Nursing assistants, also called nursing aides or certified nursing assistants (CNA), provide hands-on care for patients in nursing homes, hospitals and long-term care facilities. Their role first originated back in WWI, when the American Red Cross formed the Volunteer Nurses’ Aide Service. Young women were trained by this program so they could assist working nurses, who were overwhelmed by the numbers of the injured and desperately needed support.

According to the Bureau of Labor Statistics, there were more than 1.43 million nursing assistants working in the U.S. in 2017. More than a third of all nursing assistants work in skilled nursing facilities, and another 25 percent work in hospitals.

Career Outlook for Nursing Assistants

Nursing AssistantNational Average
Average Salary$30,720$53,490
Projected Job Growth8.9%5.2%
Source: 2017 Occupational Employment Statistics and 2016-26 Employment Projections, Bureau of Labor Statistics,

Best States for Nursing Assistants

New York$38,810
District of Columbia$35,320
Job Growth
Source: 2017 Occupational Employment Statistics and 2016-26 Employment Projections, Bureau of Labor Statistics,

What is a Nursing Assistant?

Nursing assistants play a crucial role in healthcare settings such as hospitals and long-term care facilities by providing individualized patient care. They aren’t licensed to perform the same tasks as registered nurses or licensed vocational nurses; instead, they help patients with essential daily tasks such as bathing, dressing, eating, going to the bathroom and other aspects of personal hygiene. They also might assist elderly patients getting to and from dining rooms or activity centers, or help bedridden patients turn and reposition themselves. In short, nursing aides help improve the quality of daily life for the patients under their care.

Nursing assistants are an integral part of a care team and work under the supervision of RNs or LVNs. In some states, nursing assistants can dispense medication, but they are not licensed to prescribe medication.

Although licensed practical nurses and registered nurses often perform some of the same tasks as nursing assistants, their roles are quite different. LPNs are certificate- or diploma-educated nurses who administer basic medical care, and RNs are degree-educated nurses who perform more advanced medical diagnoses and procedures. Nursing assistants perform important aspects of patient care, but they do not generally focus on the kinds of medical tasks that define the role of an LPN or an RN.

Nursing Assistants Skills

Skill NameImportanceCompetence
Source: O*NET® 22.1 Database, O*NET OnLine, National Center for O*NET Development, Employment & Training Administration, U.S. Department of Labor,

Step One: Earn Your Education

The position of nursing assistant is a popular choice for many people due to its ease of entry. NAs don’t need to earn a college degree to gain employment. Instead, they must complete a state-approved nursing education training program, commonly available at community colleges and technical/vocational schools. The American Red Cross also provides a Certified Nursing Assistant training program, and training programs also are offered in hospitals, nursing homes, high schools and private training companies.

Students who enroll in certain nursing assistant training programs may be required to pass a background check and drug screening prior to beginning their clinical rotations. They also may be required to provide verification of pertinent immunizations, and in some cases they also must complete cardiopulmonary resuscitation certification through the American Heart Association or similar approved CPR training provider.


Nursing assistant training programs vary in length, and training requirements for these programs can also vary by state. As an example, the American Red Cross CNA program runs between four and eight weeks and focuses on the following core competencies:

  • CPR
  • Taking and monitoring vital signs
  • Control of infectious diseases
  • Helping patients with range of motion exercises
  • Caregiving and safety

Typically, training programs also include completing clinical work in a healthcare setting or long-term care facility. During this clinical work, students work directly with patients under the supervision of licensed nurses, learning the daily roles that nursing assistants can play in these facilities.

Step Two: Earn Your Certification

All nursing aides must earn certification to gain employment. According to the National Council of State Boards of Nursing (NCSBN) — which licenses all registered nurses in the U.S. — there are 22 states and the District of Columbia that utilize the NCSBN’s National Nurse Aide Assessment Program (NNAAP) to certify nursing assistant competency. In states that don’t use the NNAAP certification exam, nursing assistants are licensed through their home state’s board of nursing. Certificates typically must be renewed every two years.

Here’s a rundown of certifications that are pertinent to the field of nursing assistant:

  • National Nurse Aide Assessment Program (NNAAP): This two-part exam consists of a written or oral portion and a demonstration of skills. Candidates who successfully pass the exam have their names added to their state’s nurse aid registry, allowing them to seek employment and ensures employers they are hiring candidates who have met all state and federal requirements for gainful employment.
  • Medication Aide Certification Examination (MACE): Also administered by the NCSBN, this is an important national certification exam for nursing assistants because it allows successful candidates to distribute medications in hospitals and long-term care facilities.
  • Certified Phlebotomy Technician (CPT): Many nursing assistants also earn a certification in phlebotomy, which allows them to draw patient’s blood for samples. Certification is administered by the American Society for Clinical Pathology.

Step Three: Continuing Education

All nursing professionals are required to keep their skills sharp through required continuing education courses. Many states require nursing assistants to complete continuing education as well in order to enhance their knowledge and refresh their core competencies.

Although continuing education requirements vary by state and are established by the state’s board of nursing or nursing aide registry, nursing assistants who are required to complete continuing education often must document up to 48 hours of in-service training within the standard two-year certification period.

Nursing assistants should check with their home state’s board of nursing or state nurse aide registry to learn the specific continuing education requirements for their state and situation.

  1. A Brief History of CNA Careers,”, Accessed June 2018,
  2. Nursing Assistants, Occupational Employment and Wages, May 2017, U.S. Bureau of Labor Statistics,
  3. What is a Certified Nursing Assistant, academy,
  4. Certified Nursing Assistant Program, Truckee Meadows Community College,
  5. CNA Nurse Assistant Training and Testing, American Red Cross,
  6. MACE Exam, National Council for State Boards of Nursing,
  7. Certified Nursing Assistant, Florida Board of Nursing,