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Nursing assistants, sometimes called nursing aides, help provide basic care for patients in hospitals and residents of long-term care facilities, such as nursing homes. Orderlies transport patients and clean treatment areas.
Nursing assistants provide basic care and help with activities of daily living. They typically do the following:
Some nursing assistants also may dispense medication, depending on their training level and the state in which they work.
In nursing homes and residential care facilities, assistants are often the principal caregivers. They have more contact with residents than other members of the staff. Because some residents stay in a nursing home for months or years, assistants may develop close relationships with their residents.
Orderlies typically do the following:
Nursing assistants and orderlies work as part of a healthcare team under the supervision of licensed practical or licensed vocational nurses and registered nurses.
Nursing assistants hold about 1.5 million jobs. Orderlies hold about 53,000 jobs.
The industries that employ the most nursing assistants are as follows:
| Nursing care facilities (skilled nursing facilities) | 41% |
| Hospitals; state, local, and private | 25 |
| Continuing care retirement communities and assisted living facilities for the elderly | 11 |
| Home healthcare services | 5 |
| Government | 4 |
The industries that employ the most orderlies are as follows:
| Hospitals; state, local, and private | 70% |
| Nursing care facilities (skilled nursing facilities) | 11 |
| Ambulatory healthcare services | 6 |
| Government | 4 |
| Continuing care retirement communities and assisted living facilities for the elderly | 3 |
The work of nursing assistants and orderlies can be strenuous. They spend much of their time on their feet as they take care of many patients or residents.
Because they frequently lift people and do other physically demanding tasks, nursing assistants and orderlies have a higher rate of injuries and illnesses than the national average. They are typically trained in how to properly lift and move patients, which can reduce the risk of injuries.
Most nursing assistants and orderlies work full time. Because nursing homes and hospitals provide care at all hours, nursing assistants and orderlies may need to work nights, weekends, and holidays.
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Nursing assistants must complete a state-approved education program and must pass their state’s competency exam. Orderlies generally have at least a high school diploma.
Nursing assistants must complete a state-approved education program in which they learn the basic principles of nursing and complete supervised clinical work. These programs are found in high schools, community colleges, vocational and technical schools, hospitals, and nursing homes.
In addition, nursing assistants typically complete a brief period of on-the-job training to learn about their specific employer’s policies and procedures.
Orderlies typically have at least a high school diploma and receive a short period of on-the-job training.
After completing a state-approved education program, nursing assistants take a competency exam. Passing this exam allows them to use state-specific titles. In some states, a nursing assistant or aide is called a Certified Nursing Assistant (CNA), but titles vary from state to state.
Nursing assistants who have passed the competency exam are placed on a state registry. Nursing assistants must be on the state registry to work in a nursing home.
Some states have other requirements as well, such as continuing education and a criminal background check. Check with state boards of nursing or health for more information.
In some states, nursing assistants can earn additional credentials, such as becoming a Certified Medication Assistant (CMA). As a CMA, they can give medications.
Orderlies do not need a license, however, many jobs require a Basic Life Support (BLS) certification, which shows they are trained to provide cardiopulmonary resuscitation (CPR).
Communication skills. Nursing assistants and orderlies must be able to communicate effectively to address patients’ or residents’ concerns. They also need to relay important information to other healthcare workers.
Compassion. Nursing assistants and orderlies assist and care for the sick, injured, and elderly. Doing so requires a compassionate and empathetic attitude.
Patience. The routine tasks of cleaning, feeding, and bathing patients or residents can be stressful. Nursing assistants and orderlies must have patience in order to complete these tasks.
Physical stamina. Nursing assistants and orderlies spend much of their time on their feet. They should be comfortable performing physical tasks, such as lifting or moving patients.
The median annual wage for nursing assistants is $25,710. The median wage is the wage at which half the workers in an occupation earned more than that amount and half earned less. The lowest 10 percent earned less than $19,390, and the highest 10 percent earned more than $36,890.
The median annual wage for orderlies is $25,580. The lowest 10 percent earned less than $18,770, and the highest 10 percent earned more than $39,030.
The median annual wages for nursing assistants in the top industries in which they work are as follows:
| Government | $31,130 |
| Hospitals; state, local, and private | 27,820 |
| Nursing care facilities (skilled nursing facilities) | 24,700 |
| Continuing care retirement communities and assisted living facilities for the elderly | 24,200 |
| Home health care services | 23,620 |
The median annual wages for orderlies in the top industries in which they work are as follows:
| Government | $29,940 |
| Ambulatory health care services | 26,020 |
| Hospitals; state, local, and private | 25,930 |
| Nursing care facilities (skilled nursing facilities) | 22,580 |
| Continuing care retirement communities and assisted living facilities for the elderly | 19,950 |
Most nursing assistants and orderlies work full time. Because nursing homes and hospitals provide care at all hours, nursing aides and orderlies may need to work nights, weekends, and holidays.
Employment of nursing assistants is projected to grow 18 percent over the next ten years, much faster than the average for all occupations. Employment of orderlies is projected to grow 11 percent over the next ten years, faster than the average for all occupations.
As the baby-boom population ages, many nursing assistants and orderlies will be needed to assist and care for elderly patients in long-term care facilities, such as nursing homes. Older people are more likely than younger people to experience dementia, as well as chronic diseases such as heart disease and diabetes. More nursing assistants will be needed to care for patients with these conditions.
Demand for nursing assistants may be constrained by the fact that many nursing homes rely on government funding. Cuts to programs, such as Medicare and Medicaid, may affect patients’ ability to pay for nursing home care. In addition, patient preferences and shifts in federal and state funding are increasing the demand for home and community-based long-term care, which should lead to increased opportunities for nursing assistants working in home health and community rehabilitation services.
Job prospects for nursing assistants who have completed a state-approved education program and passed their state’s competency exam should be good, particularly in home healthcare services and community-based care settings. The low pay and high emotional and physical demands cause many workers to leave the occupation, and they will have to be replaced. This creates opportunities for jobseekers.
| Occupational Title | Employment, 2014 | Projected Employment, 2024 | Change, 2014-24 | |
|---|---|---|---|---|
| Percent | Numeric | |||
| Nursing assistants and orderlies | 1,545,200 | 1,813,000 | 17 | 267,800 |
| Nursing assistants | 1,492,100 | 1,754,100 | 18 | 262,000 |
| Orderlies | 53,000 | 58,800 | 11 | 5,800 |