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Certified Nursing Assistant (CNA): The Eyes and Ears of the Nurse

One of the most interesting parts of the nursing profession is the many different points of entry into the profession. Most people are aware that it takes eight or more years to become a doctor or a lawyer. Teachers are now encouraged if not required to have a Master's Degree, meaning about six years of college.

What happens if you enter medical school, but are forced to leave in year five due to illness, family issues, or other problems? What happens if you complete six years of law school, or make it three years into preparation to become a teacher, but do not complete the degree?

What you have is a hefty student loan bill, but with an inability to be qualified for all jobs in your chosen career path. Likely, you are stuck with the student loan bill and a low paying job. This is where nursing is different.

The path into the nursing profession can be described as a ladder. You can begin at entry level as a Certified Nursing Assistant in a matter of weeks, and have a job that is in high demand.

While working as a CNA, you can study to become a Licensed Practical Nurse (LPN) or in some states a Licensed Vocational Nurse (LVN), then work as an LPN while studying to become a Registered Nurse (RN). After attaining the RN license, a nurse can continue to further his or her education while still earning a good salary. Like steps on a ladder, nurses can continue to move up in their career field, without the need for completing a four-year or longer degree program before getting into the field. This article focuses on the first step of the entry into nursing, the Certified Nursing Assistant, or CNA.

The most recent U.S. Bureau of Labor Statistics data states that the mean salary for a CNA was $25,090 per year, or $12.06 per hour. However, this varies widely by state, and even by the area of the state in which the CNA is employed. In a rural area, the salary may be as low as in the $9.00 per hour range, while in some states and metropolitan areas the salary may be much higher, as the cost of living tends to be greater in those areas.

Experience is also a key factor. In general, the more years of experience a CNA has, the higher their salary becomes. New employees at a facility who are experienced CNAs will usually make more than those just graduating from a program.

By mean annual wage, the 10 highest-paying states are:

  1. Alaska - $35,440
  2. Nevada - $32,130
  3. New York - $32,130
  4. Connecticut - $31,950
  5. Massachusetts - $30,010
  6. California - $29,910
  7. Hawaii - $29,780
  8. Washington, D.C. - $29,730
  9. Maryland - $28,880
  10. Washington - $28,850

By mean annual wage, the 10 lowest-paying states are:

  1. Mississippi - $20,380
  2. Louisiana - $20,660
  3. Arkansas - $21,280
  4. Puerto Rico - $21,520
  5. Alabama - $21,590
  6. Oklahoma - $21,820
  7. Georgia - $21,910
  8. South Carolina - $22,240
  9. West Virginia - $22,440
  10. Idaho - $22,730
The mean average annual salaries for certified nursing assistants in the US by state:
Alabama$21,590 Alaska$35,440 Arizona$27,890
Arkansas$21,280 California$29,910 Colorado$28,120
Connecticut$31,950 Delaware$27,630 District of Columbia$29,730
Florida$23,870 Georgia$21,910 Hawaii$29,780
Idaho$22,730 Illinois$25,340 Indiana$23,390
Iowa$25,310 Kansas$23,110 Kentucky$23,290
Louisiana$20,660 Maine$24,610 Maryland$28,880
Massachusetts$30,010 Michigan$26,460 Minnesota$27,450
Mississippi$20,380 Missouri$22,820 Montana$24,810
Nebraska$24,730 Nevada$32,130 New Hampshire$28,550
New Jersey$28,090 New Mexico$26,010 New York$32,130
North Carolina$22,860 North Dakota$28,070 Ohio$24,700
Oklahoma$21,820 Oregon$27,720 Pennsylvania$27,850
Puerto Rico$21,520 Rhode Island$28,750 South Carolina$22,240
South Dakota$23,250 Tennessee$23,110 Texas$23,810
Utah$23,110 Vermont$27,060 Virginia$24,190
Washington$28,850 West Virginia$22,440 Wisconsin$26,230

CNA Job Description

The CNA is sometimes described as "the eyes and ears of the nurse". Because they perform basic nursing skills that need to be done routinely, they often spent the most time with the patient and are therefore often the first to notice changes in the patient's condition.

These basic nursing skills include providing cares such as helping a resident to walk, eat, use the restroom, shower or bathe, perform grooming tasks, and assist patients who are too weak to turn themselves in bed to do so. These skills are known as "activities of daily living" (ADLs), and are absolutely vital for a patient's well-being.

If a patient is not repositioned in bed at least every couple of hours, they could develop pressure ulcers, more commonly known outside the field as "bed sores". These not only cause pain, but can be deadly for the patient if they become infected. Tasks such as cueing a confused patient to eat, or assisting those who are too weak to feed themselves, ensures adequate nutrition. The CNA is trained to allow the patient to do as much as they can for themselves, and to assist with tasks the patient is unable to do.

Another vital part of the CNA's job is to note any changes and report them to the nurse. Because they assist patients to dress, shower, and perform other tasks, the CNA is often the first person to notice bruising, the beginning of a pressure ulcer, or other skin conditions. They are likely to be the first person to notice if a patient is not eating as well as usual, is having trouble swallowing, or seems more confused than normal.

Taking vital signs, including temperature, pulse rate, respiration rate and blood pressure is a routine part of the CNA's job, so they are responsible for reporting readings outside of normal levels to the nurse. The CNA noticing these conditions early and reporting them to the nurse can make the difference between a minor injury or illness and a major, life threatening condition. This is why the CNA is sometimes called "the eyes and ears of the nurse."

At one time, nursing assistants were simply hired and received on-the-job training. The Omnibus Budget Reconciliation Act of 1987 (OBRA), in addition to establishing many rights for patients of nursing homes and long term care facilities, mandated that nursing assistants attend a formal training program, be tested and become certified in order to provide care for patients or residents of these facilities. Most hospital units are not bound by OBRA, but the vast majority of hospitals will only hire nursing assistants that are certified.

Nursing assistants are required by OBRA to have a minimum of 75 hours training, with at least 16 of those hours in the clinical environment, performing basic care tasks under the supervision of their instructor, who must be a nurse, other nurses and CNAs of the facility. However, the length of training programs vary greatly from state to state and even from program to program when examining different training programs within the same state.

Some facilities receive certification to host their own training programs, and are able to hire and complete the required training for the student before allowing them to work as a CNA. Other places where CNA training can be obtained include community colleges and vocational schools, and independent businesses. Each of these must undergo state inspection of curriculum, lab and clinical facilities prior to receiving authorization to host classes.

In addition to attending required training, prospective CNAs must also pass the certification exam. This must consist of a written exam and a practical exam, where skills are performed in front of a certified judge, and must show proficiency in those skills in order to pass. How this is done varies from state to state.

As of early 2016, the state of Kansas required students to take their written test at a certified testing center, but the instructor was authorized to administer the practical part of the exam and attest to the student's readiness to work as a CNA. Just to the west in the State of Colorado, both the written and practical exam must be completed at a certified testing center, and the practical exam is not administered by the instructor, but by an employee of the state.

Once the student (also referred to as nursing assistant or NA) passes both parts of the exam, they are certified within their state to use the title of CNA and to work as such. If the CNA desires to work in a different state, they must re-certify for that state, and again, requirements are different in individual states. In some states, the CNA may have to retest before being authorized to work in another state.

Career Outlook

According to the U.S. Bureau of Labor Statistics most recent data, job opportunities for Certified Nursing Assistance are expected to rise at a rapid rate between now and 2024, as the "Baby Boomer" population ages and a greater number of people are in need of 24 hour care. The majority of CNAs are employed by long term care facilities or nursing homes, or with a home health agency, and since the population of adults needing these services is projected to rise steadily, there will be a need for more CNAs.

In addition, since the job can be both physically and emotionally stressful, a number of people who obtain CNA certification leave the field, leaving an opening for new CNAs. The Bureau of Labor Statistics estimate that between 2014 and 2024, the need for CNAs would increase by 18 percent, which is substantially higher than many other jobs. In summary, the Bureau says that the chances of finding a job for a CNA who has obtained certification in their state to be very good, especially in long term care and home health environments.

In summary, while the salary of a Certified Nursing Assistant may not be high, they provide some of the most vital care to patients. And the short training time required may give a person a chance to "try out" the nursing profession before entering school to become an LPN or RN, and being a CNA allows students in LPN and RN programs to have some income while furthering their education.

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