CNA, STNA, LNA: one job, many state titles
Certified nursing assistants are counted in occupation 31-1131, nursing assistants. The title on your badge depends on your state: certified nursing assistant (CNA), certified nurse aide, licensed nursing assistant (LNA), state tested nursing assistant (STNA), patient care assistant and nursing aide are all titles for the same work. The figures on this page, including the median wage of $42,260 and the 1,505,900 jobs, cover all of them. Orderlies, who transport patients and clean treatment areas, are counted as a separate occupation, so the combined median of $41,870 you may see for nursing assistants and orderlies is slightly lower than the figure for nursing assistants alone.
Nursing home, hospital or assisted living
Where you work changes the job more than the title does. Nursing care facilities employ 36% of nursing assistants. There, CNAs are often the principal caregivers, each responsible for a group of long-term residents, and they get to know residents who stay for months or years. The pace is steady and physical: mornings are a race to get everyone washed, dressed and to breakfast.
Hospitals employ 32%. Hospital nursing assistants, sometimes called patient care technicians or assistants, see patients come and go quickly, take more vital signs, measure intake and output and work closely with registered nurses on acute problems. Continuing care retirement communities and assisted living facilities employ 11%, with residents who are generally more independent, and home healthcare services employ 5%.
Where the jobs and the pay are
California has the most jobs, 110,060, with a median of $47,630. Florida follows with 96,960 jobs at $37,510, Texas with 88,680 at $37,500, New York with 87,990 at $48,590 and Illinois with 68,640 at $45,960. The highest state medians are in Oregon ($49,830), Washington ($49,180) and New York ($48,590). The gap between the highest and lowest of the big states is more than $11,000 a year, so where you work matters.
Nationally, the lowest-paid 10% earned less than $33,940 and the top 10% more than $51,980; the middle half earned between $37,260 and $47,220. Pay by years of experience is not published.
Getting certified and hired
Federal rules for nursing homes set the baseline: a state-approved nurse aide training program of at least 75 hours, including at least 16 hours of supervised practical training, followed by a competency evaluation. Programs run at high schools, community colleges, vocational and technical schools, hospitals and nursing homes, and some nursing homes train new hires on the job. Many states use the National Nurse Aide Assessment Program, which has a written or oral test and a skills evaluation where you perform tasks in front of an evaluator. Passing puts you on your state's nurse aide registry, and you must be on it to work in a nursing home. Some states add continuing education or a criminal background check.
Employers look for a current registry listing, reliability on shift work and comfort with lifting and personal care. Experience with electronic records such as Epic or MEDITECH helps in hospitals. Keep your certification active: under federal rules, 24 consecutive months without paid nursing work means retraining or retesting before you can work in a nursing home again.
The honest downsides
Nursing assistants and orderlies have one of the highest rates of injuries and illnesses of all occupations, mainly because they frequently move patients. Proper lifting training and equipment reduce, but do not remove, that risk. Facilities provide care at all hours, so nights, weekends and holidays come with the job. The emotional load is real too: residents decline and die, and the routine of cleaning, feeding and bathing can be stressful.
Growth is modest. Employment is projected to grow 3% over the next decade, and financial pressures on nursing homes could lead some to close or reduce staff, while more opportunities are expected in home and community settings. Openings remain plentiful, about 196,200 a year, mostly from turnover. For many people the job works best as a first step: LPNs earn a median of $64,400 and registered nurses $97,550.