Nursing assistants held about 1.5 million jobs in 2018. The largest employers of nursing assistants were as follows:
|Nursing care facilities (skilled nursing facilities)||38%|
|Hospitals; state, local, and private||27|
|Continuing care retirement communities and assisted living facilities for the elderly||11|
|Home healthcare services||5|
Orderlies held about 51,000 jobs in 2018. The largest employers of orderlies were as follows:
|Hospitals; state, local, and private||79%|
|Nursing care facilities (skilled nursing facilities)||6|
|Ambulatory healthcare services||6|
|Continuing care retirement communities and assisted living facilities for the elderly||1|
The work of nursing assistants and orderlies may be strenuous. They spend much of their time on their feet as they care for patients.
Injuries and Illnesses
Nursing assistants and orderlies have one of the highest rates of injuries and illnesses of all occupations. These workers frequently move patients and have other physically demanding tasks. They typically get training in how to properly lift people, which can reduce the risk of injuries.
Although most nursing assistants and orderlies work full time, some work part time. Because nursing and residential care facilities and hospitals provide care at all hours, nursing assistants and orderlies may need to work nights, weekends, and holidays.
Nursing assistants typically must complete a state-approved education program and pass their state’s competency exam. Orderlies typically have at least a high school diploma or equivalent.
Education and Training
Nursing assistants often need to complete a state-approved education program that includes both instruction on the principles of nursing and supervised clinical work. These programs are available 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 or equivalent and receive a short period of on-the-job training.
Licenses, Certifications, and Registrations
Specific requirements for nursing assistants vary by state. Nursing assistants often need a state-issued license or certification. After completing an approved education program, nursing assistants often must pass a competency exam, which allows them to use state-specific titles. In some states, a nursing assistant is called a Certified Nursing Assistant (CNA), but titles vary by state.
Nursing assistants who have passed the competency exam are placed on a state registry. They 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 may earn additional credentials, such as Certified Medication Assistant (CMA). As a CMA, they may dispense medications.
Orderlies do not need a license; however, jobs might require certification in cardiopulmonary resuscitation (CPR) or basic life support (BLS).
Nursing assistants typically have an interest in the Building and Helping interest areas, according to the Holland Code framework. The Building interest area indicates a focus on working with tools and machines, and making or fixing practical things. The Helping interest area indicates a focus on assisting, serving, counseling, or teaching other people.
If you are not sure whether you have a Building or Helping interest which might fit with a career as a nursing assistant, you can take a career test to measure your interests.
Nursing assistants should also possess the following specific qualities:
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 provide 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 be patient to provide quality care.
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 was $29,660 in May 2019. 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 $21,960, and the highest 10 percent earned more than $40,620.
The median annual wage for orderlies was $28,980 in May 2019. The lowest 10 percent earned less than $21,590, and the highest 10 percent earned more than $42,860.
In May 2019, the median annual wages for nursing assistants in the top industries in which they worked were as follows:
|Hospitals; state, local, and private||31,120|
|Nursing care facilities (skilled nursing facilities)||28,910|
|Home healthcare services||28,600|
|Continuing care retirement communities and assisted living facilities for the elderly||28,590|
In May 2019, the median annual wages for orderlies in the top industries in which they worked were as follows:
|Ambulatory healthcare services||$31,950|
|Hospitals; state, local, and private||29,050|
|Continuing care retirement communities and assisted living facilities for the elderly||28,350|
|Nursing care facilities (skilled nursing facilities)||24,300|
Although most nursing assistants and orderlies work full time, some work part time. Because nursing and residential care facilities 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 9 percent from 2018 to 2028, faster than the average for all occupations. Employment of orderlies is projected to grow 5 percent from 2018 to 2028, about as fast as the average for all occupations.
As the baby-boom population ages, nursing assistants and orderlies will be needed to help care for an increasing number of older patients in nursing and residential care facilities. Older people are more likely than younger people to have disorders such as dementia, or to live with 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.
About 190,700 openings for nursing assistants and 6,100 openings for orderlies are projected each year, on average, over the decade.
Many of those openings are expected to result from the need to replace workers who leave the occupations, often because of their low pay and high emotional and physical demands.
For more information about nursing assistants and orderlies, visit
National Network of Career Nursing Assistants
For more information about state requirements, visit
National Council of State Boards of Nursing
For a career video on nursing assistants, visit