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Certified Nurse Aides
 This page was last updated on 15-Jun-02

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 Occupational Outlook:
  Certified Nurse Aides
ob prospects for nursing aides should be good through the year 2008. Numerous openings will arise from a combination of fast growth and high turnover for this large occupation. Employment of nursing aides is expected to grow faster than the average for all occupations in response to an emphasis on rehabilitation and the long-term care needs of a rapidly growing elderly population.  Read on for a detailed report!

Nature of the Work | Working Conditions | Employment | Training, Other Qualifications, and Advancement | Job Outlook | Earnings | Related Occupations | Sources of Additional Information

Significant Points

Job prospects for nursing aides will be good because of fast growth and high turnover in this large occupation.
Minimum education or training is generally required for entry level jobs, but earnings are low.

Nature of the Work

Nursing and psychiatric aides help care for physically or mentally ill, injured, disabled, or infirm individuals confined to hospitals, nursing or residential care facilities, and mental health settings.

Nursing aides, also known as nursing assistants, geriatric aides, unlicensed assistive personnel, or hospital attendants, perform routine tasks under the supervision of nursing and medical staff. They answer patients’ call bells, deliver messages, serve meals, make beds, and help patients eat, dress, and bathe. Aides may also provide skin care to patients; take temperatures, pulse, respiration, and blood pressure; and help patients get in and out of bed and walk. They may also escort patients to operating and examining rooms, keep patients’ rooms neat, set up equipment, or store and move supplies. Aides observe patients’ physical, mental, and emotional conditions and report any change to the nursing or medical staff.

Nursing aides employed in nursing homes are often the principal caregivers, having far more contact with residents than other members of the staff. Since some residents may stay in a nursing home for months or even years, aides develop ongoing relationships with them and interact with them in a positive, caring way.

Psychiatric aides are also known as mental health assistants and psychiatric nursing assistants. They care for mentally impaired or emotionally disturbed individuals. They work under a team that may include psychiatrists, psychologists, psychiatric nurses, social workers, and therapists. In addition to helping patients dress, bathe, groom, and eat, psychiatric aides socialize with them and lead them in educational and recreational activities. Psychiatric aides may play games such as cards with the patients, watch television with them, or participate in group activities such as sports or field trips. They observe patients and report any physical or behavioral signs which might be important for the professional staff to know. They accompany patients to and from wards for examination and treatment. Because they have the closest contact with patients, psychiatric aides have a great deal of influence on their outlook and treatment.
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Working Conditions

Most full-time aides work about 40 hours a week, but because patients need care 24 hours a day, some aides work evenings, nights, weekends, and holidays. Many work part-time. Aides spend many hours standing and walking, and they often face heavy workloads. Because they may have to move patients in and out of bed or help them stand or walk, aides must guard against back injury. Nursing aides may also face hazards from minor infections and major diseases such as hepatitis, but can avoid infections by following proper procedures.

Nursing aides often have unpleasant duties; they empty bed pans and change soiled bed linens. The patients they care for may be disoriented, irritable, or uncooperative. Psychiatric aides must be prepared to care for patients whose illness may cause violent behavior. While their work can be emotionally demanding, many aides gain satisfaction from assisting those in need.

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Nursing aides held about 1.4 million jobs in 1998, and psychiatric aides held about 95,000 jobs. About one-half of all nursing aides worked in nursing homes, and about one-fourth worked in hospitals. Others worked in residential care facilities, such as halfway houses and homes for the aged or disabled, or in private households. Most psychiatric aides worked in psychiatric units of general hospitals, psychiatric hospitals, State and county mental institutions, homes for mentally retarded and psychiatric patients, and community mental health centers.

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Qualifications & Advancement

In many cases, neither a high school diploma nor previous work experience is necessary for a job as a nursing or psychiatric aide. A few employers, however, require some training or experience. Hospitals may require experience as a nursing aide or home health aide. Nursing homes often hire inexperienced workers who must complete a minimum of 75 hours of mandatory training and pass a competency evaluation program within 4 months of employment. Aides who complete the program are placed on the State registry of nursing aides. Some States require psychiatric aides to complete a formal training program.
These occupations can offer individuals an entry into the world of work. The flexibility of night and weekend hours also provides high school and college students a chance to work during the school year.

Nursing aide training is offered in high schools, vocational-technical centers, some nursing homes, and community colleges. Courses cover body mechanics, nutrition, anatomy and physiology, infection control, communication skills, and resident rights. Personal care skills such as how to help patients bathe, eat, and groom are also taught.

Some facilities, other than nursing homes, provide classroom instruction for newly hired aides, while others rely exclusively on informal on-the-job instruction from a licensed nurse or an experienced aide. Such training may last several days to a few months. From time to time, aides may also attend lectures, workshops, and in-service training.

Applicants should be healthy, tactful, patient, understanding, emotionally stable, dependable, and have a desire to help people. They should also be able to work as part of a team, have good communication skills, and be willing to perform repetitive, routine tasks.

Opportunities for advancement within these occupations are limited. To enter other health occupations, aides generally need additional formal training. Some employers and unions provide opportunities by simplifying the educational paths to advancement. Experience as an aide can also help individuals decide whether to pursue a career in the health care field.

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Job Outlook

Job prospects for nursing aides should be good through the year 2008. Numerous openings will arise from a combination of fast growth and high turnover for this large occupation. Employment of nursing aides is expected to grow faster than the average for all occupations in response to an emphasis on rehabilitation and the long-term care needs of a rapidly growing elderly population. Employment will increase as a result of the expansion of nursing homes and other long-term care facilities for people with chronic illnesses and disabling conditions, many of whom are elderly. Financial pressure on hospitals to release patients as soon as possible should produce more nursing home admissions. Modern medical technology will also increase the employment of nursing aides. This technology, while saving and extending more lives, increases the need for long-term care provided by aides. As a result, nursing and personal care facilities are expected to grow rapidly and to provide most of the new jobs for nursing aides.

Employment of psychiatric aides is expected to grow slower than the average for all occupations. Employment will rise in response to the sharp increase in the number of older persons—many of whom will require mental health services. Employment of aides in outpatient community mental health centers is likely to grow because of increasing public acceptance of formal treatment for drug abuse and alcoholism, and a lessening of the stigma attached to those receiving mental health care. However, employment in hospitals—where one-half of psychiatric aides work—is likely to decline due to attempts to contain costs by limiting inpatient psychiatric treatment.

Replacement needs will constitute the major source of openings for aides. Turnover is high, a reflection of modest entry requirements, low pay, and lack of advancement opportunities.

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Median hourly earnings of nursing aides, orderlies, and attendants were $7.99 in 1998. The middle 50 percent earned between $6.72 and $9.54 an hour. The lowest 10 percent earned less than $5.87 and the highest 10 percent earned more than $11.33 an hour. Median hourly earnings in the industries employing the largest number of nursing aides, orderlies, and attendants in 1997 were as follows:

Local government, except education and hospitals
Personnel supply services
Nursing and personal care facilities
Residential care

Median hourly earnings of psychiatric aides were $10.66 in 1998. The middle 50 percent earned between $8.33 and $13.36 an hour. The lowest 10 percent earned less than $6.87 and the highest 10 percent earned more than $15.28 an hour. Median hourly earnings of psychiatric aides in 1997 were $11.20 in State government and $9.80 in hospitals.

Aides in hospitals generally receive at least 1 week’s paid vacation after 1 year of service. Paid holidays and sick leave, hospital and medical benefits, extra pay for late-shift work, and pension plans also are available to many hospital and some nursing home employees.

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Related Occupations

Nursing and psychiatric aides help people who need routine care or treatment. So do home health and personal care aides, child-care workers, companions, occupational therapy aides, and physical therapy aides.

Sources of Additional Info

Information about employment opportunities may be obtained from local hospitals, nursing homes, psychiatric facilities, State boards of nursing and local offices of the State employment service.
For information about a career as a nursing aide and schools offering training, contact:
National Association of Health Career Schools, 2301 Academy Dr., Harrisburg, PA 17112.

PLEASE NOTE:  The material in this publication is within the public domain and has been reprinted here from the Occupational Outlook Handbook (Division of Occupational Outlook, Bureau of Labor Statistics, U.S. Department of Labor, Washington, DC 20212. Phone: (202) 691-5700. Fax: (202) 691-5745. E-mail:  To view other articles from the Occupational Outlook Handbook, please visit the BLS.

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