Certified Nursing Assistant Guide

    Nurse assistant helping an elderly patient in a nursing home

    Part One What is a Certified Nursing Assistant (CNA)?

    A certified nursing assistant, or CNA, helps patients with activities of daily living and other healthcare needs under the direct supervision of a Registered Nurse (RN) or Licensed Practical Nurse (LPN). CNA’s are also commonly referred to as a Nursing Assistant, Patient Care Assistant (PCA), or a Nurse’s Aid.

    Some individuals will use their knowledge as a CNA to bridge the gap to further their career and become an LPN or RN. Interestingly, a large number of CNAs are already in a nursing school program and use this career as a chance to learn more about the healthcare world and gain additional real world application and knowledge. Others become a CNA in order to determine if they want to continue to the next step in their healthcare journey.

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    Part Two How is a CNA different from a Medical Assistant (MA) and an LPN?

    While certified nursing assistants and medical assistants (MAs) do have some similarities, such as working with patients and providing patient care, it is important not to confuse the two healthcare careers.

    Both careers assist doctors, nurses, and other healthcare providers with treatments, procedures, and tests. Medical assistants focus primarily on patient assessment, evaluation, and assisting doctors with patient care and treatment, whereas nursing assistants are generally more involved in direct patient care. Nursing assistants have specific job-related duties they are able to perform that are dictated by the state of employment. 

    LPNs, otherwise known as a Licensed Practical Nurse, require a license and passing a state-mandated exam. CNA’s on the other hand only need to obtain a certification in order to practice. LPNs often take classes similar to RNs in order to obtain additional information about health care and the human body. Additionally, there are certain tasks and procedures that LPNs are able to perform that CNA’s can not, such as inserting a peripheral intravenous catheter.

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    Part Three What Does a CNA Do?

    CNAs can help a unit run smoothly, especially for those nurses that have multiple medically complex patients. Responsibilities of a CNA include, but are not limited to:

    • Turning or repositioning patients
    • Gathering supplies for the RN or MD
    • Obtaining vital signs per protocol
    • Answering patient calls/bells
    • Bathing patients
    • Documentation of information obtained
    • Feeding patients, measuring and recording their food and liquid intake
    • Combing hair, shaving, caring for nails and brushing teeth
    • Cleaning rooms and bed linens
    • Stock supplies
    • Prepare rooms for admissions 
    • Helping with medical procedures
    • Dressing wounds
    • Assisting patients with elimination

    Direct responsibilities will vary based on the location of employment and ultimately the nurses level of need. CNA duties are determined by individual states and it is up to the individual to ensure they are following state guidelines and not performing duties outside the scope of practice. 

    CNAs can work in an inpatient hospital setting but are more commonly found in long-term residential facilities, rehabilitation centers, and adult daycare centers. They are rarely employed in outpatient office/clinic settings. These facilities all require nursing assistants to act as a liaison between the nurse and the patient. 

    Per the U.S. Bureau of Labor Statistics, in 2018, there were approximately 1,564,200 employed as certified nursing assistants. Nursing care facilities employed the greatest number of nursing assistants (38%) while only 4% currently work for the government.

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    Part Four What Qualities Should a CNA Possess?

    Nursing assistants first and foremost must enjoy interacting with people on a daily basis in order to find enjoyment and fulfillment in this career. Other attributes should include:

    • Flexibility
    • Advanced communication skills
    • Time management
    • Compassion
    • Reliability
    • Physical Strength
    • Empathy

    Part Five What is the Salary for CNAs?

    According to the U.S. Bureau of Labor Statistics (BLS), the median average annual salary for certified nursing assistants in 2018 was $28,530. It is important to note that this does vary depending on the setting. CNAs working in a government setting such as a VA hospital earned the highest median pay at $33,800, while home health care services have the lowest median pay at $27,290. 

    Nursing assistants can work on a variety of schedules which vary greatly based on the needs of the employer. Some work a variety of shifts throughout the course of the week while others have a set schedule and earn an annual salary. Those paid on an hourly scale are able to earn overtime pay whereas salary employees would need to discuss that with the hiring committee. An individual’s earning potential is determined by the needs of the hospital and the offer contract. 

    Currently, the following states have the highest pay scale for certified nursing assistants according to the BLS. 

    Highest Paying States For CNAs

    State Hourly Avg Annual Average
    Alaska $19.15 $39,830
    New York $17.79 $37,010
    Hawaii $17.20 $35,770
    California $16.93 $35,220
    Nevada $16.89 $35,130

    Metropolitan areas tend to pay higher for nursing assistants. Some of the highest paying cities include:

    Highest Paying Cities for CNAs

    Metro Area Hourly Annual
    San Francisco $21.83 $44,260
    Salinas, CA $20.47 $42,590
    Fairbanks, AK $19.57 $40,710
    San Jose $19.05 $39,620

    Nonmetropolitan and/or rural areas with the highest employment of certified nursing assistants are:

    • Kansas nonmetropolitan area
    • Southeast Coastal North Carolina nonmetropolitan area
    • Piedmont North Carolina nonmetropolitan area
    • North Northeastern Ohio non-metropolitan area (non-contiguous)

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    Part Six How Do I Become A CNA?

    Certified nursing assistants must complete a state-approved training program. These programs are generally found at local community colleges, high school, vocational or technical schools, or local hospitals.

    Programs do vary so it is important that interested students research programs thoroughly to find one that best suits their needs.

    Most programs have similar requirements that must be completed prior to application and acceptance. The American Red Cross runs a popular CNA training program throughout the country which runs for 4-8 weeks depending on class size and location. Prerequisites include:

    • Attendance at an orientation information session
    • TABE (reading and math assessment) OR verification of High School diploma or GED
    • Red Cross criminal background check prior to registration
    • Completion of Red Cross physical form and TB test

    Online CNA Programs

    While the Red Cross offers in-person classes, some vocational schools and community colleges offer online CNA programs. Many programs operate clinics at local hospitals.

    There are pros and cons to the online programs. While individuals may be able to obtain their certification quicker there is concern that individuals graduating from these programs are not gaining the same core knowledge and skills as their in-classroom counterparts.

    Most programs average roughly 4 to 12 weeks for completion depending on the class schedule. Programs are comprised of class hours and clinical hours. Each state has a designated number of clinical hours that an individual must complete before applying for certification.

    After completion of a state-approved training program, an individual can take a competency exam. The exam consists of two parts: a multiple choice written exam and a practical skill based exam. Once passed, the certified nursing assistant is placed on a state registry and can begin to apply for jobs.

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    Part Seven How do CNAs Transition to Other Nursing Positions?

    Becoming a certified nursing assistant does not immediately translate into other nursing degrees.

    In fact, it will only provide clinical knowledge and experience which may in turn help earn entrance into an LPN or RN program. Otherwise, becoming an LPN or RN requires acceptance into those individual programs.

    Once accepted into an LPN or RN program it may make certain aspects easier because of the knowledge and experience already obtained from on the job training; however, it very rarely decrease time in those programs.

    On the other hand, having the experience and healthcare connections could potentially assist in job placement after graduation.

    Part Eight Where Can I Learn More About Being A CNA?

    For those interested in more information about becoming a CNA, professional organizations such as the National Network of Career Nursing Assistants and Nursing Association of Health Care Assistants are great resources.

    Both discuss growing trends in healthcare that impact nursing assistants. Other information includes healthcare conventions targeted for this audience, access to continuing education hours, job opportunities, and contact information for local chapters.

    While these associations are not only a great resource for new to practice CNAs, they also provide vital information for those who are already established in the career. By joining these professional organizations, vital connections are made to industry experts and managers which can lead to future employment opportunities.

    Part Nine CNA Jobs

    Currently, states such as California, Florida, Texas, New York, and Pennsylvania have the highest number of employed certified nursing assistants. Growth is expected to rise in areas with warmer climate as the older population continues to retire and move to these areas. 

    Part Ten What is the Career Outlook for a CNA?

    Certified nursing assistants are currently in high demand and the need is projected to continue through 2028.

    This number will only increase as the baby boomer generation ages and there is an increased demand for additional long-term nursing care facilities. Nursing assistants will be needed to care for this population which is more likely to suffer from dementia and other neurologic changes.

    The BLS projects that employment for nursing assistants will grow 9 percent from 2018 to 2028.

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