An NA in nursing stands for nursing assistant, a healthcare worker who provides hands-on personal care to patients under the supervision of a licensed nurse. You may also see the term CNA, which stands for certified nursing assistant and refers to someone who has completed a state-approved training program and passed a competency exam. The two terms are often used interchangeably, though “CNA” specifically indicates the person holds certification.
What a Nursing Assistant Does
Nursing assistants are the members of the care team who spend the most direct time with patients. Their core job is helping people with activities of daily living: bathing, grooming, dressing, eating, using the bathroom, and moving around safely. In a nursing home or long-term care facility, this work follows a daily rhythm. Morning care includes toileting, oral care, helping with breakfast, assisting with bathing or showering, and getting residents dressed. Evening care covers many of the same tasks in reverse: changing into pajamas, washing up, removing makeup, and tidying the room.
Beyond personal care, NAs take and record vital signs like blood pressure, temperature, and pulse. They measure height and weight, maintain urinary catheters, help with bowel and bladder retraining, and keep the patient’s environment clean and safe. One of their most important responsibilities is recognizing changes in a patient’s condition, such as a new skin breakdown or a shift in mental alertness, and reporting those changes to the supervising nurse. NAs also escort residents to physical therapy, occupational therapy, and group activities throughout the day.
Who Supervises Nursing Assistants
NAs always work under the direction of a licensed nurse, typically a registered nurse (RN) or licensed practical nurse (LPN). The supervising RN is legally responsible for the nursing care provided and must ensure that any task delegated to an NA falls within that person’s scope of practice and training. Not every nursing task can be delegated. NAs cannot administer medications, perform sterile procedures, or make clinical judgments about a patient’s treatment plan. If a task is delegated that falls outside what an NA is trained and authorized to do, liability falls on the nurse who assigned it.
Training and Certification Requirements
Federal law requires a minimum of 75 clock hours of training for nursing assistants, with at least 16 of those hours spent in supervised hands-on clinical practice. Before an NA has any direct contact with a patient, they must complete at least 16 hours of classroom instruction covering communication skills, infection control, safety and emergency procedures (including the Heimlich maneuver), promoting patient independence, and residents’ rights.
The full curriculum goes well beyond those initial hours. It covers basic nursing skills like taking vital signs and recognizing abnormal body changes, personal care skills such as bathing and skin care, safe transfers and positioning, care for people with cognitive impairment, mental health and social service needs, and basic restorative services. After completing an approved program, candidates must pass a competency evaluation that includes both a written (or oral) exam and a practical skills test.
Many states set their training hour requirements significantly higher than the 75-hour federal minimum. Each state maintains its own nurse aide registry, a database that tracks qualified nursing assistants and flags anyone with a substantiated finding of resident abuse. Long-term care facilities are required to check this registry before hiring any NA.
Where Nursing Assistants Work
The largest employer of NAs is long-term care: nursing homes, skilled nursing facilities, and assisted living communities. Hospitals employ a significant number as well, where NAs work on medical-surgical floors, in emergency departments, and in rehabilitation units. Home health agencies hire NAs to provide personal care in patients’ homes, and some NAs work in hospice settings, outpatient clinics, or group homes for people with disabilities.
Pay and Job Outlook
The median annual wage for nursing assistants was $39,530 as of May 2024, which works out to about $18.96 per hour. The lowest 10 percent earned less than $31,390, while the highest 10 percent earned more than $50,140. Pay varies considerably by state, with higher wages in metropolitan areas and states with a higher cost of living. Facilities that struggle to recruit often offer shift differentials for evening, night, or weekend work.
Career Advancement From NA
Working as an NA is one of the most common entry points into a nursing career. Many people use the role to gain clinical experience and patient-care hours while they decide whether to pursue further education. The most direct path forward is a CNA-to-RN bridge program, which typically takes one to two years and includes coursework in nursing theory, health assessment, and clinical rotations. Bridge programs are specifically designed to give credit for prior training and experience so students don’t start from scratch.
The full pathway to becoming a registered nurse involves completing either an Associate Degree in Nursing or a Bachelor of Science in Nursing, then passing the NCLEX-RN licensing exam. Some NAs take an intermediate step by becoming licensed practical nurses first, then moving on to an LPN-to-RN bridge program. Either way, time spent as an NA builds foundational skills in patient communication, time management, and hands-on care that carry directly into more advanced nursing roles.