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Nursing Assistants are Underpaid and Overworked


Certified Nursing Assistants’ (CNAs) primary role is to help patients with their daily activities, such as bathing, toileting, eating, and moving. In addition, nursing assistants are responsible for checking the vital signs of the patient. According to Walton & Rogers, approximately 1,420,570 people work as nursing assistants in the United States (2017). CNAs are commonly employed in skilled nursing facilities, hospitals, retirement communities, and insurance companies (Walton & Rogers, 2017). The workload that nursing assistants have is significant. Consequently, CNA’s job is physically and mentally challenging. Moreover, CNA’s job requires assistants to be readily available. CNAs are underpaid and overworked due to low wages, high CNA-to-person ratio, poor working conditions, and common burnouts.

Underpayment Among CNAs

Low Wages

It is generally accepted that the salary level should depend on the degree of responsibility of the position and the number and complexity of the tasks performed. Comparing different fields of activity is difficult enough, but analyzing close positions is correct. A nurse’s responsibilities include an initial check-up, medical history, physical and emotional needs analysis, coordination with healthcare providers, and testing (What Do Nurses Do, 2021).

At the same time, CNAs must perform physically challenging tasks such as moving patients and bathing them and frequently check the patient’s vital signs. In an emergency, CNAs are responsible for informing physicians of low vital signs. By comparing the two alternative positions, it can be understood that the CNA and nurses perform similar jobs in terms of responsibility and complexity. Now it is necessary to compare the level of wages, which will show that the CNA lacks the payments. The salary per hour of an ordinary nurse in California is $ 35.18, and a nurse’s assistant is $ 18.56 (Nurse Salary in California, 2021). It follows that CNAs are underpaid because of the amount of work they do.

Lack of Benefits

Benefits are necessary for every employee since people need intermittent vacations and sick leaves. Nurses and other professionals can receive help in the form of paid days off and for periods of professional development. Nursing assistants, in turn, do not experience these benefits even though they work full-time (Kennedy et al., 2020). It affects their mental and physical health as well as job satisfaction. CNAs in California are forced to work with rare days off and low wages because they do not have enough resources to spend their holidays. It is one of the reasons for staff turnover and affects the level of patient care. A person must have a balance of work and rest to perform their functions efficiently. The lack of benefits does not provide CNA with such an opportunity; hence the profession loses worthy workers.

Lack of Employee-Subsidized Health Insurance

Nursing Assistants are at the bottom of the grade; therefore, the best health insurance coverage does not serve them. The lack of health insurance subsidized by CNA workers severely limits their financial resources. From a study by Kennedy et al. (2020), the lack of distribution of good corporate insurance policies for nurse assistants forces them to be treated at their own expense. They can buy individual insurance, the average $ 500 per month for California, or pay cash for treatment, which can be very expensive. (How Much Does Health Insurance Cost, 2021).

In addition to the fact that nursing assistants do not pay for sick days, the lack of insurance will further exacerbate CNAs’ financial problems. In other words, CNAS is not provided financial support in case they fall ill. They have to take unpaid leave to treat their health problems. This way, they get back to work as soon as possible. Consequently, CNAS are underpaid because they do not need to subsidize insurance, which can ease the financial burden if they get sick.

High CNA-to-patient Ratio

Furthermore, because of a high CNA-to-patient ratio in comparison with nurse-to-patient, nursing assistants are overworked. The nurse-to-patient ratio is one nurse responsible for providing treatments to five patients (Byrnes, 2017). As a result, junior nurses can work at a moderate pace and control the quality of their service. The CNA-to-patient ratio, in turn, is one nursing assistant who has to work with 12 patients (Byrnes, 2017). Consequently, CNAs have to work quickly to be able to help 12 patients and fulfill their requests. Having 12 patients is not only challenging to assistants but also not ideal for patients since the service that they receive from CNA might be rushed. Thus, the workload that nursing assistants have is twice as significant as the workload of nurses. Moreover, they are paid less than half of what nurses earn per hour. Consequently, nursing assistants are overworked because they have to work with 12 patients in the same period of time.

Poor Working Conditions

Risk of Catching Infectious Disease

Moreover, nursing assistants are at risk for injury because of the poor working conditions. Because of high workload levels, CNAs might catch infectious diseases while being in close contact with patients. Infectious patients with contagious viruses, bacteria, or fungi can spread their illness to CNAs through body fluids (Walton & Rogers, 2017). Thus, nursing assistants are at risk of catching infectious diseases from patients. Since most CNAs are middle-aged women capable of giving birth, the most concerning infectious threats include being infected with human immunodeficiency virus, hepatitis B virus, hepatitis C virus, varicella-zoster virus, cytomegalovirus, rubella, mumps, and influenza.

These diseases might cause harm to unborn children of nursing assistants. The possibility of catching infectious diseases is high among nursing assistants because vaccination rates are low among CNAs. For example, the influenza vaccination rate among nursing assistants is 37 % (Walton & Rogers, 2017). People who have not been vaccinated have higher risks of catching the diseases and having severe symptoms. The fact that CNAs are not vaccinated puts them in a risk group and makes them vulnerable. Thus, since CNAs are working in close contact with many infected patients without vaccination, they are at a high risk of catching an infectious disease.

Suffering From Chemicals

Next, nursing assistants are at a high risk of experiencing chemical hazards while working because of the exposure to chemical solutions. According to the study conducted by Walton & Rodgers, the most common chemical hazard that nursing assistants experience is being exposed to cleaning chemicals (2017). CNAs use chemical solutions to clean after patients in health care facilities and at their homes. Strong chemicals are specifically used to destroy bacteria, viruses, and fungi. Using cleaning chemicals might lead to nursing assistants developing allergies and skin irritation. Thus, chemical cleaners can harm the skin of nursing assistants and cause allergic reactions.

Moreover, chemicals in the fluids of patients can be harmful to CNAs, as well. For instance, nursing assistants got an allergic reaction from cleaning the urine of cancer patients (Walton & Rogers, 2017). Chemical waste after the chemotherapy is transported out of the patient’s body by urine. Nursing assistants whose job requirements include cleaning after patients might develop allergic reactions after being exposed to chemicals in the urine. Thus, CNAs are constantly at risk of chemical hazards because of chemical cleansing solutions and patient’s body fluids.

Risk of Developing Musculoskeletal Disease

As a result of environmechanical hazards, nursing assistants are likely to develop musculoskeletal disease (MSD). Nursing assistants have to work in poor ventilation, bad lighting, and constantly lift, pugh, pull objects or people. A nursing assistant’s job requires a significant amount of body movement and weight lifting. Moving equipment closer to patients and removing unnecessary equipment are the most common activities that CNAs must do. Consequently, nursing assistants are twice as likely to injure themselves than nurses because of frequent weight lifting and transporting objects (Walton & Rogers, 2017). For example, CNAs risk developing MSD as laborers, stock movers, and heavy tractor-trailer truck drivers (Walton & Rogers, 2017). Consequently, nursing assistants commonly suffer from MSD and injuries because of poor environmrchanical conditions.

Injuries Among CNAs

Moreover, physical hazards can lead to the formation of injuries and diseases among CNAs. Physical hazards can result in nursing assistants being injured from electricity, fire, high heat or cold, as well as radiation. For instance, eye injuries, skin burns, and electrocution are common problems CNAs encounter while working with laser radiation (Walton & Rodgers, 2017). These injuries can be caused by laser radiation, which is used while performing laser procedures. Since CNAs are commonly exposed to laser radiation, nursing assistants might injure their eyes and skin (Walton & Rodgers, 2017).

Nursing assistants are exposed to radiation not only from lasers but also from the body fluids of patients who are treated by radioactive elements. Moreover, nursing assistants might get damaged by being exposed to radiation from the urine and feces of patients who received treatment by Radium-223 and Iodine-131 (Walton & Rogers, 2017). Thus, nursing assistants can be injured from physical hazards, such as electricity, fire, heat, cold, and radiation.

Mental Health Issues

In addition, heavy workload and high levels of responsibility can lead to mental health disorders among nursing assistants, which puts patients at risk of receiving poor healthcare services. CNAs can have depressive symptoms because of poor psychological conditions. Firstly, nurses work full time with no part-time working hours. Moreover, they are underpaid and overworked since each nurse is responsible for 12 patients and is paid $12.21. As a result, CNAs’ mental health worsens, developing depression, anxiety, and somatization symptoms. For instance, the survey that interviewed 473 female CNAs in the US indicated that having two or more double shifts in one month can lead to depression and anxiety (Walton & Rogers, 2017).

Moreover, the risk of having depression or somatization increases as the number of working hours and working shifts increases (Walton & Rogers, 2017). Consequently, CNAs can be depressed because of the heavy workload and poor psychological conditions. Depression can affect the abilities of nursing assistants to provide healthcare services to patients. Similarly, anxiety might make the working process more difficult for CNAs, thus, decreasing their efficiency. As a result, mental health disorders among CNAs can negatively affect patients, as well.

Burnout Syndrome and Turnovers


Psychological problems from heavy workload, in turn, lead to an occupational disease called burnout. Symptoms of burnout syndrome include physical and mental exhaustion, cynicism, detachment, and a negative attitude towards the working process, resulting in decreased efficiency. Burnout syndrome can further exacerbate health conditions, such as diabetes, sleep deprivation, headache, musculoskeletal and cardiovascular problems (Molero Jurado et al., 2018).

Consequently, depression and anxiety can lead to burnout syndrome. Nursing assistants with burnout syndrome will be negatively affected in terms of pre-existing health conditions. Chronic illnesses and health issues can worsen from burnout syndrome. Nursing assistants are a vulnerable group when it comes to suffering from burnout syndrome. It has been estimated that CNAs have a 26-50% spread of burnout (Molero Jurado et al., 2018). Thus, being overworked leads to burnout syndrome among CNAs, which can further complicate their health problems.


It is common among nursing assistants who suffer from burnout syndrome to turnover. In addition to negatively affecting the health of CNAs, burnout syndrome decreases the motivation of assistants. Consequently, nursing assistants chose to quit working because of a lack of motivation. Turnover percentage is an equivalent measure to staff stability percentage. In other words, it measures the percentage of staff who stopped working within one year period. Because of high levels of workload and responsibility, CNAs’ turnover rate tends to be high. Analysis of 354 facilities in four states across the US showcased that the turnover rate among nursing assistants is 85.8 % (Berridge et al., 2016). Thus, poor working conditions and demanding work commonly force CNAs to quit their jobs because of burnout syndrome.

Staff Empowerment

Healthcare facilities that practiced staffing empowerment practices experienced a decrease in turnover rate. For instance, the number of nursing assistants who remained at the same job for over a year is 44% (Berridge et al., 2016). The percentage of retention among CNAs who experience staff empowerment strategies is 64%. Thus, staffing empowerment motivates CNAs to work increases the number of nursing assistants who work at the same place by 20%. Consequently, fewer CNAs are likely to turnover when comfortable working conditions are provided via staff empowerment. Therefore, because staff empowerment is not practiced in most healthcare facilities, CNAs stop working more frequently due to the difficulty of the work.


In conclusion, nursing assistants are not paid enough considering the amount of work that they have. Firstly, their wages are half of what nurses earn. Secondly, CNAs do not have paid time off; thus, assistants need to minimize days off to maximize the amount of money they make. Thirdly, assistants do not have insurances that can cover their treatment on sick days. Moreover, CNAs have a high risk of catching infections or being injured by being in close contact with patients. In addition, nursing assistants might get injured from physically moving equipment or from the equipment itself. Physical hazards such as fire, heat, cold, or radiation are common causes of injuries among nurses. Because of the heavy workload and poor working conditions, nursing assistants might develop mental health conditions.

Depressive symptoms and anxiety, in turn, prevent assistants from delivering high-quality service to patients. Moreover, these symptoms might result in the formation of burnout syndrome. Burnout syndrome can lead to nurses quitting their jobs and deciding to turnover. Healthcare facilities that provide staff empowerment services to their NCAs have noted that these practices help nursing assistants manage their demanding work.


Berridge, C., Tyler, D. A., & Miller, S. C. (2016). Staff empowerment practices and CNA retention: Findings from a nationally representative nursing home culture change survey. Journal of Applied Gerontology, 37(4), 419–434. Web.

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Kennedy, K. A., Applebaum, R., & Bowblis, J. R. (2020). Facility-level factors associated with CNA turnover and retention: Lessons for the long-term services industry. The Gerontologist, 60(8), 1436–1444. Web.

Molero Jurado, M., Pérez-Fuentes, M., Gázquez Linares, J., Simón Márquez, M., & Martos Martínez, F. (2018). Burnout risk and protection factors in certified nursing aides. International Journal of Environmental Research and Public Health, 15(6), 1116. Web.

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Walton, A., & Rogers, B. (2017). Workplace hazards faced by nursing assistants in the United States: A focused literature review. International Journal of Environmental Research and Public Health, 14(5), 544. Web.

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