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Nursing Assistants
Significant Points
  • 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.
Nature of the Work

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.

Nursing Aid, GS-0621-01

Nature, range, and complexity of work

Performs simple personal nursing care tasks in a hospital ward for patients who are not critically ill.

  • Makes patient's bed; gives a bed bath.
  • Collects and bags soiled linen for the laundry.
  • Places clean linen in proper storage area.
  • Fills water pitchers and gives ice water to patients.
  • Passes food trays. Feeds patients
  • Nursing Aid, GS-0621-02

    Nature, range, and complexity of work

    Observes and performs simple personal nursing care duties and related support duties for diagnostic services in a hospital ward for noncritically ill patients.

  • Gives bed bath, feeds patients, and provides oral and related hygiene care.
  • Takes vital signs and records results.
  • Collects and labels specimens (urine, stool and sputum).
  • Nursing Assistant, GS-0621-03

    Nature, range, and complexity of work

    Performs a variety of personal nursing care and diagnostic support duties, and learns to perform simple treatment, charting and patient teaching tasks in a medical ward.

    Personal Nursing Care Duties

    Performs a variety of personal nursing care which includes feeding, bathing, lifting, turning, oral care, nail care, hair care and related personal hygiene duties.

    Support Duties for Diagnostic Services

    Performs a variety of supporting diagnostic duties which includes taking, recording, and reporting to the supervisor deviations in vital signs, taking specimens, labeling specimens for the laboratory, calling the laboratory for laboratory reports and recording the report given over the telephone, and assisting the doctor in a variety of diagnostic examinations such as lumbar punctures, liver biopsies and bone marrow examinations by positioning and draping the patient and passing instruments.

    Treatment Duties

    Changes sterile dressings and observes and reports whether the wound is healing.

    Monitors the administration of intravenous solutions and reports to the nurse when the intravenous fluids are running low. Shuts off the administration of intravenous fluids as instructed.

    Patient Charting Duties

    Provides verbal information on unusual deviations in vital signs to the nurse. Graphs vital signs. Requests specific information from the patient and records data on the patient's admission history form.

    Patient Teaching Duties

    Teaches diabetic patients to perform the common urine test.

    Nursing Assistant, GS-0621-04

    Nature, range, and complexity of work

    Performs a range of patient care in a surgical ward.

    Personal Nursing Care Duties

    Performs a range of personal nursing care which includes feeding, bathing, lifting and turning patients, and providing oral, nail, hair and related hygiene care. Personal nursing care includes tube feeding with care given to assure that the tube is in the stomach and the feeding is given slowly.

    Support Duties for Diagnostic Services

    Performs a range of diagnostic support duties which includes taking, recording, and reporting to the supervisor deviations in vital signs, taking specimens, labeling specimens for the laboratory, calling the laboratory for lab reports and recording reports given over the telephone, and assisting the doctor in a variety of diagnostic examinations such as lumbar punctures, liver biopsies, and bone marrow examinations by positioning and draping patients and setting out and passing instruments. Makes gross visual observations (heavy vomiting, bleeding, fainting) and subtle visual observations of the patient's condition (slight drooling at the mouth, inattention (in the eyes) to patient teaching, and breaking down of the skin (leading to decubitus ulcer if not corrected promptly).

    Treatment Duties

    Performs a complete range of treatment procedures that includes using hot and cold packs; changing sterile dressings; giving enemas; monitoring intravenous fluids; hanging new intravenous fluids, changing intravenous tubing; inserting catheters; irrigating catheters; caring for patients in isolation; and setting up and giving treatments that require auxiliary equipment such as oxygen and respirator.

    Patient Charting Duties

    Verbally provides patient information to the supervisor for inclusion in the nursing care plan. Enters information about the patient's condition in the patient's chart following the ward's prescribed charting technique. Asks the patient questions from the patient's admission form and completes it for the chart.

    Patient Teaching Duties

    Instructs patient on the patient's role in various procedures, such as biopsies, covering information previously supplied by the doctor or the nurse. Instructs patient on the set-up and purpose of treatment supported by auxiliary equipment such as oxygen and respirator. Instructs the patient on pre and postoperative care based on standard, general information covered with the patient previously by either the doctor or the nurse.

    Psychiatric Nursing Assistant, GS-0621-05

    Nature, range, and complexity of work

    Provides personal care to psychiatric patients, and on a regular, continuing basis, serves as a member of the treatment team in motivating patients and redirecting their behavior toward treatment plan goals. These patients' nursing needs change within a predictable range, and the objectives set in the treatment plan are established by the treatment team.

    Personal Nursing Care Duties

    Encourages patients to maintain self-care and participates in the admission of patients by collecting patient information, orienting patients to the unit, checking them for contraband, when indicated, and assisting the nurse in formulating nursing actions.

    Support Duties for Diagnostic Services

    Takes vital signs, takes specimens, and supports the doctor in diagnostic tests such as biopsies and lumbar punctures.

    Treatment Duties

  • Participates in patient care planning with the nurse by suggesting nursing actions based on information obtained from the patients, group meetings or interactions with the patients.
  • Works with patients using a variety of treatment procedures in groups (reality orientation, small group therapy) or individually (one-to-one therapy) to explore their behavior and feelings for the purpose of establishing more acceptable approaches to daily living. Strives to maintain a ward environment which is oriented toward future independent life. Shares patient information and reactions with treatment team.
  • Identifies and meets needs of patients for information and guidance in daily living.
  • Promotes a sense of worth and dignity to the patient by such techniques as addressing the patient with his name, "Mr. Jones".
  • Promotes patient participation in therapeutic community by fostering increased self-reliance and independence and by involving patients not only in their own treatment plan but also that of other patients. Motivates family members to accept the patient and the patient's illness.
  • Participates in group meetings with patients by sharing thoughts and feelings in reference to what is going on in the meetings and in reference to the behavior of the participants.
  • Reports any changes in patient's condition or behavior that might be caused by drug reactions or problems on the ward.
  • Performs patient care treatments such as foot soaks or changes of sterile dressings.
  • Patient Charting Duties

    Charts patient's physical and emotional progress using the designated charting technique for the ward. Describes subtle behavior changes and interactions among patients and nursing staff.

    Security Duties

    Maintains a safe and secure environment for patients.

    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.

    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.


    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:

    Employment services $12.10
    General medical and surgical hospitals 12.05
    Nursing care facilities 11.13
    Community care facilities for the elderly 10.91
    Home health care services 10.58

    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:

    Psychiatric and substance abuse hospitals $13.43
    General medical and surgical hospitals 13.29
    Nursing care facilities 11.66
    Individual and family services 10.78
    Residential mental retardation, mental health and substance abuse facilities 9.89
    Sources of Additional Information

    Information about employment opportunities may be obtained from local hospitals, nursing care facilities, home healthcare agencies, psychiatric facilities, State boards of nursing, and local offices of the State employment service. Information on licensing requirements for nursing aides, and lists of State-approved nursing aide programs are available from State departments of public health, departments of occupational licensing, and boards of nursing.

    For more information on nursing aides, orderlies, and attendants, contact:

    For more information on the assisted living, nursing facility, developmentally-disabled, and subacute care provider industry, contact:

    • American Health Care Association, 1201 L St. NW., Washington, DC 20005. Internet:

    Information on obtaining Nursing Aid or Nursing Assistant positions with the Federal Government is available from the Office of Personnel Management through USAJOBS, the Federal Government's official employment information system. This resource for locating and applying for job opportunities can be accessed through the Internet at or through an interactive voice response telephone system at (703) 724–1850 or  (703) 724–1850  or TDD (978) 461–8404 and   (978) 461–8404. These numbers are not toll free, and charges may result. For advice on how to find and apply for Federal jobs, download the Insider's Guide to the Federal Hiring Process” online here.


    • Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2010-11 Edition; and
    • Office of Personnel Management, Position Classification Standards.

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