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Certified Nursing Assistant Careers

A Certified Nursing Assistant (CNA) is a credentialed healthcare professional who is supervised by a registered nurse (RN) or a licensed practical nurse (LPN). By assisting RNs and LPNs with some caregiving tasks, CNAs help free up nurses to perform the more technical tasks for which nurses are trained (preparing an operating room for a surgical procedure, giving patients pharmaceuticals, reporting information to the attending physician, etc.). In some cases, certified nursing assistants may spend more face time with patients than any other healthcare professional during the patient’s stay at a hospital or other care facility.

These licensed professionals are sometimes referred to as a patient care assistant (PCA), healthcare assistant (HCA), home


The CNA fills an important role in the healthcare community by extending the reach of RNs. The CNA responds to patient calls in nursing homes and clinical settings, reports back on patient conditions to the nurse on call, helps clean patients and their rooms, helps move patients from one place to another in a wheelchair, helps patients prepare for their examinations by the nurse or doctor, assists bedridden patients with exercise and helps feed people who are unable to feed themselves. CNAs also record vital data about the patient’s condition (such as food consumption, pulse and temperature) on a regular basis so the nurse can record it on the patient’s medical chart and relay the results to the doctor when appropriate. In some ways, CNAs are more on the frontlines of the patient/healthcare community relationship than anybody else.

Many of the responsibilities handled by today’s CNAs were once assumed by family members—spouses, parents, children or friends—and sometimes still are. But the reality of the American economy is that many families require two working parents, the divorce rate is high and children generally move out of their parents’ home—often to another city. While many people might prefer to take care of their loved ones by themselves, they may not be physically capable of doing so, or be able to afford to take the time off work to spend with the patient (or “client” as a CNA’s charges are often referred to). Other people may be unable to tolerate the mentally and physically challenging regimen associated with caring for a bedridden or invalid person. This regimen includes not only maintaining proper hygiene and nutrition, but helping monitor the patient’s bodily functions as well as sterilizing and maintaining medical equipment and relaying medical information to the nurse in an efficient manner.

Certified nursing assistants may continue with their education and become RNs or, in some cases, assume administrative roles in the nursing facilities. The experience and education gained by working as a CNA can be parlayed into other healthcare careers, as well as higher paying nursing assistant roles. Working as a CNA is an excellent way to determine whether moving into another nursing or medical role is the ideal career path. Achieving CNA certification is much quicker and cheaper than earning a nursing license and can quickly expose a young healthcare professional to the best and the worst conditions of hospital life to help them discover whether this is the field in which to work. It is also an opportunity for potential nurses to explore a specialty area (obstetrics, oncology, surgery) that they are considering. For students already enrolled in a nursing program, working as a CNA is also a opportunity to learn real-life medical skills and earn money to pay for their education while watching professional nurses do their jobs.


For those who choose to make nursing assistant their ultimate career goal, there are a handful of state organizations that offer CNAs networking, representation, camaraderie and educational opportunities. There is, however, a national organization that represents CNAs and other paramedical workers. The National Association of Health Care Assistants was founded in 2006 and represents over 35,000 caregivers in 29 states and Washington D.C. This organization gives awards to outstanding caregivers, offers training and mentoring and advocates on issues important to CNAs and other caregivers. The NAHCA notes that more than 90 percent of the direct care that patients receive is handled by nursing assistants and that they comprise the single largest percentage of nursing home employees.

View lists of CNA Jobs here.

Certified Nurse Assistant (CNA) Salary

There are over 680,000 certified nursing assistants (CNAs) working in nursing homes across the country, according to the Centers for Disease Control and Prevention (CDC), but nearly 24 percent of these said they are looking for another job and another 3 percent said they are thinking about it. This shows that turnover rates in the U.S. can be fairly high and that hospitals, healthcare facilities and long-term care sites may be in constant need of qualified staff. That said, the mean stay for CNAs in nursing homes was 61 months, which is just over five years.

The U.S. Bureau of Labor Statistics (BLS) includes CNAs within the occupational profile of nursing assistants. According to May 2014 BLS data, nursing assistants earned mean annual wages of $26,250, but annual income typically ranged from $18,790 to $37,160, about $9.03 to $17.39 per hour. The highest paying areas for CNAs in the U.S. included Alaska, Nevada, New York, Connecticut and Washington, D.C., where mean annual wages were all above $30,000. Two of the highest paying metropolitan areas were the New York-White Plains-Wayne area of New York and New Jersey and the greater Chicago-Joliet, Naperville, Illinois area, both which reported mean wages above $25,000 for nursing assistants, according to the BLS.

Are certified nursing assistants in high demand?

The BLS reports that job demand for nursing assistants is expected to grow by 21 percent from 2012 to 2022. This job growth is faster than average and could result in 312,200 new positions becoming available during this time. One factor leading to demand includes more elderly patients in need of care, including those in long-term care sites, such as nursing homes. Another factor is increasing incidence of chronic illnesses in the U.S. that will lead to more need for patient care.

Is there room for advancement?

Job opportunities for nursing assistants will likely be the best for those who have completed an educational program and passed the competency exam within their state, reports the BLS. Passing the state exam allows someone to be called a CNA. Also, opportunities for advancement could be particularly strong for those interested in working in home health care or community-based sites, suggests the BLS. CNAs who seek advanced certification, such as the certification necessary to become a Certified Medication Assistant (CMA), could also find better opportunities for advancement.

How to Become a Certified Nurse Assistant

Just as a parent cares for children who are ill and unable to take care of their own basic needs, a certified nursing assistant performs these tasks for their clients. To further the analogy, this work is often done in the client’s home, whether it is their lifelong residence or a nursing facility.

Possessing the disposition to want to care for those in need is the first prerequisite towards becoming a CNA or, frankly, almost

Certified Nurse Assistant (CAN) Certification and Training

Almost all healthcare professions require national and/or state certification or licensing. This ensures that patients, administrators and other healthcare professionals can expect the same standards of treatment and behavior throughout the state, if not in all of America. Start certification offers patients and other interested parties a forum to lodge complaints against healthcare professionals and helps ensure to insurance companies that the care received by their customers is legitimate.

To become certified as a nurse’s aide or a nursing assistant, candidates must meet the following requirements. (State requirements may vary, but these are generally accurate.

  • Pass a criminal history check This involves an investigation into felony and misdemeanors committed by the candidate, as well as any disciplinary actions against the candidate in a health care setting. Traffic offenses are not likely to have any effect on certification eligibility. But some misdemeanors that occurred while caring for a patient may prevent candidates from ever working in a healthcare setting again. States would handle this on a case-by-case basis.
  • Complete an accredited nursing assistant program Many programs are nationally accredited, but ultimately it is up to each state to determine which programs are legitimate for certification. In some states, even this program is not necessary and the candidate can merely sit for, or “challenge” the exam. However, some potential employers may frown upon this practice and demand to see evidence of actual classroom or clinical experience.
  • Pass the CNA examination—both the written (or computer-based) and hands-on portions. Typically both portions must be taken in the same state to ensure continuity.
  • Apply to the state by filling out an application, submitting a photograph and paying the required fee. Some states have no fee for CNA applicants, and in many cases the hospital or nursing facility may be happy to pick up this cost to ensure their CNA is certified and doesn’t have to spend any more of his or her funds.


Many states accept reciprocal licenses. A CNA licensed in Oregon may be able to use his or her license to quickly earn an Alabama

CNA Continuing Education

Unlike many other healthcare professions, one only needs a high school diploma to qualify to enroll in a certified nursing assistant training program. In some cases, even that may not be necessary. Being able to speak and read English is typically a requirement for any job that requires interaction with American patients. In some settings, speaking Spanish or another language may be required.


Nursing assistant training is not hard to come by and is very affordable. Most of the training can be done in a clinical or classroom setting, but may take as little as 75 hours. Typically, though, programs include at least 50 hours of classroom study and 100 hours of hands-on training under the supervision of the instructor or a nurse. Some programs take from six to 12 weeks. CNA programs are available in technical colleges for less than $1,000. Community colleges and other specialized schools offer programs, and some may be just a few hundred dollars. Some hospitals, nursing homes, hospices or other healthcare facilities offer their own training programs, pay students while they learn, and offer the qualified graduates a position upon completion.
The teacher of these classes is likely to be a nurse with the hands-on experience of having been a CNA. The cardiopulmonary resuscitation class might be taught by the American Red Cross or by a paramedic or emergency medical technician.

Nursing assistant school includes classroom study as well as hands-on practical or clinical skills. The technical knowledge learned includes basic medical terminology, pharmacology and medical equipment, disease identification and treatment, nutrition and anatomy, nursing basics, and procedures for assisting nurses with patient needs. The clinical segment includes actually helping to transfer patients from hospital gurney to bed or chair to wheelchar, safely replacing bedpans and caring for actual people. The education itself will focus on a wide variety of topics including, but not limited to, the following:

  • Caring for infants, adults and geriatric patients
  • Maintaining patient safety and hygiene
  • Assisting patients with activities of daily living (ADLs)
  • Communicating with patients and communicating with nurses and other healthcare professionals
  • Tackling issues facing residents of long-term care facilities
  • Administering cardiopulmonary resuscitation to children and to dults
  • Administering basic first aid and life support to patients until relieved by a nurse or doctor
  • Taking vital signs from patients (conscious or otherwise)
  • Observing ergonomics—or safe body mechanics—of performing repetitive or stressful maneuvers (like moving or transporting a patient) to prevent injury to both the CNA and to the patient
  • Handling nutrition and feeding of patients
  • Controlling infection (including the importance and basics of hand washing, as well as more specific topics, like cleaning catheters)
  • Properly recording and reporting patient information to other healthcare professionals
  • Helping patients take a bath or cleaning a patient who is in bed
  • Recognizing mental problems with patients (depression, dementia, behavioral issues whose cause may be physical in nature, etc.)
  • Comforting a patients whose condition is deteriorating and who understands the situation
  • Caring for a patient with diabetes
  • Helping a patient perform his or her prescribed exercises
  • Observing laws and regulations regarding nursing assistants and patient rights
  • Maintaining one’s own dignity, sanity and safety while performing all the above duties

Following the completion of the program (and certification, licensing and obtaining a job), there will be many opportunities for on-the-job training and to continue to ask questions to the supervising nurse or other staff. Care facilities often change patient care protocol or course of treatment, and the CNA will be educated as these changes are implemented.

Once a CNA achieves state certification and licensing, the license (or certificate) must be renewed every few years—typically two. This generally requires earning continuing education hours, usually 48 of them, which may consist of reviewing knowledge already learned, or discovering new topics, techniques or healthcare theory. The medical field is constantly changing, and recent developments, like the medical field’s response to H1N1 virus, must be quickly and effectively communicated to personnel around the country. Nursing homes or hospitals may offer in-service seminars that can be applied to the continuing education requirements, and many online or at-home study programs are also eligible. Nursing assistants must keep accurate records of time spent in self-study and classroom education for times when their state conducts a random audit of the continuing education documentation.

CNA State Exam

The nurse aide assessment examination is also known as the national nurse aide assessment program (NNAAP). The written portion takes about two hours and gives candidates 50 or more multiple-choice questions. However, the time and number of questions varies from state to state, and some states ask up to 70 questions. A Spanish-version is optional, as is a verbally delivered version.

Pearson VUE is one of the agencies that administer the test and lists skills that CNAs can expect to have to know for the computer-based test. These include

  • Storage and cleaning of patient dentures
  • Caring for a patient’s catheter
  • Oral hygiene and care
  • Foot, fingernail and perineal hygiene and care
  • Helping a client move in bed and out of bed
  • Basic hand washing and sanitary concepts
  • Helping a client wear elastic stockings and other clothing
  • Preparing and removing a bedpan
  • Taking a patient’s pulse on their wrist, counting their breathing rate and recording this information
  • Protecting one’s self from infection
  • Making a bed while someone is lying in it and unable to move
  • Using a sphygmomanometer to take a patient’s blood pressure
  • Recognizing and using common medical terminology and abbreviations
  • Reading the results from a thermometer
  • Feeding a client and encouraging good nutritional habits
  • Recording a patient’s weight • Recording a patient’s urinary and stool output
  • Draining a used catheter bag
  • Effective use of protective gear, like globes
  • Bathing a patient in bed

Here is some sample questions taken from the NNAAP Nurse AID study guide: Which of these common stages of dying is typically

A Depression
B Acceptance
C Bargaining
D Anger

If bed linens are cleaned and brought to a patient’s room but have not been used, what should you do with them?

A Put them back in the linen closet
B Hand them to the LPN or RN in charge
C Place them in the laundry hamper
D Use them for a different patient

A pressure sore can often first be noticed by?

A Swelling
B Coldness
C Numbness
D Discoloration

The practical portion of the exam is hands-on skill assessment for which the proctor can choose from 25 skills relevant to a nursing assistant position. The assessment might be conducted in a classroom or care a facility, with actual equipment (and sometimes real people) being used for the demonstration. The assessment is timed (25 to 30 minutes is typical) and the proctor will be looking for many things. Among them are good posture (to prevent CNAs from injuring themselves in the line of duty), good hygiene, quick and thoughtful response, good attitude and knowledge of protocol and medical terminology.

Activities to be performed may include taking a patient’s blood pressure or temperature (in one of several possible ways), washing hands properly, dressing a patient, changing a bedpan, sterilizing medical equipment or helping a patient move from a bed to a wheelchair.

There are many online resources to help prepare for the exam, and in many cases, the hospital, nursing home or care facility will have staff happy to help candidates prepare, as it is in everybody’s interest to ensure the CNA is able to pass the exam and apply for a certificate or license.

Certified Nurse Assistant Job Description

CNAs help patients with activities of daily living (ADLs). They are responsible for helping patients maintain good hygiene, follow doctor and nurse orders, dressing, feeding and grooming patients, positioning them comfortably and helping them with some exercises. CNAs also take patients’ temperature, blood pressure and pulse, respiration rate and can inquire about a patient’s level of pain. Certified nursing assistants may also help care for the bodies of patients who have died in the hospital or nursing home.

Just as licensed nurses get to choose their shift, certified nursing assistants can work day or night, or fill the heavy demand for

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The CNA schools, colleges, and universities below offer some of the best training available to CNA degree seeking individuals. Request information from multiple schools in order to compare programs and find the best CNA degree for you.


Sources:

  1. Nursing Assistants, Bureau of Labor Statistics, Occupational Employment Statistics, May 2014. http://www.bls.gov/oes/current/oes311014.htm
  2. Nursing Assistants, Bureau of Labor Statistics, Occupational Outlook Handbook, Jan. 8, 2014. http://www.bls.gov/ooh/healthcare/nursing-assistants.htm
  3. National Nursing Home Survey, Center for Disease Control and Prevention. http://www.cdc.gov/nchs/nnhs/nursing_assistant_tables_estimates.htm#WorkEnv

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