1. Tewell, Barbara MS, RN

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I believe there are many reasons why assistive personnel should not be required to be licensed. In 2002, there were 2.1 million healthcare aides, nursing assistants, home healthcare aides, and psychiatric aides working in healthcare (Kleinman & Saccomeno, 2006). This number will only become larger as the nursing work force and the population age, resulting in even more stress on the healthcare system. With this thought in mind, it may start to sound like a good idea to license these workers, but think again.


In many institutions, the annual turnover rate of assistive personnel is almost 100% because of low pay, difficulty of the job, and little status, respect, or input into scheduling, workload, or policy (Crickmer, 2005). Trying to license all these people will turn into an administrator's worst nightmare and quickly become a further burden to the system. With this high turnover rate, there also could be a backlog of people awaiting license approval, causing many potential staff to look for other jobs or positions that do not include waiting periods or lag time. Expecting people to pay for a license when they are then paid small salaries makes little sense and seems to be an excessive and unusual hardship on the people involved and the administrators who are charged with tracking the significant, associated paperwork.


In many institutions, nursing aides are students who are waiting to get into nursing schools or are already in nursing programs. They use their salaries as income during their schooling. Working as a nursing assistant also enhances their educational experience and gives them valuable knowledge to carry into future professional roles. I doubt that most students would be willing to pay for the privilege of working in a temporary position. This could prove to be a loss to the workforce we want to keep at the bedside.


Currently, the programs for training nursing assistants are many and varied. In some places, community colleges may provide training, whereas in others it may be on-the-job training done by the hospital at which they are working. Without any consistent guidelines in place, it is difficult, if not impossible, to establish criteria upon which to base the licensure. Do we license people who completed one program but not another? What about currently employed nursing assistants? Should they be required to pass tests, or do we "grandfather" them into certification? Who decides which people are "grandfathered?" Who tracks all this information-a State Board of Nursing that controls this population or another government regulatory body? Who decides what guidelines are used to issue the license, when it has to be renewed, and at what cost? These are just some of the many questions that currently have no clear answers.


Last and probably most importantly, nursing assistants are just that-assistants. They work to assist the nurse in providing care to patients. They lack the education to be working as independent practitioners. Most RNs have worked with many wonderful, caring, and competent nursing assistants over the years, but we always knew that they were there to assist us, not decide on care issues independently. This system works best when it includes mutual support, respect, and collaboration to give patients and their families the best possible outcomes. The last thing nursing should do is create more layers of staff who are working independently and not together.


Licensing nursing assistants will create more paper work, waste more time and money, and not impact the healthcare environment in any positive way. The current system may not be perfect, but what system is? The answer does not lie in adding more bureaucracy, paperwork, and cost for the people who can least afford it.




Crickmer, A. (2005). Who wants to be a CNA? Journal of Nursing Administration, 35, 380-381. [Context Link]


Kleinman, C., & Saccomeno, S. (2006). Registered nurses and unlicensed assistive personnel: An uneasy alliance. The Journal of Continuing Education in Nursing, 37, 162-170. [Context Link]