Nursing Aides, Home Health Aides, P.C.A.s, and U.A.P.s
Nursing aides work with patients of all ages in a variety of settings such as hospitals, skilled-nursing facilities, residential facilities for the disabled, senior residential homes, patients' homes, and mental health facilities. Home health aides work with patients in their home on an intermittent basis; C.N.A.s (certified nursing assistants) who work in patients' homes are usually hired on an hourly basis and perform some housekeeping duties as well as patient care. P.C.A.s (patient care assistants) are C.N.A.s who have been given additional training by employers to assume more responsibilities in a specific facility. There is another group known as UAP (unlicensed assistive personnel) who receive on-the-job training (usually in hospitals or skilled-nursing facilities) to perform nursing-aide tasks. They are not licensed or certified. In some inpatient facilities, male nursing aides may also still be known as orderlies. (This term has its origin in the military and referred to a soldier assigned as an assistant to a military officer.) Orderlies typically help lift, transfer, and transport patients. They also prepare patients for surgery by shaving the operative area, inserting catheters, and giving enemas.
Duties, Activities, and Scope of Practice
Nursing aides work primarily in facilities or patients' homes to assist with tasks such as answering call lights. They take vital signs, bathe patients, make beds, and assist with dressing and grooming, and transferring or walking. In some instances, they may change simple dressings (superficial wounds), insert catheters, suction tracheostomies utilizing clean-technique (a non-sterile technique that includes meticulous hand washing, clean gloves, and a clean environment; not used for treating surgical wounds and burns), assist with tube feedings, or remind patients (at home) to take medications.
Nursing aides report to the supervising nurse any significant changes in condition or other statistics as directed by the nurse. Aides are not allowed to reassign duties or patients to another aide; they are not allowed to delegate. Only R.N.s can delegate and assign duties.
In facilities such as skilled-nursing homes, the C.N.A.s are the primary caregivers, and if family members are scarce, they may be the main contact that the residents have for long periods of time.
The types of duties aides typically perform meet these criteria:
Constitute routine care for the patient
Pose little or no hazard for the patient
Have a predictable outcome
Are similar from one patient to another
Don't require the aides to assess, interpret, or make decisions
Education and Training
Nursing aides complete a program of seventy-fives hours of training in both classroom and clinical supervised care. They may then take a competency exam to obtain certification. Home health aides have additional training of up to seventy-five hours of classroom and clinical supervised care. They also take an additional competency exam. U.A.P.s are trained on the job. P.C.A.s are usually, but not always, trained on the job. C.N.A.s receive some additional on-the-job training in areas such as phlebotomy.
Upon the completion of the nursing aide training, the aide is eligible to take a written and skills competency test to become certified. Then they are placed on the state's registry of nurses' aides. Home health aides complete a written and skills competency exam in twelve areas, including communication skills, documentation skills, taking and recording vital signs, basic nutrition, basic bodily functions, basic infection control, range of motion, and basics involving maintaining a hygienic environment in the home setting. The National Association of Home Care offers national certification for home health aides. P.C.A.s are usually C.N.A.s with additional training. U.A.P.s are not certified. None of the workers in this category are licensed.
Work Settings and Salaries
Nursing aides work in hospitals, skilled-nursing facilities, residential care facilities, and in patients' homes. Home health aides are specifically trained to assist patients at home, although they may also work as a C.N.A. in other facilities.
Many facilities rely on nursing aides to assume more responsibilities for patients in their creative attempts to improve working conditions for R.N.s in light of the nursing shortage. This is a physically and emotionally demanding job.
The median hourly income for C.N.A.s as reported by the U.S. Department of Labor for 2004 was $10.09. Hourly wages ranged from $7.31 to $14.02. Home health aides are usually said to earn slightly more, but the median hourly income in 2004 was reported to be $8.81. Salaries were reported to be between $6.52 and $12.32 per hour. They are paid for the time spent in each patient's home. This may or may not include an allowance for mileage, but they are not paid for travel time from patient to patient.
Career Potential and Additional Information
Excellent opportunities will continue to exist in this field because of the increasing need posed by an aging population and the need to replace aides who have moved up the career ladder.
This is an entry-level position, and opportunities for advancement are limited. Home health aide positions are expected to grow faster than for C.N.A.s, P.C.A.s, and U.A.P.s due to an aging population requiring more assistance at home.
To find out more about nursing aide positions, contact your state board of nursing. You can locate your state board's information from the National Council of State Boards of Nursing. Their Web site is
For more information about becoming a home health aide, contact the National Association for Home Care (NAHC). Their Web site is