Nursing aides and psychiatric aides help care for physically or mentally ill, injured, disabled, or infirm individuals confined to hospitals, nursing or residential care facilities, and mental health settings. (Homemaker-home health aides, whose duties are similar but who work in clients' homes, are discussed elsewhere in the Handbook.)
Nursing aides, also known as nursing assistants or hospital attendants, work under the supervision of nursing and medical staff. They answer patients' call bells, deliver messages, serve meals, make beds, and feed, dress, and bathe patients. Aides may also give massages, provide skin care to patients who cannot move, take temperatures, pulse, respiration, and blood pressure, and help patients get in and out of bed and walk. They may also escort patients to operating and examining rooms, keep patients' rooms neat, set up equipment, or store and move supplies. Aides observe patients' physical, mental, and emotional conditions and report any change to the nursing or medical staff.
Nursing aides employed in nursing homes are sometimes called geriatric aides. They are often the principal caregivers, having far more contact with residents than other members of the staff do. Since residents may stay in a nursing home for months or even years, aides are expected to develop ongoing relationships with them and respond to them in a positive, caring way.
Psychiatric aides are also known as mental health assistants, psychiatric nursing assistants, or ward attendants. They 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 dress, bathe, groom, 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 signs which might be important for the professional staff to know. If necessary, they help restrain unruly patients and accompany patients to and from wards for examination and treatment. Because they have the closest contact with patients, psychiatric aides have a great deal of influence on patients' outlook and treatment.
One-half of nursing aides work in nursing homes.
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. Aides spend many hours standing. Since they may have to move partially paralyzed patients in and out of bed or help them stand or walk, aides must guard against back injury.
Nursing aides often have unpleasant duties; they empty bed pans, change soiled bed linens, and care for disoriented and irritable patients. Psychiatric aides are often confronted with violent patients. While their work can be emotionally draining, many aides gain satisfaction from assisting those in need.
Nursing aides held about 1,308,000 jobs in 1992, and psychiatric aides held about 81,000 jobs. About one-half of all nursing aides worked in nursing homes, and about one-fourth worked in hospitals. Some worked in residential care facilities, such as halfway houses and homes for the aged or disabled, or in private households. Most psychiatric aides worked in State and county mental institutions, psychiatric units of general hospitals, private psychiatric facilities and community mental health centers.
In many cases, neither a high school diploma nor previous work experience is necessary for a job as a nursing or psychiatric aide. A few employers, however, require some training or experience. Hospitals may require experience as a nursing aide or home health aide. Nursing homes often hire inexperienced workers who must complete a minimum of 75 hours of mandatory training and pass a competency evaluation program within 4 months of employment. Aides who complete the program are placed on the State registry of nursing aides. Some States require psychiatric aides to complete a formal training program.
These occupations can offer individuals an entry into the world of work. The flexibility of night and weekend hours also provides high school and college students a chance to work during the school year. The work is also open to middle-aged and older men and women.
Nursing aide training is offered in high schools, vocational-technical centers, many nursing homes, and community colleges. Courses cover body mechanics, nutrition, anatomy and physiology, infection control, and communication skills. Personal care skills such as the bathing, feeding, and grooming of patients are also taught.
Some facilities, other than nursing homes, provide classroom instruction for newly hired aides, while others rely exclusively on informal on-the-job instruction from a licensed nurse or an experienced aide. Such training may last several days to a few months. From time to time, aides may also attend lectures, workshops, and in-service training.
Applicants should be healthy, tactful, patient, understanding, emotionally stable, dependable, and have a desire to help people. They should also be able to work as part of a team, and be willing to perform repetitive, routine tasks.
Opportunities for advancement within these occupations are limited. To enter other health occupations, aides generally need additional formal training. Some employers and unions provide opportunities by simplifying the educational paths to advancement. Experience as an aide can also help individuals decide whether to pursue a career in the health care field.
Job prospects for nursing aides should be very good through the year 2005. Employment of nursing aides is expected to grow much faster than the average for all occupations in response to an emphasis on rehabilitation and the long-term care needs of a rapidly growing population of those 75 years old and older. Employment will increase as a result of the expansion of nursing homes and other long-term care facilities for people with chronic illnesses and disabling conditions, many of whom are elderly. Also increasing employment of nursing aides will be modern medical technology which, while saving more lives, increases the need for the extended care provided by aides. As a result, nursing and personal care facilities are expected to grow very rapidly and to provide most of the new jobs for nursing aides. Employment also is expected to grow very rapidly in residential care facilities.
Employment of psychiatric aides is expected to grow faster than the average for all occupations. Employment will rise in response to the sharp increase in the number of older persons many of whom will require mental health services. Employment of aides in private psychiatric facilities and community mental health centers is likely to grow because of increasing public acceptance of formal treatment for drug abuse and alcoholism, and a lessening of the stigma attached to those receiving mental health care. While employment in private psychiatric facilities may grow, employment in public mental hospitals is likely to be stagnant due to constraints on public spending.
Replacement needs will constitute the major source of openings for aides. Turnover is high, a reflection of modest entry requirements, low pay, and lack of advancement opportunities.
Median annual earnings of nursing and psychiatric aides who worked full time in 1992 were about $13,800. The middle 50 percent earned between $11,000 and $17,900. The lowest 10 percent earned less than $9,500; the top 10 percent, more than $23,900.
According to a University of Texas Medical Branch survey of hospitals and medical centers, the median annual salary of nursing aides, based on a 40 hour week and excluding shift or area differentials, was $15,121 in October 1992.
According to the Buck Survey conducted by the American Health Care Association, nursing aides in chain nursing homes had median annual earnings of approximately $11,600 in January, 1993. The middle 50 percent earned between $10,400 and $13,200 a year.
Aides in hospitals generally receive at least 1 week's 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 and some nursing home employees.
Nursing aides and psychiatric aides help people who need routine care or treatment. So do homemaker-home health aides, childcare attendants, companions, occupational therapy aides, and physical therapy aides.
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Reprinted with Permission of U. S. Department of Labor