Working as a CNA in a nursing home means giving most of the hands-on care: helping residents bathe, dress, eat, move and get through the day, under the direction of a licensed nurse. Nursing homes are the biggest employer of nursing assistants: skilled nursing facilities had 534,270 nursing assistant jobs in May 2025, about 35% of all jobs in those facilities, at a median $20.67 an hour ($43,000 a year), slightly above the all-industry median of $20.32 (BLS, May 2025). The work is physical, runs around the clock, and federal rules set how you're trained, checked and kept up to date.

What the job involves

Medicare describes the role this way: CNAs "work under the direction of a licensed nurse to assist residents with activities of daily living," and nursing homes need them "24 hours per day, 7 days a week" (Medicare.gov, nursing home staffing). The Bureau of Labor Statistics adds that nursing assistants are often the principal caregivers in nursing and residential care facilities, and that many get to know residents who stay for months or years (BLS Occupational Outlook Handbook).

Nursing assistants do most of the nursing work in nursing homes. In April to June 2026, U.S. nursing homes reported 2.35 nurse aide hours per resident per day out of 3.90 total nursing staff hours, so aides supplied about 60% of nursing staff time (CMS staffing data). Because care never stops, expect nights, weekends and holidays; most nursing assistants work full time (BLS).

New to the field? Start with

CNA training programs

near you.

Pay in nursing homes vs. other settings (May 2025)

SettingNursing assistant jobsMedian hourlyMedian annual
Skilled nursing facilities534,270$20.67$43,000
Hospitals479,330$20.34$42,310
Retirement communities and assisted living161,150$18.99$39,490
All industries1,448,910$20.32$42,260

Source: BLS Occupational Employment and Wage Statistics, May 2025: nursing care facilities, hospitals, retirement communities and assisted living, all industries.

Pay depends more on the state than the setting: state medians for nursing assistants ranged from $30,510 in Louisiana to $49,830 in Oregon in May 2025 (BLS).

The federal rules that shape the job

Every nursing home that takes Medicare or Medicaid follows the same federal rules for nurse aides:

  • Four months to get certified. A nursing home can't use you as a nurse aide for more than 4 months full time unless you're competent and have completed a state-approved training and competency evaluation program (42 CFR 483.35(d)(1)).
  • Registry checks. Before you start, the home must verify your status on the nurse aide registry and check every state registry it believes has information on you (483.35(d)(4)–(5)).
  • Training every year. You get a performance review at least once every 12 months, and at least 12 hours of in-service training a year, including dementia care and abuse prevention (483.35(d)(7), 483.95(g)).
  • Keep working to stay certified. After 24 consecutive months without paid nursing work, you have to retrain or retest before working as a nurse aide again (483.35(d)(6)).
  • Free training. If a nursing home employs you, or has offered you a job, when you start training, it can't charge you for the program; if you're hired within 12 months after finishing, the state must reimburse part of your costs (42 CFR 483.152(c)).
  • Posted staffing. At the start of each shift, the home must post how many certified nurse aides, RNs and LPNs are on duty and the hours they work, with the resident census (483.35(g)).

Staffing levels: what changed in 2025 and 2026

A 2024 federal rule would have required at least 2.45 nurse aide hours per resident per day. It never took effect for aides: a federal court in Texas vacated the staffing requirements on April 7, 2025, Congress barred HHS from enforcing them through September 30, 2034 (Public Law 119-21, sec. 71111), and CMS repealed them, effective February 2, 2026 (90 FR 55687).

What applies now: nursing homes must have enough staff to care for residents safely, a registered nurse on site at least 8 consecutive hours a day, 7 days a week, and a licensed nurse in charge on each shift, but there is no federal minimum for CNA hours (42 CFR 483.35(a)–(b)). Turnover is high: total nursing staff turnover averaged 45.3% nationally from April 2025 through March 2026 (CMS). CMS doesn't publish a turnover rate for aides alone.

The physical side of the job

Nursing assistants and orderlies have one of the highest injury and illness rates of any occupation, mostly from moving patients (BLS). In 2023 and 2024, nursing assistants in private industry had 363.7 injury and illness cases involving days away from work per 10,000 full-time workers a year, more than four times the all-occupation rate of 86.6; overexertion while moving or handling people or objects caused 108.9 of those cases per 10,000 (BLS, Table R100). Skilled nursing facilities reported 6.3 recordable injuries and illnesses per 100 full-time workers in 2024, against 2.3 for private industry as a whole (BLS, Table 1). Good lifting training and equipment matter; ask about both.

How to check a nursing home before you apply

  • Look it up on Care Compare. Medicare's Care Compare shows each home's staffing hours per resident per day, including nurse aides, weekend staffing and nurse staff turnover. Medicare notes that lower turnover is better, because staff who stay longer know the residents and the facility's procedures (Medicare.gov).
  • Ask to see the posted staffing for the shifts you'd work.
  • Ask how many residents you'd care for on each shift, how long shifts are, and how often you'd work weekends.
  • Ask whether it pays for training. If it hires you first, federal rules say it can't charge you for an approved program.

Looking for a lower-cost start? Compare

low-cost CNA training programs

near you.

How to start

To work as a CNA in a nursing home, finish a state-approved training program (at least 75 hours, including 16 hours of supervised practical training, under 42 CFR 483.152; many states require more), pass your state's written or oral exam and skills test, and get listed on the state's nurse aide registry. Our guide to becoming a CNA online walks through each step.

Sources

Last reviewed November 2026. ThinkCNA doesn't run courses; the form matches you with schools near you.