Certified nursing assistant career guide

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Your guide to becoming a certified nursing assistant  

Certified nursing assistants (CNAs) play a key role in direct patient care. They assist licensed practical or vocational nurses (LPNs or LVNs), doctors, and registered nurses (RNs) with assessments, treatments, and procedures. It’s an entry-level position in nursing that doesn’t require a college degree, which makes it a quick route into the profession. 

CNAs are often referred to as nursing assistants. The role shares many similarities with positions such as certified medical assistants (CMAs) and patient care technicians (PCTs), although the tasks and responsibilities vary. As a CNA, you’ll typically work in hospitals, nursing homes, retirement communities, and home care. Primary tasks include taking vital signs, responding to patient calls, listening to patient needs, dressing wounds, and helping with daily patient activities.

Certified nursing assistants work under the supervision of LPNs, RNs, and doctors. The work is demanding, days can be long, and CNAs spend a lot of time on their feet. The tasks CNAs perform are vital to patient comfort and can include providing emotional support. The role is ideal for those who enjoy interacting with people.

You’ll need to complete an education program, which often includes a competency exam at the end. As CNAs work in retirement homes and the need to care for the elderly is growing, the position is in demand. The occupation is growing fast, with a projected growth of 8% predicted between 2019 and 2029, according to the U.S. Bureau of Labor Statistics (BLS).

It’s possible to make a living and start a lifelong career by gaining a position as a CNA. The annual salary is modest; it starts at around $19,000 and goes up to $45,000. The states with the highest concentration of jobs are Rhode Island, North Dakota, Kansas, Maine, and Iowa, according to the BLS.

Pursuing a career as a CNA

If you’re interested in working in healthcare, a position as a certified nurse assistant is an excellent starting point. It’s accessible in terms of the time and education required to qualify, as the programs are short, with only a few requirements. As you work as a CNA, you’ll gain more experience and understand clinical settings, placing you in an ideal position to progress as a medical professional.

The role doesn’t just get you experience in healthcare. If your interests lay in helping people, a CNA position can give you the most contact time with patients. What you do will have a significant impact on each person’s day, which is why the role is best suited to those who are compassionate and have a pleasant demeanor. Many job opportunities are in nursing homes, working with the elderly.

Many aspects of a CNA’s duties are physical and demanding. For example, you might need to turn patients over, feed them, bathe them, and change their bedding. Besides strength and stamina, you’ll need to be flexible and manage your time well to be able to complete a wide variety of tasks with several patients. They will depend on you, which means you’ll need to be reliable, show empathy, and be there for emotional support.

Whether you work in a nursing home or a hospital, patients need care around the clock and all through the week. Your shifts are more likely to be during the day and into the evening to assist with meals and other daily activities. You may be employed in a role visiting patients at home, similar to the home health aide (HHA) role. In that case, you’re more likely to have regular patterns of working during the day, often for long hours.

How to become a CNA

The CNA role is an entry-level position, which means you don’t necessarily need experience to get a job. However, you’ll need to study before you apply, and you’ll likely learn a lot on the job. You’ll need to apply to and complete a state-approved education program, complete the courses for your certificate, and then take an exam.

After your training, you’ll be ready to start as a CNA. The time from enrollment to starting your job is quite quick; the process usually takes between 6 and 12 weeks to complete. Programs are typically run by community colleges, high schools, hospitals, or health organizations and need to be approved by the state where you want to work.

Courses cover theory and practical training, and the program generally culminates in a competency exam that shows your preparedness to enter the workforce. The exam covers the academic and practical aspects of knowledge, with a multiple-choice section and a clinical skills element.

CNA certificate

To become a certified nurse assistant or nurse aide, you’ll need to complete a nursing assistant (NA) program. These programs aren’t equivalent to a degree, although you do get a certificate and credits that could count towards a degree in the future. You’ll need to complete between 4 and 6 credits, or between 125 to 165 hours.

The curriculum includes:

  • introduction to healthcare
  • diet and nutrition
  • life support
  • anatomy
  • patient care and support

Typically, you’ll complete theoretical courses, practical simulations, and a clinical placement, usually at a local nursing home. Some programs will include a cardiopulmonary resuscitation (CPR) element, whereas others will require you to hold that certificate already.  Admission requirements usually ask for a reading and math assessment, a high school diploma, and a physical exam.

Licensure and certification

At the end of your program, you’ll typically sit for a competency exam, which, if it’s a state-approved program, will be enough for certification. It’s also best to choose an accredited school that has been approved by the Commission on Collegiate Nursing Education (CCNE).

Each state will have its own procedures after you get your certification. However, you’ll likely need to maintain your knowledge by keeping a role in the profession or attending a minimum number of education hours to keep your certification current and valid.

Working as a CNA

The average annual salary for certified nursing assistants is $29,115 or an average hourly rate of $13.12. This rate is similar to that of HHAs. Many states have a distinction between CNA-1s, who work in nursing homes and residential facilities, and CNA-2s, who work in hospitals and clinics. In some states, CNAs can perform additional tasks, such as draw blood or administer flu shots, if they take the appropriate training.

As CNAs work under the supervision of other medical professionals, it’s essential to have excellent communication skills and be able to work well in a team. CNAs often have the most contact with patients, which requires empathy, the ability to listen, understand, and pass on critical information.

Duties of CNAs include:

  • dress wounds
  • document health issues
  • complete treatment charts
  • report patient status to RNs and doctors
  • assist with feeding, bathing, and dressing
  • take blood pressure, temperature, and other vital signs
  • comb hair, cut nails, and shave
  • stock supplies
  • prepare patient beds and rooms

CNAs play a crucial role in patient comfort during their stay in nursing home facilities or hospitals. The duties of a certified nursing assistant also impact patient recovery. The position is similar to CMAs, who might have more training and also deal with administrative aspects. PCTs also have more training and more responsibility, and usually a higher pay grade. Some CNAs progress to these roles as the next step in their careers.

People who can work for long hours with enough energy and have physical strength are suited for the CNA position. Other attributes that are an asset in the role are compassion, flexibility, and the ability to listen and provide support. You’ll liaise with patients, family members, and a broad range of medical professionals, so being able to adapt your manner and style will be useful.

Future outlook
future outlook tooltip icon

Future Outlook Projections are taken from the Projections Management Partnership (PMP). The PMP is funded by the Department and Labor, Employment and Training Administration, with direct support from the Bureau of Labor Statistics. The PMP provides data-driven projections of future workforce needs.

1,450,960

Nursing Assistants total employment

190,700

Nursing Assistants annual openings
future outlook tooltip icon

Annual openings include jobs available due to both an increase in demand, and regular employee turnover (retirees, career switchers, etc.).

8.9%

Estimated increase in Nursing Assistants jobs (2018-2028)
future outlook tooltip icon

The estimated increase in jobs (2018-2028) is the increase in total jobs expected and does not consider employee turnover.

High job growth-0

High job growth
future outlook tooltip icon

To provide context to estimated job growth, we employ a “fire and ice” system, which compares projected career growth to the national average of 5.2%, as follows:

<-10% = 3 ices
Btwn -5 to -9.9% = 2 ices
Between -5% to-.1% = 1 ice
between 0- 5.5% = neutral
Between 5.5%-10% = 1 fire
Between 10-20% = 2 fire
>20%=3 fires

At the state level, we simply sort the states from fastest growing to slowest within the particular career, or 1st to 50th.

Nursing assistant top line employment numbers have been forecast to increase by 8.9% in the period from 2018-28, though this has not been borne out in 2018-2020, as we describe below. Note the particularly high turnover for nursing assistants, a good deal above 10%. We might attribute this turnover to the perceptions of the role of nursing assistant, considered a gateway in the healthcare industry, with ambitious assistants moving up their career ladder after a few years.

The fastest growth states

1.

Colorado

+24.8%

2.

Utah

+23.8%

3.

Arizona

+22.2%

4.

Nevada

+20.2%

5.

Maryland

+18.4%

6.

Idaho

+18.1%

7.

Georgia

+15%

Nursing Assistants salary information by state

Nominal
Real salary
future outlook tooltip icon

The nominal salary is the unadjusted salary paid.

The real salary is adjusted to consider the purchasing power by state. We multiply the nominal salary by a state purchasing parities index to indicate the relative value of salaries by state. For instance, while New York or California might pay the highest nominal salary, these states are relatively expensive and so the real value of the salary is often less than a cheaper to live in state with a lower nominal salary.

BLS
Payscale
future outlook tooltip icon

When available we provide 2020 state level salary information from the Bureau of Labor Statistics showing 10th, 50th, and 90th percentile earnings to provide the range of salary experienced by each career. Salary data is aggregated from the actual reported income of the US labor force, and is considered the most trustworthy data source for salary information.

Payscale is a salary survey service meant to provide employers and employees with salary data at local levels to benchmark and compare. While Payscale has a much smaller sample size than BLS, Payscale does update more frequently so data may be considered fresher. Payscale also indicates salaries at a wider range of roles whereas BLS sometimes aggregates numerous professions into one category which may skew salary data. For this reason, we find Payscale to be a good secondary salary indicator. All information received from payscale is via a paid API. You can read more about payscale and their data methodology here.

Highest salary states

1.

Alaska

$38,500

Average salary

2.

New York

$36,610

Average salary

3.

Hawaii

$34,870

Average salary

4.

Nevada

$34,060

Average salary

5.

North Dakota

$33,980

Average salary

6.

Minnesota

$33,350

Average salary

7.

California

$33,070

Average salary

Last five years employment and salary
future outlook tooltip icon

We utilize historic annual BLS salary and total employment statistics to create a trend line which illustrates the job market over time for a particular career.

National

Average Wage Total employment
2016: $26,590 1,443,150
2017: $27,520 1,453,670
2018: $28,540 1,450,960

Though not displayed in the line chart above, total employment numbers continue to fall. Total employment dropped to 1,419,920 in 2019 before diving in COVID-ravaged 2020 to 1,371,050. This constitutes a 2-year employment drop of approximately 5%, though thankfully wages have increased by a good amount in the same time period, from a median average of $28,540 to $30,850. Hopefully, these salary increases signify that employment downturns are a supply issue, with wages continuing to increase to retain labor.

Advance your career in nursing

As the CNA post is an entry-level position, there are many ways to progress in your career. With experience, on-the-job training, and some further education, you could become a CMA or a PCT. A step up from either of those would be to train as a licensed practical/vocational nurse. 

After gaining experience as a CNA, many choose to pursue a degree while working so they can sit for the NCLEX-RN exam and become a registered nurse. As a minimum, that role requires an associate degree in nursing.

Associate degree in nursing (ADN)

CNAs with experience and training might be well suited to an ADN program, and some schools will recognize nursing assisting program credits to contribute towards the degree.

Generally, you can complete the program in 18 months to 2 years. Hybrid, mostly online, and campus-based courses are available. Most degrees require you to earn 65 and 80 credits in nursing curriculum and general education, respectively.

The program typically includes:

  • pathophysiology
  • human anatomy and physiology
  • clinical assessments
  • basic nutrition
  • community care

Who is this career best for?

A role as a CNA is ideal for those who want to start their career in nursing. It’s an entry point that costs less than nursing degrees and requires less time and training. The role is demanding but also rewarding, as you get to spend a lot of time with patients helping them physically and emotionally.

You’ll need to work in the setting where your patients are, so you can’t work from home in this role. It’s also worth bearing in mind that you’ll be on your feet a lot, and most positions require shift work over evenings and weekends.

American Nurses Association (ANA)

The ANA is the national association for nurses at all levels in the U.S. It has been promoting the profession for more than a century.

National Student Association of Nurses (NSNA)

With over 60,000 members, NSNA is the national organization that supports nurse education and nursing students around the country.

Commission on Collegiate Nursing Education (CCNE)

This is the national accreditation body for nursing programs in the U.S.