Foundational Concepts

Nursing assistants (NAs), also called nursing aides, are important members of the health care team. NAs work under the supervision of licensed practical/vocational nurses (LPNs/VNs) and registered nurses (RNs).

NAs provide basic care and help patients* with activities of daily living. They typically perform the following tasks[1]:

  • Clean and bathe patients
  • Help patients use the toilet and dress
  • Turn, reposition, and transfer patients between beds and wheelchairs
  • Listen to and record patients’ health concerns and report that information to nurses
  • Measure patients’ vital signs, such as temperature
  • Serve meals and help patients eat

* Note: The terms patient, client, and resident are used interchangeably throughout this book to represent the people cared for by nursing assistants. Definitions of these terms are discussed in Chapter 2.6, “Health Care Settings.”

Each state defines the actions and skills that nursing assistants can perform in health care facilities, also referred to as their scope of practice. Job descriptions in health care agencies also list specific expectations and duties for NAs within that facility. Depending on the NA’s level of training, the facility, and the state law in which they work, nursing assistants may also dispense medication. These actions and associated skills checkoffs will be discussed throughout this book.

View the following YouTube video about Nursing Assistants[2]: Certified Nursing Assistant Career.

In 2020, nursing assistants were employed in 1.4 million jobs in many types of health care facilities. The largest employers of nursing assistants were as follows[3]:

  • Skilled nursing facilities: 37%
  • Hospitals: 30%
  • Assisted-living facilities: 11%
  • Home health care agencies: 6%
  • Government agencies: 4%

Skilled nursing facilities (commonly referred to as “nursing homes”) provide inpatient services to patients who require medical, nursing, or rehabilitative services but do not provide the level of care or treatment available in a hospital. Assisted-living facilities are living arrangements where people live on their own in a residential facility but additional personal care services such as meals, housekeeping, transportation, and assistance with activities of daily living are available. Residents in assisted living facilities typically pay monthly rent with additional fees for requested services. Home health care agencies provide skilled nursing care, physical therapy, occupational therapy, speech therapy, and personal care in an individual’s home.[4]Health care settings” are further discussed in Chapter 2.

Overall employment of nursing assistants is projected to grow eight percent from 2020 to 2030. As the baby-boom population ages, nursing assistants will help care for an increasing number of older adults who have chronic or progressive diseases, such as heart disease and diabetes.

Client preferences and shifts in federal and state funding are also increasing the demand for home and community-based long-term care, which should lead to increased opportunities for nursing assistants in home health and community rehabilitation services.[5].

Nursing assistants may work full time or part time. Because health care facilities provide patient care at all hours, nursing assistants often work nights, weekends, and holidays.[6]

Becoming a Nursing Assistant

To become a nursing assistant, an individual must complete a state-approved education program and pass their state’s competency exam. A state-approved education program includes classroom instruction on nursing assistant principles, as well as supervised clinical work. These educational programs are available in high schools, community colleges, vocational and technical schools, hospitals, and nursing homes. Nursing assistants who pass their state’s competency exam are placed on a state registry. They must be on this state registry to work in a skilled nursing facility.[7]

Professional Qualities of a Nursing Assistant

As personal caregivers, nursing assistants must demonstrate professional qualities, including communication skills, compassion, patience, and physical stamina[8]:

  • Communication skills. Nursing assistants must listen and respond to patients’ concerns. They must appropriately share observed patient information with nurses and other health care workers caring for that patient. Communicating professionally in a health care setting is discussed in Chapter 1.
  • Empathy. Nursing assistants care for people who are sick, injured, debilitated, cognitively impaired, or need assistance for other reasons. A compassionate attitude is required to do this type of work.
  • Physical stamina. Nursing assistants spend much of their time on their feet performing tasks such as lifting or moving patients. It is important to be in good physical condition to safely perform these tasks and avoid injury to oneself or others. “Body mechanics and safe equipment use” are discussed in Chapter 3.
  • Professionalism. Repetitive tasks of cleaning, feeding, and bathing patients can be stressful. Nursing assistants must complete these tasks with professionalism.

Nursing assistants have one of the highest rates of injuries and illnesses of all occupations from lifting and moving patients and other physically demanding tasks. Nursing assistants typically complete a brief period of on-the-job training to learn about their specific employer’s equipment, policies, and procedures, as well as training in how to properly lift people to reduce the risk of injuries. [9]


What does professionalism mean? Being professional means delivering patient care in a manner that is ethical, respectful, competent, knowledgeable, and caring. Professional nursing assistants are committed to promoting clients’ dignity and well-being, as well as displaying high standards of professional behavior.[10] Good hygiene principles as a health care professional include the following:

  • Wear clean scrubs every shift. Scrubs should be wrinkle-free and the correct size for a professional appearance.
  • Keep your hair clean and neatly combed. Long hair should be pulled back for safety and infection control purposes.
  • Keep nails clean and trimmed short. Most agencies do not permit nail polish or artificial nails. Long nails and nail polish harbor microorganisms that can spread infection.
  • Get plenty of sleep before coming to work so you are alert at work.
  • Wear comfortable, closed-toe shoes with nonskid soles.
  • Do not wear jewelry for safety and infection control purposes. Some agencies permit wedding rings.
  • Do not wear perfume or strong-smelling deodorants or powders. Strong odors can cause nausea, headaches, or allergic reactions in some patients, especially if they are not feeling well.
  • Follow agency policies regarding tattoos and piercings.
  • Always wear your name badge while at work.
  • Wear a watch with a second hand that is easily cleaned.
  • Carry a pen and paper in your pocket for taking client care notes to report or document.
  • Use effective coping skills to deal with stress at work, home, and school.
  • Notify your supervisor if you are not feeling well.

Overview of This Book

The chapters in this book discuss the following competencies that a student must demonstrate to successfully become a certified nursing assistant:

  • Chapter 1: Communicate Professionally Within a Health Care Setting
  • Chapter 2: Demonstrate Professionalism in the Workplace
  • Chapter 3: Maintain a Safe Health Care Environment
  • Chapter 4: Adhere to Principles of Infection Control
  • Chapter 5: Provide for Personal Care Needs of Clients
  • Chapter 6: Provide for Basic Nursing Care Needs
  • Chapter 7: Demonstrate Reporting and Documentation of Client Data
  • Chapter 8: Utilize Principles of Mobility to Assist Clients
  • Chapter 9: Promote Independence Through Rehabilitation/Restorative Care
  • Chapter 10: Provide Care for Clients Experiencing Acute and Chronic Health Conditions
  • Chapter 11: Apply Knowledge of Body Systems to Client Care

  1. Bureau of Labor Statistics, U.S. Department of Labor. Occupational Outlook Handbook, Nursing Assistants and Orderlies.
  2. WVHCA. (2012, July 27). Certified nursing assistant career [Video]. YouTube. All rights reserved.
  3. Bureau of Labor Statistics, U.S. Department of Labor. Occupational Outlook Handbook, Nursing Assistants and Orderlies.
  4. Centers for Medicare & Medicaid Services.
  5. Bureau of Labor Statistics, U.S. Department of Labor. Occupational Outlook Handbook, Nursing Assistants and Orderlies.
  6. Bureau of Labor Statistics, U.S. Department of Labor. Occupational Outlook Handbook, Nursing Assistants and Orderlies.
  7. Bureau of Labor Statistics, U.S. Department of Labor. Occupational Outlook Handbook, Nursing Assistants and Orderlies.
  8. Bureau of Labor Statistics, U.S. Department of Labor. Occupational Outlook Handbook, Nursing Assistants and Orderlies.
  9. Bureau of Labor Statistics, U.S. Department of Labor. Occupational Outlook Handbook, Nursing Assistants and Orderlies.
  10. Miller-Hoover, S. (2018). I said what? Professionalism for the CNA.[/footnote] Professional behavior includes communicating respectfully with clients, their family members, and other health care team members and introducing oneself before beginning care. It also includes being a professional employee, such as performing hand hygiene, exhibiting good personal hygiene and appearance, being dependable and on time for work, and completing one’s assigned tasks in an accurate and timely manner. Professionalism includes understanding and working within one's scope of practice and being a lifelong learner to continue to provide excellent care as the health care environment changes. “Demonstrating professionalism in the workplace” is further discussed in Chapter 2.

    Initiating and Concluding Personal Cares

    When initiating care with a client, it is important to begin by introducing oneself. When initiating care with patients, it is essential to first provide privacy and then introduce yourself and explain what will be occurring. Providing privacy means taking actions such as talking with the patient privately in a room with the door shut. When concluding care, it is also important to ask if the resident needs anything else, as well as ensuring safety measures are in place. These routine actions are further discussed in “Pre- and Post-Procedural Steps” in Chapter 5. Before initiating care and after performing care, it is vital to perform good hand hygiene. Using hand hygiene is a simple but effective way to prevent the spread of infection when performed correctly and at the appropriate times. More details about using effective hand hygiene and preventing the spread of infection are discussed in the “Precautions Used to Prevent the Spread of Infection” in Chapter 4.

    Maintaining Good Hygiene and Personal Appearance

    Managing your personal hygiene with good grooming habits is a component of professionalism that contributes to patient satisfaction and prevents the spread of infection.[footnote]Miller-Hoover, S. (2018). I said what? Professionalism for the CNA.


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