 3 Elder Care Coordinators
  • 2 Legal Assistants
  • Medicare Specialist
  • Public Benefits Specialist

Tim Takacs

This is how Tim describes his operation:  For almost 20 years, the Elder Law Practice of Timothy L. Takacs has been helping families respond to the legal, financial, physical and psychological challenges presented by long life, illness and disability. As an elder law practice that specializes in Life Care Planning, we help families protect assets and coordinate care. Founder Timothy L. Takacs, CELA, one of the most respected elder law attorneys in the nation, leads an interdisciplinary team of care coordinators and other professionals who work together to enhance the quality of life for elders

We discussed a whole range of issues we need to consider about various aspects of getting on in years. One of the real dangers we discussed is the danger of a fall when no one is nearby. I have had 3 falls in the last few years, one required the Emergency Rescue firemen, one fall was immediately outside the VA Medical Center and two veteran medical providers pulled me up like a baby doll, I describe the third fall in my blog post

Tim and Debra King (Eldercare Coordinator) emphasized the dangers of a fall when alone. They talked about risks of the “long lie”. Older people, who fall at home with nobody around, may have what doctors call a “long lie”: you are in pain or too shocked to get up, do not have a way to call for help and assistance, may have to wait for a long time before help arrives. This in itself can create further health problems and even death.

This caught our attention but I wanted some option that would not cost me over $360/year. My wife found a lanyard that she used to carry a Police Whistle around her neck when she was a K-3 grade teacher. I removed the whistle and attached my cell phone to the lanyard. I am wearing it now, it is completely invisible and I can’t even feel that I am wearing it. Frankly it’s more convenient than a holster or belt clip.

I am registered with Metro Nashville’s SMART911 program, if I fall, I dial 911, I can talk to the 911 person, and the emergency people know where I am and my various medical and physical health conditions. They even know what cars are in our driveway. See about SMART911.

With this set-up I don’t need the “Help I’ve Fallen and I Can’t Get Up” service that costs a minimum of $29.95 per month.

Making Cloister Life A Little Easier

None of us move to The Cloister at Saint Henry if we don’t have some unique situation where a “Universal Design” Condo will make life easier. Universal Design is a set of construction principles that help people with either advancing age or physical limitations be more independent.


Health issues can pose a burden upon a Cloister resident.  Bonney and I have decided to take action to reduce the workload on Bonney that results from some of my health issues. We have hired someone to come twice a month and do a thorough house cleaning. I find the biggest problem during her first visit is staying out of her way as she works her way through our home. She is a whirlwind!

Donita came highly recommended by a good neighbor. Not only is she available to help out with keeping our home clean and livable, she has helped some neighbors with other issues that we Cloister residents sometimes face because of need for assistance whatever the reason, including errands, appointments, etc. Currently she has five clients who reside at The Cloister.

Donita (Tel. 226-4408, she says “Leave a Message”) gives our home a thorough cleaning while Bonney can enjoy doing what she likes, working with our garden. I especially enjoy basil, mint, peppers and tomatos Bonney magically harvests from our little garden area.

Memorial Day Thoughts From A Viet Nam War Veteran Neighbor and Wife

It seems to me that the greatest emotional pain I have seen in others is the pain of a mother or father who has lost a child, or had a child gravely injured during military service to their country. Today Bonney and I honor our wounded and dead veterans who have sacrificed in their service to their country with a US Flag in the front of our home. Our special thoughts go to parents of children who sacrificed their health and lives serving their country.

Three flags honor the Mothers:

Gold Star for the Mothers of those who have died.


Silver Star for Mothers of the maimed and injured.


Blue Star for Mothers whose children are serving our country.