Career Guide for Nursing Aides

Nursing aides provide care in hospitals, nursing care facilities, and mental health facilities. They assist medical staff under the supervision of nursing staff. There are numerous opportunities in this profession with limited entry requirements, but also limited advancement opportunities.

In this free career guide, you will learn how to have a successful career as a nursing aide.

Nursing Aide Summary

• Numerous job openings and excellent job opportunities are expected.
• Most jobs are in nursing and residential care facilities and in hospitals.
• A high school diploma is required for many jobs; specific qualifications vary by occupation, State laws, and work setting.
• This occupation is characterized by modest entry requirements, low pay, high physical and emotional demands, and limited advancement opportunities.

Working as a Nursing Aide

Nursing and psychiatric aides help care for physically or mentally ill, injured, disabled, or infirm individuals in hospitals, nursing care facilities, and mental health settings. Nursing aides and home health aides are among the occupations commonly referred to as direct care workers, due to their role in working with patients who need long-term care. The specific care they give depends on their specialty.

Nursing aides, also known as nurse aides, nursing assistants, certified nursing assistants, geriatric aides, unlicensed assistive personnel, orderlies, or hospital attendants, provide hands-on care and perform routine tasks under the supervision of nursing and medical staff. Specific tasks vary, with aides handling many aspects of a patient’s care. They often help patients to eat, dress, and bathe. They also answer calls for help, deliver messages, serve meals, make beds, and tidy up rooms. Aides sometimes are responsible for taking a patient’s temperature, pulse rate, respiration rate, or blood pressure. They also may help provide care to patients by helping them get out of bed and walk, escorting them to operating and examining rooms, or providing skin care. Some aides help other medical staff by setting up equipment, storing and moving supplies, and assisting with some procedures. Aides also observe patients’ physical, mental, and emotional conditions and report any change to the nursing or medical staff.

Nursing aides employed in nursing care facilities often are the principal caregivers and have more contact with residents than do other members of the staff. Because some residents may stay in a nursing care facility for months or even years, aides develop positive, caring relationships with their patients.

Psychiatric aides, also known as mental health assistants or psychiatric nursing assistants, 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 to dress, bathe, groom themselves, and eat, psychiatric aides socialize with them and lead them in educational and recreational activities. Psychiatric aides may play card games or other games with patients, watch television with them, or participate in group activities, such as playing sports or going on field trips. They observe patients and report any physical or behavioral signs that might be important for the professional staff to know. They accompany patients to and from therapy and treatment. Because they have such close contact with patients, psychiatric aides can have a great deal of influence on their outlook and treatment.

Work environment. Work as an aide can be physically demanding. Aides spend many hours standing and walking, and they often face heavy workloads. Aides must guard against back injury, because they may have to move patients into and out of bed or help them stand or walk. It is important for aides to be trained in and to follow the proper procedures for lifting and moving patients. Aides also may face hazards from minor infections and major diseases, such as hepatitis, but can avoid infections by following proper procedures. Nursing aides, orderlies, and attendants and psychiatric aides have some of the highest non-fatal injuries and illness rates for all occupations, in the 98th and 99th percentiles in 2007.

Aides also perform tasks that some may consider unpleasant, such as emptying bedpans and changing soiled bed linens. The patients they care for may be disoriented, irritable, or uncooperative. Psychiatric aides must be prepared to care for patients whose illnesses may cause violent behavior. Although their work can be emotionally demanding, many aides gain satisfaction from assisting those in need.

Most full-time aides work about 40 hours per week, but because patients need care 24 hours a day, some aides work evenings, nights, weekends, and holidays. In 2008 about 24 percent of nursing aides, orderlies, and attendants and psychiatric aides worked part-time.

Training, Other Qualifications, and Advancement

In many cases, a high school diploma or equivalent is necessary for a job as a nursing or psychiatric aide. Specific qualifications vary by occupation, State laws, and work setting. Advancement opportunities are limited.

Education and training. Nursing and psychiatric aide training is offered in high schools, vocational-technical centers, some nursing care facilities, and some 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 themselves, also are taught. Hospitals may require previous experience as a nursing aide or home health aide. Some States also require psychiatric aides to complete a formal training program. However, most psychiatric aides learn their skills on the job from experienced workers.

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

Licensure and certification. Federal Government requirements exist for nursing aides who work in nursing care facilities. These aides must complete a minimum of 75 hours of State-approved training and pass a competency evaluation. Aides who complete the program are known as certified nurse assistants (CNAs) and are placed on the State registry of nurse aides. Additional requirements may exist, but vary by State. Therefore, individuals should contact their State board directly for applicable information.

Other qualifications. Aides must be in good health. A physical examination, including State-regulated disease tests, may be required. A criminal background check also is usually required for employment.

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

Advancement. Opportunities for advancement within these occupations are limited. Aides generally need additional formal training or education to enter other health occupations. The most common healthcare occupations for former aides are licensed practical nurse, registered nurse, and medical assistant.

For some individuals, these occupations serve as entry-level jobs. For example, some high school and college students gain experience working in these occupations while attending school. And experience as an aide can help individuals decide whether to pursue a career in healthcare.

Employment as a Nursing Aide

Nursing and psychiatric aides held about 1.5 million jobs in 2008. Nursing aides, orderlies, and attendants held the most jobs—approximately 1.5 million, and psychiatric aides held about 62,500 jobs. About 41 percent of nursing aides, orderlies, and attendants worked in nursing care facilities and another 29 percent worked in hospitals. About 50 percent of all psychiatric aides worked in hospitals. Others were employed in residential care facilities, government agencies, outpatient care centers, and individual and family services.

Job Outlook

Employment is projected to grow faster than the average. Excellent job opportunities are expected.

Employment change. Overall employment of nursing and psychiatric aides is projected to grow 18 percent between 2008 and 2018, faster than the average for all occupations. However, growth will vary for individual occupations. Employment for nursing aides, orderlies, and attendants will grow 19 percent, faster than the average for all occupations, predominantly in response to the long-term care needs of an increasing elderly population. Financial pressures on hospitals to discharge patients as soon as possible should boost admissions to nursing care facilities. As a result, new jobs will be more numerous in nursing and residential care facilities than in hospitals, and growth will be especially strong in community care facilities for the elderly. Modern medical technology will also drive demand for nursing aides, because as the technology saves and extends more lives, it increases the need for long-term care provided by aides. However, employment growth is not expected to be as fast as for other healthcare support occupations, largely because nursing aides are concentrated in the relatively slower growing nursing and residential care facilities industry sector. In addition, growth will be hindered by nursing facilities’ reliance on government funding, which does not increase as fast as the cost of patient care. Government funding limits the number of nursing aides nursing facilities can afford to have on staff.

Psychiatric aides are expected to grow 6 percent, more slowly than average. Psychiatric aides are a small occupation compared to nursing aides, orderlies, and attendants. Most psychiatric aides currently work in hospitals, but the industries most likely to see growth will be residential facilities for people with developmental disabilities, mental illness, and substance abuse problems. There is a long-term trend toward treating psychiatric patients outside of hospitals, because it is more cost effective and allows patients greater independence. Demand for psychiatric aides in residential facilities will rise in response to increases in the number of older persons, many of whom will require mental health services. Demand for these workers will also grow as an increasing number of mentally disabled adults, formerly cared for by their elderly parents, will need care. Job growth also could be affected by changes in government funding of programs for the mentally ill.

Job prospects. High replacement needs for nursing and psychiatric aides reflect modest entry requirements, low pay, high physical and emotional demands, and limited opportunities for advancement within the occupation. For these same reasons, the number of people looking to enter the occupation will be limited. Many aides leave the occupation to attend training programs for other healthcare occupations. Therefore, people who are interested in, and suited for, this work should have excellent job opportunities.

Projections Data

Projections data from the National Employment Matrix

Occupational Title	SOC Code	Employment, 2008	Projected Employment, 2018	Change, 2008-18
				Number	Percent
Nursing and psychiatric aides	—	1,532,300	1,811,800	279,600	18
Nursing aides, orderlies, and attendants	31-1012	1,469,800	1,745,800	276,000	19
Psychiatric aides	31-1013	62,500	66,100	3,600	6
NOTE: Data in this table are rounded.

Earnings for Nurse Aides

Median hourly wages of nursing aides, orderlies, and attendants were $11.46 in May 2008. The middle 50 percent earned between $9.71 and $13.76 an hour. The lowest 10 percent earned less than $8.34, and the highest 10 percent earned more than $15.97 an hour. Median hourly wages in the industries employing the largest numbers of nursing aides, orderlies, and attendants in May 2008 were:

Median hourly wages of psychiatric aides were $12.77 in May 2008. The middle 50 percent earned between $10.00 and $15.63 an hour. The lowest 10 percent earned less than $8.35, and the highest 10 percent earned more than $18.77 an hour. Median hourly wages in the industries employing the largest numbers of psychiatric aides in May 2008 were: