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Nursing Aides and Psychiatric Aides

Nursing aides and psychiatric aides help care for people who are physically or mentally ill, disabled, or infirm. Their job duties vary depending on the work setting and the characteristics of their patients.

Typical duties of nursing aides in general hospitals, sometimes known as nursing assistants, orderlies, or hospital attendants, include answering patients' bell calls and delivering messages, serving meals, feeding patients who are unable to feed themselves, making beds, and bathing and dressing patients. Aides also may give massages, take temperatures, and assist patients in getting out of bed and walking. In some hospitals, they may help registered nurses and licensed practical nurses care for patients. The work depends on whether the patient is confined to bed after major surgery, is recovering after a disabling accident or illness, or needs assistance in daily activities because of advanced age. At times they may have to escort patients to operating and examining rooms or store and move supplies in hospital pharmacies or supply rooms.

Nursing aides employed in nursing homes, sometimes referred to as geriatric aides, perform many of the same tasks as their counterparts in general hospitals. However, because the patients often stay for months or even years, the nursing aide must be able to sustain ongoing personal relationships with them. Often such patients are confused and disoriented, which requires that the aide respond in a positive, caring way. For example, in nursing homes that have reality orientation and resocialization programs, aides play an important role in reinforcing the strategies designed by the professional staff.

Nursing aides employed by home health programs, usually known as home health aides, provide personal as well as nursing care to patients in their homes. Besides caring for the patient, these aides have to work closely with the family. Reliability, honesty, and good judgement are essential since they work without direct supervision.

Psychiatric aides, known also as mental health assistants, psychiatric nursing assistants, or ward attendants, are found in a variety of settings: State and county mental hospitals, private psychiatric hospitals, psychiatric units of general hospitals, community mental health centers, residential facilities for the mentally retarded, halfway houses, and, increasingly, drug abuse and alcoholism treatment programs. They work as part of a team that may include many kinds of mental health professionals, such as psychiatrists, psychologists, psychiatric nurses, social workers, and various types of therapists. In addition to their personal care duties--helping dress, bathe, groom, and feed patients-- psychiatric aides spend a lot of time with patients. They may play cards or other games with patients, talk with them and encourage them, participate in activities with them, and, in general, strive to implement the treatment plan designed by the professional staff. They observe the patients and report any meaningful signs or actions to the professional staff. If necessary, they help restrain and seclude unruly, disturbed patients. Because they are the staff members in closest contact with patients, psychiatric aides can greatly influence patients' outlook and treatment by being patient, understanding, and emotionally supportive.

Working Conditions

With a few exceptions, the scheduled workweek of aides in hospitals and nursing homes is 40 hours or less. Because patients need care 24 hours a day, scheduled work hours include evenings, nights, weekends, and holidays. Workers spend many hours standing and may have to move patients in bed or help them stand or walk.

Nursing aides often empty bed pans, change soiled bed linens, and care for disoriented and irritable patients. Psychiatric aides sometimes are confronted with violent patients. Such experiences can be emotionally draining. Many gain personal satisfactions, however, from assisting those in need.


Nursing aides held about 1,225,000 jobs in 1990, while psychiatric aides held about 120,000 jobs. Almost half of all nursing aides worked in nursing homes, and about one- quarter worked in hospitals and State and county mental institutions. Almost all psychiatric aids worked in psychiatric hospitals, State and county mental institutions or private psychiatric facilities.

Training, Other Qualifications, and Advancement

These are entry level jobs that do not ordinarily require work experience. Educational requirements are minimal. Although employers prefer high school graduates, many, such as Veterans Administration medical centers, do not require a high school diploma. Employers often accept applicants who are 17 or 18 years of age.

In addition to providing young people with an entry to the world of work, these occupations offer good opportunities for middle-aged and older individuals who do not have a high school diploma.

The fact that personal qualifications such as warmth, dependability, and maturity outweigh formal educational requirements is a distinctive feature of these occupations. However, hiring requirements are beginning to change in the direction of more formal preparation.

In many States, nursing aides must be certified. To receive certification, they must pass an approved course of instruction from a State-approved school. These courses, which range in length from 65 to 240 hours, are offered in high schools, vocational education schools, and schools affiliated with nursing homes. Subjects taught include body mechanics, nutrition, anatomy and physiology, infection control, and communications skills.

In States which do not require certification, nursing aides generally are trained after they are hired. Some institutions combine on-the-job training, under registered nurses or licensed practical nurses, with classroom instruction. Trainees learn to take and record temperatures, bathe patients, change linens on beds occupied by patients,and move and lift patients. Initial training may last several days or a few months, depending on the policies of the institution, the complexity of the duties, and the aide's aptitude for the work. Psychiatric aides, for example, are taught interpersonal relations, group dynamics, and socialization techniques to enable them to work constructively with the mentally ill. Opportunities for learning continue, even after the initial orientation or training period ends; most aides are required to attend lectures, workshops, and other forms of in-service training from time to time.

Courses in home nursing and first aid, offered by many public school systems and other community agencies, provide a useful background of knowledge for the work. Volunteer work and temporary summer jobs in hospitals and similar institutions also are helpful. Applicants should be healthy, tactful, patient, understanding, emotionally stable, and dependable. Nursing aides and psychiatric aides, as other health workers, should have a genuine desire to help people, 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. Career ladders, where they exist at all, are very short. Nonetheless, the large and growing health industry-- which comprises hundreds of occupations and employment settings--offers career opportunities for aides who undertake additional training. Experience in health care almost invariable is an asset when applying for such training, which is offered by community colleges, vocational-technical institutes, and trade schools. Hospital occupations requiring approximately 1 year of training beyond high school include surgical technician, licensed practical nurse, EEG technologist, EKG technician, respiratory therapy technician, clinical laboratory assistant, and dietetic technician.

Job Outlook

Job prospects for nursing aides and psychiatric aides are expected to be excellent through the year 2000.

Employment of nursing aides is expected to grow faster than the average for all occupations in response to an emphasis on rehabilitation and the long-term care needs of rapidly growing aged population (those 75 years old and older. Employment will increase as a result of the anticipated expansion of nursing homes and other long-term care facilities for people with chronic illnesses and disabling conditions, many of whom are elderly. As a result, long-term care settings, not hospitals--are expected to provide most of the new jobs for nursing aides in the years to come. Also contributing to the growing demand will be modern medical technology which, while saving more lives, also increase the need to provide care for those who never fully recover.

Employment of psychiatric aides is expected to grow about as fast as average for occupations. As in the past, job prospects for aides will be tied almost exclusively to the outlook for public and private mental hospitals. Demand for inpatient psychiatric care may rise in the years ahead because of demographic factors. The very sharp increase in the number of older persons--many of whom experience severe depression or are unable to recognize friends and relatives--is likely to increase demand, as is the movement of the large baby-boom generation through young adulthood, a time of life when schizophrenia and other severe mental illnesses peak. However, employment in public mental hospitals is not likely to grow much, if at all, due to constraints on public spending and continued support for a policy of deinstitutionalization, which has "emptied" State hospitals and diverted new admissions for more than 20 years. Demand for inpatient care in private psychiatric facilities is likely to grow somewhat, however, for several reasons. Among them are broad third-party coverage for acute psychiatric episodes; growing public acceptance of formal treatment for drug abuse and alcoholism; and some lessening of the stigma attached to receiving mental health care.

While most openings for psychiatric aides are likely to occur in hospitals, additional opportunities will be available in such settings as community mental health centers, residential treatment facilities, halfway houses, and outpatient psychiatric clinics.

In both occupations, replacement needs will constitute the major source of openings. Turnover is high, a reflection of relatively low skill requirements and low pay.


Median annual earnings of nursing aides who worked full time in 1990 were about $12,200. The middle 50 percent earned between $9,430 and $16,430. The lowest 10 percent earned about $7,425 or less. The top 10 percent earned $22,375 or more.

Nursing aides in hospitals had median average salaries ranging from $14,500 in 1990, according to the Hospital and Health Report.

Nursing homes paid certified nursing aides median annual salaries of $17,600 and noncertified nursing aides, about $11,025 in 1990, according to a survey by the Hospital Compensation Service.

Attendants in hospitals and similar institutions 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 employees.

Related Occupations

Nursing aides and psychiatric aides help with the care and treatment of people who are sick, disabled, or infirm. They may move and assemble heavy equipment and perform housekeeping chores. Workers with similar duties include homemaker-home health aides, mental health technicians, childcare attendants, companions, occupational therapy aides, physical therapy aides, caretakers, and central supply workers.

Sources of Additional Information

For information on nursing careers in hospitals, contact:

American Hospital Association, Division of Nursing, 840 North Lake Shore Dr., Chicago, IL 60611.

For a copy of Health Careers in Long-Term Care, write:

American Health Care Association, 1200 15th St. NW., Washington, D.C. 20005.

Information about employment also may be obtained from local hospitals and nursing homes.


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