A nursing assistant is a healthcare worker who provides basic, hands-on care to patients under the supervision of licensed nurses. Sometimes called a certified nursing assistant (CNA), nurse aide, or patient care assistant, this role serves as the frontline of daily patient care in hospitals, nursing homes, and other healthcare settings. Nursing assistants help with everything from bathing and feeding to checking vital signs, making them essential to a patient’s comfort and safety.
What Nursing Assistants Do Every Day
The core of a nursing assistant’s job is direct patient care. On a typical shift, that means measuring temperature, pulse, respiration, and blood pressure, then recording everything in the patient’s medical record. It also means helping people with basic needs they can’t manage alone: bathing, dressing, eating, and getting in and out of bed.
Beyond personal care, nursing assistants transport patients to exams, clinics, or recreational areas. They reposition patients in bed to prevent bedsores, help with walking exercises, and perform basic procedures like skin care or enemas as directed by a licensed nurse. In many facilities, they’re the staff members who spend the most time at the bedside, so they’re often the first to notice changes in a patient’s condition.
Where Nursing Assistants Work
Skilled nursing facilities (nursing homes) are the largest employer, with roughly 458,600 nursing assistants working in that setting as of May 2023. General hospitals employ the second-largest group at about 410,900. Home health care is a smaller but growing segment, with around 81,400 nursing assistants providing care in patients’ homes. Pay varies by setting: hospital-based nursing assistants earned an average of $19.64 per hour, compared to $18.62 in nursing homes and $17.13 in home health care.
Training and Certification Requirements
Federal law requires that nursing assistants working in Medicare- or Medicaid-certified nursing homes complete a state-approved training program with at least 75 hours of instruction, including a minimum of 16 hours of supervised clinical practice. In reality, most states set the bar higher. Over half require more than 75 total hours, and 13 states plus Washington, D.C. require 120 hours or more.
Some states go well beyond the federal minimum. Maine requires 180 hours of training, Missouri requires 175, and Oregon requires 155. California mandates 150 total hours with 100 of those in clinical practice. On the other end, states like Alabama, Ohio, and Mississippi stick to the 75-hour federal floor with just 16 hours of clinical time.
After completing the training program, candidates must pass a competency evaluation, which typically includes both a written test and a skills demonstration. Passing earns a spot on the state’s nurse aide registry. The job title varies by state: Ohio uses “State Tested Nursing Assistant” (STNA), New Hampshire uses “Licensed Nursing Assistant” (LNA), and many states simply use “Certified Nursing Assistant” (CNA) or “Certified Nurse Aide.”
What Nursing Assistants Cannot Do
Nursing assistants work under a defined scope of practice that’s narrower than what licensed nurses handle. They cannot administer medications, start or maintain IV lines, perform wound care, or carry out more complex nursing procedures. Those tasks fall to licensed practical nurses (LPNs) or registered nurses (RNs), who also supervise and delegate tasks to nursing assistants. If you’re considering this career, it’s important to understand that your clinical responsibilities will always be directed by a licensed nurse above you.
Physical and Emotional Demands
This is a physically demanding job. Nursing assistants spend most of their shifts on their feet, regularly helping patients move, stand, and transfer between beds, wheelchairs, and exam tables. Turning patients in bed, lifting, and repositioning are routine parts of the work. The physical strain, particularly on the back and joints, is one of the most commonly reported challenges in the field.
The emotional side is significant too. Nursing assistants often develop close relationships with patients, especially in long-term care settings where they may care for the same residents for months or years. Witnessing decline, managing difficult behaviors, and working through grief when patients pass away are all part of the reality. The combination of physical labor, emotional weight, and often understaffed shifts contributes to high turnover in the profession.
Pay and Job Outlook
The median annual wage for nursing assistants was $39,530 in May 2024, which works out to about $18.96 per hour. That figure sits roughly in the middle of healthcare support occupations. Employment is projected to grow about 8 percent over a decade, driven largely by the aging population and increasing demand for long-term care. That growth rate is on par with the average across all occupations, and it translates to more than 115,000 new positions.
Career Advancement Paths
Many people enter the nursing assistant role as a stepping stone into other healthcare careers. The most common next step is pursuing a licensed practical nurse or registered nurse credential. Moving from CNA to RN generally takes two to three years through an Associate Degree in Nursing (ADN) program, which covers anatomy, pharmacology, psychology, nutrition, and clinical theory. After completing the degree, graduates sit for the national licensing exam (NCLEX-RN) and then obtain a state license to practice.
Working as a nursing assistant before entering a nursing program offers a real advantage. You arrive with direct patient care experience, comfort in clinical environments, and a practical understanding of how healthcare teams function. Some nursing programs even give preference to applicants with CNA experience or offer credit for prior clinical hours.