Need A Job? Certified Nursing Assistants Are In High Demand In SoCal
Eduard Izatov practices turning a bedridden patient — actually a mannequin — to give it a light back massage.
"One, two, three. Ok, here we go," Izatov said, pushing on the mannequin's shoulder to maneuver it onto its side. He and six fellow students at the Encino LA Skills Academy are finishing up a six-week training course to become certified nursing assistants, or CNAs. They're learning how to feed and bathe patients, take vital signs, and prevent infections and falls.
Thanks to our aging population, nursing assistants and home health aides are among the fastest-growing, most in-demand health care jobs in California and nationwide. These careers can provide dependable, flexible employment with minimal investment in higher education. Becoming a CNA can also be a stepping stone to higher-level jobs in the health field.
CNA jobs are also physically and emotionally demanding, generally low-paying and tend to have high turnover rates. During the COVID-19 pandemic, these frontline health care workers have been among the most at-risk for infection because of their work environment -- largely in nursing homes and other congregate living facilities -- and the need to be in close proximity with patients.
The policy research group California Competes: Higher Education for a Strong Economy estimates that close to 13,000 nursing assistant jobs go unfilled every year in California. As our population ages, in California and nationally, the need for CNAs is massive.
"There is literally a challenge of whether we're going to have enough people, forget about whether they're qualified or not, to actually do this work," said Robyn Stone, vice president of research at Leading Age, a coalition of nonprofit aging services organizations.
Why Become A CNA? At A Glance
- Jobs are plentiful and offer a variety of schedules.
- Training programs are relatively inexpensive. The courses offered through the LA Skills Academy, which is the local provider for American Red Cross CNA training, cost $1,800. Some other courses are free.
- Training programs are relatively short: the state of California requires 60 hours of classroom training; 100 hours of on-the-job clinical practice.
- Dozens of institutions, including community colleges, offer the training in the L.A. area. Some hospitals and nursing homes will train you on site and give you a job once you're certified.
- Becoming a CNA requires relatively minimal qualifications:
- Be at least 16 years old
- Complete required training hours
- Pass certification exam
- Pass a criminal background check (a conviction does not necessarily disqualify an applicant, depending on the crime)
- Complete continuing education and recertify every two years
- It's relatively easy to find jobs in other parts of the state and country because of high demand, although each state has its own licensing requirements.
Also of note: Nursing assistants do not need to be citizens or legal permanent residents to get certified in California.
- CNA jobs are relatively low-paying: the average hourly wage in the Los Angeles area is $16.73 -- not much above the $15/hour local minimum wage -- according to the most recent data (2019) from the U.S. Bureau of Labor Statistics.
- It's hard work, physically and emotionally. CNAs usually work with people who are elderly and infirm, sometimes with severe physical and cognitive impairment.
- Job turnover is high among CNAs who work in nursing homes and long-term care facilities (which the majority do), in large part because of low pay and difficult working conditions.
- CNAs are highly exposed to infectious diseases, including COVID-19 and influenza.
Why These Angelenos Are Becoming CNAs
Pandemic-induced career switch. Izatov, who's 46 and originally from Russia, was a ballroom dance instructor until the pandemic hit. "The studios are still closed right now, so I completely lost my business," he said.
A friend who's a nurse encouraged him to become a certified nursing assistant. The hourly pay is a lot less than what Izatov charged for an hour of dance lessons. But he figures if he works full time at a hospital, which he's hoping for, and picks up some overtime shifts, he can make a decent living.
"If you can calculate for, like, four days of 12-hours shifts, it's going to be in a year around $65,000," he said.
Dipping her toes in. Christina Pesina, 36, has bounced around low-wage jobs: retail, cigar-roller. Now, she's dipping her toes into the health care field by becoming a CNA. Her mom and Pesina's wife are both licenced vocational nurses, which is one step up from a CNA.
"They always have a job and they seem happy," Pesina said. "So I wanted to try it, you know, to make sure that this is something that I wanted to do."
Pesina is getting ready to take her state exam to become a CNA, but in the meantime, she already has a job at the skilled nursing home in Santa Monica where she did her clinical training.
"I started just coming into this thinking ... I'm going to give it a try, may not work out. And now, today, I feel very positive. Everything's starting to line up," Pesina said.
Transitioning from a career overseas. For recent immigrants, becoming a CNA can be a way to break into the U.S. health care field. Parveen Saqib worked as a nurse for 13 years in Pakistan and Saudi Arabia before moving to the U.S. in 2014. But when she didn't pass the exam required to work as a registered nurse here, she realized she needed a better understanding of U.S. laws and regulations around patient care. "Here it is very strict," she said of U.S. patient privacy laws.
So she decided to enroll in a CNA course through the Los Angeles Skills Academy. Saqib said that since she got her state nursing assistant certification in January, she's had multiple job offers and is planning to accept one at a local Veterans Affairs hospital.
She hopes to take the nursing exam, called the NCLEX, again in the future. But in the meantime, she enjoys caring for seniors and talking with them about their life experiences.
"CNA is a hard job," she said. But "if you are patient, if you think you are a good listener ... this is the best thing you can do."
Clinical experience. Jessica Williams, a junior at USC, plans to work as a CNA to get the hands-on clinical experience required to enter physician assistant school. Plus, she's thrilled to get out into the real world after a year of fully online classes.
"Being able to get that experience and do something where I know I'll be able to go in and actually be working with people is very exciting," she said.
Many students who enroll in CNA programs are hoping to become registered nurses. Nursing programs are highly competitive and applicants get extra points for having clinical experience.
Talin Arikian, 39, became a CNA in January 2020 after finishing the CNA/home health aide course at Los Angeles Mission College. She now works at Olive View - UCLA Medical Center while finishing up her prerequisites for nursing school at the college.
She loves her CNA job, Arikian said, and it's been a great way to try out the nursing field. "Saying you want to be a nurse is one thing, but you should go in and see if you can handle it," Arikian said. "It's a dirty job."
Complex Job, Low Pay
Low pay for CNAs and other caregivers is widely recognized as a major problem in attracting and retaining workers, and has also been linked to lower-quality care for elderly and disabled patients, and heightened health and safety risks, especially during the coronavirus pandemic.
A recent report from LeadingAge notes:
"...underpaid, financially strapped direct care workers had few other options than to keep working during the coronavirus pandemic, even if it put at risk their own health and the health of their families and care recipients."
Stone from LeadingAge notes that a CNAs job is much more complex than taking care of a patient's basic needs, in part because they are often the only people with patients, whether in a nursing home or the patient's home.
"So they are dealing with all the medical and social support needs that these individuals have, as well as the emotional and behavioral health issues that may often occur, particularly since a lot of this population has some level of cognitive impairment and many have dementia."
Stone said these caregivers deserve higher pay and greater recognition of the professionalism required by their jobs.
"They are a very underpaid professional set of occupations that is undervalued by our society and that is essential in the long-term sector because so much of the services are provided by these people," Stone said.
According to PHI, a nonprofit organization focused on improving elder and disability care, 36% of nursing assistants working in nursing homes require some form of public assistance to make ends meet, like Medicaid or food aid. Women of color, who make up the majority of caregivers in nursing homes and residential settings, make even less money, on average, than white women and especially white men, according to PHI.
Arikian, the CNA, said she has to work overtime to keep up with her bills. If not, "I fall a little bit behind," she said.
How To Use CNA Training As A Stepping Stone
PHI, LeadingAge, and other groups want policymakers to raise the minimum wage for CNAs and direct caregivers. At the same time, health educators say it's important to lay out clear career pathways for would-be entry-level health care workers. Amal Amanda Issa, Bay Area regional coordinator for the California Community Colleges Guided Pathways initiative, said:
"It's like if you start here, this is your wage, if you take these two courses, this will be your next job, and this is your new wage. So it's kind of really creating a ladder."
Issa also said educators need to do more to encourage working high school and community college students to get a job related to their field of study. Often, she said, students will take whatever job they can get that helps pay the bills "and what ends up happening too often, and I've seen this with so many of my students, is that work starts to take priority over school.
"But when you're working in the field and learning the field, that commitment between the two grows," Issa said.
She said educators also need to make students aware, starting at the high school level, that there are numerous professions in the healthcare field besides doctors and nurses, and many of them don't require years and years of higher education and training.
Arikian, the CNA, said working at a hospital has been a great way to learn about all the other health careers out there: respiratory therapist, phlebotomist, pharmacy technician. Still, she has her sights set on becoming a registered nurse. She hopes to be enrolled in nursing school by the end of this year.