Skip to Main Content

Understanding Nursing Home Staff: Who’s Caring for Your Loved One and Why It Matters


Choosing a nursing home for a loved one is one of the most difficult decisions a family can make. Families want to ensure that their loved ones receive the highest quality care, expecting that doctors and nurses will be directly involved in that care. However, the reality inside many nursing homes can be quite different. Much of the day-to-day care is often provided by Certified Nursing Assistants (CNAs) and Licensed Practical Nurses (LPNs) rather than registered nurses (RNs) or doctors. Understanding the roles, training, and responsibilities of the different types of staff in nursing homes is crucial for families who want to advocate for their loved ones’ needs.

The Different Types of Nursing Home Staff

Nursing homes employ a range of staff members with varying levels of training and expertise. They do so because nursing homes are required to ensure appropriate continuity of care across a wide variety of specialties, including therapy, diet, and others. This is important because there should always be an interdisciplinary team analyzing a patient’s care to ensure the highest practicable physical, mental, and psychosocial well-being of each patient. Here’s a closer look at the key roles:

1. Certified Nursing Assistants (CNAs) or Nursing Assistant, Nurse’s Aide, Patient Care Assistant

Role and Responsibilities: CNAs are often the caregivers in nursing homes tasked with providing most of the hands-on, day-to-day care that residents receive. Their duties include helping residents with activities of daily living (ADLs) such as bathing, dressing, eating, toileting, and mobility assistance. CNAs also take vital signs, report changes in a resident’s condition, and help maintain a clean and safe environment.

Training Requirements: CNAs typically complete a short, state-approved training program, some as short as 85 hours completed over four weeks, which covers basic nursing skills, patient care, and emergency procedures. They must pass a competency exam to become certified. Their training is limited to basic care and CNAs are not licensed to perform medical tasks or make clinical decisions.

Challenges: Although they are the least trained members of nursing home staff, CNAs often work under demanding conditions, responsible for many residents at once. Despite their crucial role, they are among the lowest-paid staff in nursing homes, which contributes to high turnover rates and burnout.

2. Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs) (used in Texas and California)

Role and Responsibilities: LPNs provide a higher level of care than CNAs and perform more medically oriented tasks, such as administering medications, dressing minor wounds, collecting samples for testing, and assisting with minimally invasive medical procedures. LPNs often supervise CNAs and report directly to registered nurses or doctors.

Training Requirements: LPNs complete a one-year nursing program at a community college or technical school, which includes classroom instruction and clinical practice. They must pass the NCLEX-PN exam to obtain licensure. Although LPNs have more training than CNAs, they still have a limited scope of practice compared to RNs.

Challenges: LPNs are often the bridge between CNAs and higher-level nursing staff. However, because of their relatively limited scope of practice, they cannot perform assessments, create care plans, or handle acute medical conditions independently.

3. Registered Nurses (RNs)

Role and Responsibilities: RNs are largely responsible for patient care, conducting assessments, creating care plans, administering medications, and performing more complex medical procedures/evaluations. They provide clinical supervision to LPNs and CNAs and are often the point of contact for doctors. RNs also play a critical role in monitoring residents for changes in condition and coordinating care with other healthcare providers.

Training Requirements: RNs must complete a two- or four-year nursing program and pass the NCLEX-RN exam to become licensed. Their training is extensive, covering a broad range of medical, clinical, and patient care skills, making them well-equipped to handle complex medical issues.

Challenges: Despite their critical role, RNs are often in short supply in nursing homes due to cost-saving measures. Many nursing homes only staff RNs for a few hours a day, limiting their availability for direct patient care, although recently enacted regulations look to drastically increase the amount of time RNs are present at nursing homes.

4. Medical Directors and Doctors

Role and Responsibilities: Medical directors are usually physicians who oversee the clinical operations of a nursing home. They establish medical policies, oversee the quality of care, and serve as a resource for clinical staff. Doctors in nursing homes are responsible for diagnosing and treating medical conditions, managing chronic illnesses, and overseeing residents’ overall medical care plans.

Training Requirements: Medical directors are licensed physicians who have completed medical school, residency, and additional specialized training, often in geriatrics or internal medicine. Their extensive education and experience enable them to make high-level medical decisions and guide the clinical staff.

Challenges: Direct interactions between residents and doctors are very limited. Indeed, very often doctors are contracted to provide medical director services to a number of nursing homes at the same time. Many medical directors will only visit a facility once a month. This handicaps their ability to oversee resident care and, in most instances, places the responsibility for serious medical care with RNs.

The Reality: Most Care is Provided by CNAs and LPNs

While families often expect that their loved ones will be under the direct care of doctors and RNs, the reality is that CNAs and LPNs handle most of the daily care in nursing homes. Nursing homes often limit the number of higher-cost staff like RNs and doctors to save money, relying on CNAs and LPNs for most interactions with residents. This cost-saving approach can have serious consequences:

  • Lack of Clinical Oversight: With few RNs and very limited doctor presence, CNAs and LPNs may be left to handle situations that exceed their training. This can lead to missed signs of illness, delayed responses to emergencies, and inadequate care.
  • Increased Workloads: High workloads and low staffing levels mean CNAs and LPNs are often stretched thin, leading to rushed care and potential neglect.
  • Misaligned Expectations: Families may not realize that their loved one’s care is primarily in the hands of staff with limited training compared to RNs and doctors, resulting in unmet expectations and dissatisfaction with the level of care.

How Chance, Forlines, Carter & King Can Help

If your loved one has suffered due to inadequate staffing or poor-quality care in a nursing home, you are not alone. Our firm specializes in holding nursing homes accountable for failing to provide the standard of care that residents deserve. We understand the staffing challenges in these facilities and know how to identify when cost-saving measures have put residents at risk.

Get in Touch with Our Expert Nursing Home Lawyers

The work of CNAs and LPNs is key, but these overworked staff are often relied upon to the detriment of residents in a misguided attempt to save money.  It is essential for nursing homes to provide adequate clinical oversight by RNs and doctors to ensure appropriate resident care. Patients and their families deserve transparency about who is caring for their loved ones and assurance that their loved ones’ health and safety are a priority. If your loved one has been affected by inadequate staffing or substandard care, contact us today to discuss your legal options.