Nursing, psychiatric, and home health aides help people who need routine care
or treatment. So do childcare workers, licensed practical and licensed
vocational nurses, medical assistants, occupational therapist assistants and
aides, personal and home care aides, physical therapist assistants and aides,
and registered nurses.
Nursing and psychiatric aides help care for physically or mentally ill,
injured, disabled, or infirm individuals confined to hospitals, nursing care
facilities, and mental health settings. Home health aides have duties that are
similar, but they work in patients’ homes or residential care facilities.
Nursing aides—also known as nursing assistants, certified nursing assistants,
geriatric aides, unlicenced assistive personnel, orderlies, or hospital
attendants—perform routine tasks under the supervision of nursing and medical
staff. They answer patients’ call lights; deliver messages; serve meals; make
beds; and help patients to eat, dress, and bathe. Aides also may provide skin
care to patients; take their temperature, pulse rate, respiration rate, and
blood pressure; and help them to get into and out of bed and walk. They also may
escort patients to operating and examining rooms, keep patients’ rooms neat, set
up equipment, store and move supplies, and assist with some procedures. Aides
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, having far 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 ongoing relationships with them and interact with them
in a positive, caring way.
Home health aides help elderly, convalescent, or disabled persons live in
their own homes instead of in a health care facility. Under the direction of
nursing or medical staff, they provide health-related services, such as
administering oral medications. (Personal and home care aides, who provide
mainly housekeeping and routine personal care services, are discussed elsewhere
in the Handbook.) Like nursing aides, home health aides may check patients’
pulse rate, temperature, and respiration rate; help with simple prescribed
exercises; keep patients’ rooms neat; and help patients to move from bed, bathe,
dress, and groom. Occasionally, they change non-sterile dressings, give massages
and alcohol rubs, or assist with braces and artificial limbs. Experienced home
health aides also may assist with medical equipment such as ventilators, which
help patients breathe.
Most home health aides work with elderly or disabled persons who need more
extensive care than family or friends can provide. Some help discharged hospital
patients who have relatively short-term needs.
In home health agencies, a registered nurse, physical therapist, or social
worker usually assigns specific duties to and supervises home health aides, who
keep records of the services they perform and record each patient’s condition
and progress. The aides report changes in a patient’s condition to the
supervisor or case manager.
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 games such as cards with the patients,
watch television with them, or participate in group activities, such as sports
or 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 examinations and treatment. Because they have such close
contact with patients, psychiatric aides can have a great deal of influence on
their patients’ outlook and treatment.
Most full-time aides work about 40 hours a week, but, because patients need
care 24 hours a day, some aides work evenings, nights, weekends, and holidays.
Many work part time. In 2004, 25 percent of aides worked part time compared with
16 percent of all workers. 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 to stand or walk.
Aides also may face hazards from minor infections and major diseases, such as
hepatitis, but can avoid infections by following proper procedures.
Aides often have unpleasant duties, 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
illness may cause violent behavior. While their work can be emotionally
demanding, many aides gain satisfaction from assisting those in need.
Home health aides may go to the same patient’s home for months or even years.
However, most aides work with a number of different patients, each job lasting a
few hours, days, or weeks. Home health aides often visit multiple patients on
the same day.
Home health aides generally work alone, with periodic visits from their
supervisor. They receive detailed instructions explaining when to visit patients
and what services to perform. Aides are individually responsible for getting to
patients’ homes, and they may spend a good portion of the working day traveling
from one patient to another. Because mechanical lifting devices available in
institutional settings are seldom available in patients’ homes, home health
aides are particularly susceptible to injuries resulting from overexertion when
they assist patients.
Nursing, psychiatric, and home health aides held about 2.1 million jobs in
2004. Nursing aides held the most jobs—approximately 1.5 million. Home health
aides held roughly 624,000 jobs and psychiatric aides held about 59,000 jobs.
Around 42 percent of nursing aides worked in nursing care facilities, and
another 27 percent worked in hospitals. Most home health aides—about 34
percent—were employed by home health care services. Others were employed in
nursing and residential care facilities and social assistance agencies. Around
54 percent of all psychiatric aides worked in hospitals, primarily in
psychiatric and substance abuse hospitals, although some also worked in the
psychiatric units of general medical and surgical hospitals. Others were
employed in State government agencies; residential mental retardation, mental
health, and substance abuse facilities; outpatient care centers; and nursing
In many cases, a high school diploma or equivalent is necessary for a job as
a nursing or psychiatric aide. However, a high school diploma generally is not
required for jobs as home health aides. Hospitals may require previous
experience as a nursing aide or home health aide. Nursing care facilities often
hire inexperienced workers, who must complete a minimum of 75 hours of mandatory
training and pass a competency evaluation as part of a state-approved training
program within 4 months of their employment. Aides who complete the program are
known as certified nurse assistants (CNAs) and are placed on the state registry
of nursing aides. 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.
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 to bathe, eat, and groom themselves, also
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.
The federal government has guidelines for home health aides whose employers
receive reimbursement from Medicare. Federal law requires home health aides to
pass a competency test covering a wide range of areas: Communication;
documentation of patient status and care provided; reading and recording of
vital signs; basic infection-control procedures; basic bodily functions;
maintenance of a healthy environment; emergency procedures; physical, emotional,
and developmental characteristics of patients; personal hygiene and grooming;
safe transfer techniques; normal range of motion and positioning; and basic
A home health aide may receive training before taking the competency test.
Federal law suggests at least 75 hours of classroom and practical training,
supervised by a registered nurse. Training and testing programs may be offered
by the employing agency but must meet the standards of the Center for Medicare
and Medicaid Services. State regulations for training programs vary.
The National Association for Home Care offers national certification for home
health aides. The certification is a voluntary demonstration that the individual
has met industry standards. Some states also require aides to be licensed.
Aides must be in good health. A physical examination, including
state-regulated tests such as those for tuberculosis, 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. Home health aides should be honest and
discreet, because they work in private homes. They also will need access to
their own car or public transportation to reach patients’ homes.
For some individuals, these occupations serve as entry-level jobs, as in the
case of high school and college students who may work while also attending
school. In addition, experience as an aide can help individuals decide whether
to pursue a career in health care. Opportunities for advancement within these
occupations are limited. Aides generally need additional formal training or
education in order to enter other health occupations. The most common health
care occupations for former aides are licensed practical nurse, registered
nurse, and medical assistant.
Numerous job openings for nursing, psychiatric, and home health aides will
arise from a combination of fast employment growth and high replacement needs.
High replacement needs in this large occupation reflect modest entry
requirements, low pay, high physical and emotional demands, and lack of
opportunities for advancement. For these same reasons, many people are unwilling
to perform the kind of work required by the occupation, limiting the number of
entrants. Many aides also leave the occupation to attend training programs for
other health care occupations. Therefore, persons who are interested in, and
suited for, this work should have excellent job opportunities.
Overall employment of nursing, psychiatric, and home health aides is
projected to grow much faster than average for all occupations through the year
2014, although individual occupational growth rates will vary. Home health aides
is expected to be the fastest growing occupation, as a result of both growing
demand for home services from an aging population and efforts to contain costs
by moving patients out of hospitals and nursing care facilities as quickly as
possible. Consumer preference for care in the home and improvements in medical
technologies for in-home treatment also will contribute to much-faster-
than-average employment growth for home health aides.
Nursing aide employment will not grow as fast as home health aide employment,
largely because nursing aides are concentrated in slower growing nursing care
facilities and hospitals. Employment of nursing aides is expected to grow faster
than average for all occupations through 2014, 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, job opportunities will be more numerous in nursing and
residential care facilities than in hospitals. Modern medical technology also
will 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.
Employment of psychiatric aides—the smallest of the three occupations—is
expected to grow more slowly than average for all occupations. Most psychiatric
aides currently work in hospitals, but most job growth will be in residential
mental health facilities and in home health care agencies. There is a long-term
trend toward treating mental health patients outside of hospitals because it is
more cost effective and allows patients to live more normal lives. Demand for
psychiatric aides in residential facilities will rise in response to growth in
the number of older persons—many of whom will require mental health services—but
also as an increasing number of mentally disabled adults, who were formerly
cared for by their elderly parents, seek care. Job growth also could be affected
by changes in government funding of programs for the mentally ill.
Median hourly earnings of nursing aides, orderlies, and attendants were
$10.09 in May 2004. The middle 50 percent earned between $8.59 and $12.09 an
hour. The lowest 10 percent earned less than $7.31, and the highest 10 percent
earned more than $14.02 an hour. Median hourly earnings in the industries
employing the largest numbers of nursing aides, orderlies, and attendants in May
2004 were: Employment services, $11.29; Local government, $11.10; General
medical and surgical hospitals, $10.44; Nursing care facilities, $9.86;
Community care facilities for the elderly, $9.56.
Nursing and psychiatric aides in hospitals generally receive at least 1 week
of paid vacation after 1 year of service. Paid holidays and sick leave, hospital
and medical benefits, extra pay for late-shift work, and pension plans also are
available to many hospital employees and to some nursing care facility
Median hourly earnings of home health aides were $8.81 in May 2004. The middle
50 percent earned between $7.52 and $10.38 an hour. The lowest 10 percent earned
less than $6.52, and the highest 10 percent earned more than $12.32 an hour.
Median hourly earnings in the industries employing the largest numbers of home
health aides in May 2004 were as follows: Nursing care facilities, $9.11;
Residential mental retardation, mental health and substance abuse facilities,
$8.97; Home health care services, $8.57; Community care facilities for the
elderly, $8.57; Individual and family services, $8.47.
Home health aides receive slight pay increases with experience and added
responsibility. Usually, they are paid only for the time worked in the home, not
for travel time between jobs. Most employers hire only on-call hourly workers
and provide no benefits.
Median hourly earnings of psychiatric aides were $11.19 in May 2004. The
middle 50 percent earned between $9.09 and $14.09 an hour. The lowest 10 percent
earned less than $7.63, and the highest 10 percent earned more than $16.74 an
hour. Median hourly earnings in the industries employing the largest numbers of
psychiatric aides in May 2004 were as follows: General medical and surgical
hospitals, $11.31; Psychiatric and substance abuse hospitals, $11.06;
Residential mental retardation, mental health and substance abuse facilities,
Additional nursing and psychiatric aide job resources are presented in the paperback
Health Care Job Explosion! 4th edition by Dennis V. Damp for this
occupational group. Resources include Job Ads, Job Hotlines, Job Fairs,
Placement services, Associations, Books, Directories and Internet (Web) Sites.
Your local library may have this book in their reference section or you can
purchase a copy for $19.95 plus shipping with all major credit cards from our
toll free service at 1-800-782-7424 (Orders Only). Also available at all major
bookstores. Also explore jobs at VA hospitals and other
federal government employment options.
101 Careers in Nursing - by Jeanne M. Novotny, Doris T. Lippman, Nicole K.
Sanders, Joyce J. Fitzpatrick; Springer Publishing Company, 2003, $33.95, ISBN:
0826120148. Profiles of careers, educational requirements, resources, and
personal stories from practicing nurses.
National Association for Home Care and Hospice, 228 7th St. SE., Washington,
DC 20003. Internet: http://www.nahc.org
American Nurses Association (ANA) - 8515 Georgia Avenue, Suite 400, Silver
Spring, MD 20910; 301/628-5000 or 800/274-4ANA. (http://www.nursingworld.org,
email@example.com) The ANA, established in 1896, is a full-service professional
organization. Career center on web site has a job agent and allows members to
post résumé. Financial aid information, links to specialty nursing associations
and much more can be viewed on the web site. Students may subscribe to access
more extensive web information for $10. Planning A Career In Nursing booklet can
be downloaded from the web. Online catalog lists dozens of publications,
including books on taking certification tests. The American Nurse is $10/yr for
students, $20 for practicing nurses (800/637-0323).
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