Here is a question that creeps up on families more often than anyone admits: Your kid—maybe eighteen, maybe twenty-two, maybe somewhere in that hazy stretch after high school where the plan hasn't quite crystallized—says they want to work in healthcare. They're interested but not ready for a four-year nursing degree. Maybe they can't afford it. Maybe they're not sure enough to commit. And someone, a school counselor or an aunt who works in a hospital, mentions becoming a CNA.

Certified Nursing Assistant. It sounds straightforward enough. But then the questions start piling up. Is it a real career or just a stepping stone? What does the work actually look like, day after day? Will it pay enough to live on? And is it a genuine pathway into something bigger—an LPN license, an RN degree—or a dead end that just sounds like a pathway?

These are fair questions, and the answers are more complicated than most career guides let on.

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Start with the demand, because the numbers are staggering. According to the Bureau of Labor Statistics, about 211,800 openings for nursing assistants are projected each year through 2034. Not total—each year. The vast majority of those openings aren't from growth in the field; they're from people leaving. CNAs cycle out of the profession at rates that would alarm any other industry. The 2025 NSI National Health Care Retention & RN Staffing Report found that hospitals have turned over 106.6 percent of their staff in the past five years, and CNAs sit at the very top of the turnover pyramid. In New York State alone, more than 42 percent of CNAs leave their positions annually.

A 2025 paper in The Gerontologist, published by researchers at the University of Georgia's College of Public Health, called the situation "a looming disaster." The researchers documented how CNAs make up roughly one-third of all nursing home staff but provide up to 90 percent of direct resident care—the bathing, feeding, mobility assistance, and emotional companionship that keeps long-term care facilities running. When those workers vanish, the consequences cascade. Remaining staff burn out faster, patient care suffers, and the facility struggles to recruit replacements for jobs that now look even less appealing.

"The amount of care that they provide and the amount of baggage that they take home with them leads to significant turnover," said Curt Harris, director of the University of Georgia's Institute for Disaster Management and a co-author of the study. "I don't think most people realize what a CNA does on a day-to-day basis, how oftentimes they are really the go-to person for nursing home residents."

The shortage extends beyond nursing homes. Hospitals need CNAs. Home health agencies need them. Assisted living facilities, rehabilitation centers, and hospice programs all compete for the same limited pool of workers. And the demographic math only tightens: roughly 10,000 Americans turn 65 every day, a trend that will continue for years. The Health Resources and Services Administration projects that the nursing workforce gap will persist well into the 2030s, with the shortage of licensed practical nurses alone expected to reach 28 percent by 2036. Every missing LPN increases pressure on the CNAs below them and the RNs above.

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So what does a CNA actually do? This is worth dwelling on, because the gap between the job description and the lived experience is where families often get surprised.

The formal answer is that CNAs assist patients with activities of daily living—the phrase healthcare uses to describe the intimate, physical acts of helping someone eat, bathe, dress, use the toilet, and move from a bed to a wheelchair. They take vital signs. They change linens. They document everything they observe, because a CNA who notices a subtle change in a patient's condition—a new confusion, a refusal to eat, a skin discoloration—may be the first person to flag something that prevents a medical crisis.

The informal answer is that CNA work is profoundly physical and emotionally demanding. An eight- or twelve-hour shift means constant motion: lifting patients, repositioning them in bed, walking the halls to check on a dozen or more residents. A 2024 report from MissionCare Collective found that CNA-to-patient ratios in skilled nursing facilities average around 1-to-13, which means one person is responsible for the basic physical needs of thirteen human beings across a shift. The work puts CNAs among the occupations with the highest rates of injury and illness in the country, according to the BLS. Chronic pain, musculoskeletal injuries, and mental health struggles are well-documented in this workforce.

But there's another side, and it would be dishonest not to mention it. CNAs often develop real, sustained relationships with the people they care for—particularly in long-term care, where residents stay for months or years. Multiple nurses and healthcare workers describe the CNA role as the most emotionally intimate position in a facility, the one where you know a patient's habits, fears, preferences, and family dynamics. For some people, that closeness is exactly what draws them to healthcare in the first place.

The shifts can be brutal. Hospitals and nursing homes operate around the clock, which means nights, weekends, and holidays. Many CNAs work rotating schedules, including every other weekend. Some work three twelve-hour shifts per week; others work five eights. The unpredictability can make childcare, school schedules, and social life genuinely difficult to manage.

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If your kid is still interested after all that—and many are—the path in is remarkably fast compared to nearly any other healthcare credential.

Federal law requires a minimum of 75 training hours for CNA certification, though most states demand more. California requires 160 hours, Maine tops the list at 180, and the most common range falls between 100 and 120 hours. That translates to programs lasting four to twelve weeks, depending on whether they're full-time, evening, or weekend formats. The curriculum covers infection control, patient safety, basic anatomy, communication skills, and supervised clinical practice in an actual healthcare setting.

The cost is relatively modest. Tuition at community colleges and vocational schools typically ranges from $500 to $1,700, with additional expenses for textbooks, uniforms, background checks, and the certification exam itself—usually between $100 and $165 for the two-part test, which includes a written knowledge section and a hands-on skills evaluation. Some employers, particularly nursing homes desperate for staff, will pay for the training outright if the graduate commits to working there for a set period. And here's a detail many families don't know: federal law requires that if a CNA is hired by a Medicare- or Medicaid-certified facility within twelve months of completing training, that employer must reimburse the cost of the training program and exam.

The minimum age is typically eighteen, though some states allow sixteen- and seventeen-year-olds with parental consent. A high school diploma or GED is usually required but not universally. The barriers to entry are genuinely low, which is by design—this is the widest door into healthcare, and the system needs it to stay wide.

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Now the hard part: money.

The median annual wage for nursing assistants was $39,530 in May 2024, according to the BLS. That's $19.01 per hour at the median. The lowest ten percent earned less than $31,390, while the highest ten percent—typically those in hospitals or higher-cost metropolitan areas—earned more than $50,140. Those numbers are real, and families should look at them clearly.

For a young person living at home or sharing expenses, $39,000 can work. For a single parent supporting children in a city with high housing costs, it is a constant struggle. A 2024 report from MissionCare Collective found that more than a third of CNAs depend on some form of public assistance for financial support. This is not a career that, at the entry level, promises middle-class comfort. It promises steady employment in a sector that will always need workers—and it promises a starting point.

The financial picture shifts meaningfully with the next credential. Licensed practical nurses earned a median of $59,730 annually as of May 2023, according to the BLS. Registered nurses earned $93,600 in May 2024. The jumps are substantial—roughly $20,000 from CNA to LPN, and another $34,000 from LPN to RN. The question is whether the stepping-stone metaphor holds up in practice.

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This is where honest conversation matters most, because the CNA-to-LPN-to-RN pathway is genuinely available, widely promoted, and more complicated to navigate than it appears.

CNA-to-LPN bridge programs typically require nine to twelve months of full-time study, sometimes longer for part-time students. The curriculum builds on clinical experience—medication administration, wound care, patient assessment, catheter insertion—and prepares graduates for the NCLEX-PN licensing exam. Community colleges offer the most affordable options, with tuition generally ranging from $3,000 to $12,000. LPN-to-RN bridge programs add another two to three semesters beyond that, leading to an associate degree in nursing and eligibility for the NCLEX-RN.

The pathway exists and works for people who pursue it. But the data suggests that most don't. A longitudinal study from the University of North Carolina's Sheps Center, tracking nurses from 2001 to 2013, found that only 8 percent of LPNs transitioned to RN during that thirteen-year window. The reasons are not mysterious: once you're earning a paycheck and managing the demands of work, family, and life, going back to school requires a level of financial and logistical support that many CNA and LPN workers simply don't have.

Some employers are trying to change this. Programs like Ohana Pacific Health in Hawaii offer CNA-to-LPN bridge pathways that allow employees to keep working while attending school, with tuition assistance and flexible scheduling. The Georgia CNA Career Pathway Initiative has helped more than 6,000 CNAs overcome certification barriers through virtual skills evaluations. These are meaningful efforts, but they remain exceptions rather than the norm.

For families trying to evaluate this pathway honestly, the key question is not whether the ladder exists—it does—but whether the specific conditions are in place for their kid to climb it. That means asking: Is there a bridge program nearby with evening or weekend hours? Does the employer offer tuition reimbursement? Is there family support to help with childcare or living expenses during school? Without those conditions, the stepping-stone can become a plateau.

HRSA data shows that 16 percent of current RNs were previously licensed as LPNs, which means the pathway does produce results at scale—just not for everyone who sets foot on it.

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None of this is meant to discourage anyone from becoming a CNA. The credential opens a door that stays open. It provides immediate employment in a field with functionally zero unemployment. It teaches clinical skills, professional communication, and—perhaps most importantly—whether direct patient care is something your kid finds meaningful or miserable. That's information worth having before committing to a two-year or four-year nursing degree.

The healthcare workforce needs CNAs desperately, and that need is not going away. An aging population, chronic disease, and years of underinvestment in the direct care workforce guarantee that someone who earns this credential will find work—in their hometown, in any state they move to, in nearly any healthcare setting that exists. The Omnibus Budget Reconciliation Act of 1987 standardized CNA training nationally, which means the certification carries across state lines more easily than many comparable credentials.

What families should resist is the oversimplification—the brochure version that presents CNA as a quick, cheap ticket to a comfortable nursing career. It can be that. It is that for some people. But it is also physically grueling, emotionally intense, modestly paid work that demands real resilience. The parents who help their kids make the best decisions about this path are the ones who hold both truths at the same time: this is important, dignified, in-demand work, and it is genuinely hard.

"Be an advocate for those who are caring for your loved ones," Harris said. "You don't need a degree to be an advocate. You just need to care."

Perhaps the same advice applies to parents watching a child consider this path. You don't need to have all the answers. You just need to care enough to ask the right questions—and honest enough to sit with answers that are complicated.

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