Nursing Assistant Salary (2026): CNA Pay Guide for All 50 States

Certified nursing assistants in the United States earn a national median of $45,007 per year — roughly $21.64/hour. CNA pay sits above the federal minimum wage in every state but well below licensed nursing roles, and continues to rise faster than inflation, driven by chronic post-pandemic staffing shortages in nursing homes, hospital float-pool needs, and the steady growth of home-care demand for an aging U.S. population.

The national median is only the middle of the distribution. Three numbers describe the real range of CNA compensation:

• Entry-level CNAs (10th percentile): $36,146/year — typically newly certified aides in their first 1–2 years, often in assisted living, smaller SNFs, or non-metropolitan nursing homes.
• Median CNA (50th percentile): $45,007/year — the working nursing assistant with 3–6 years of experience in a SNF, hospital med-surg unit, or memory-care facility.
• Top-earning CNAs (90th percentile): $55,359/year — senior CNAs at unionized hospitals in high-cost metros, certified medication aides (CMA/CMT — distinct from medical assistant), telemetry-trained patient care technicians (PCT), and dialysis-tech-credentialed CNAs.

Geographic location explains the largest single share of the gap. CNAs in Sunnyvale, CA earn a median of $61,956, while colleagues in Mayaguez, PR earn around $23,260. State minimum-wage laws, the strength of SNF and hospital unions, Medicaid nursing-home reimbursement rates, and the local mix of acute-care versus long-term-care employers all push pay in measurable ways beyond cost of living.

Nursing Assistant Salary vs CNA Salary — Are They the Same?

Yes. Nursing Assistant is the federally recognized occupational title; CNA (Certified Nursing Assistant) is what most states call the credential after a candidate completes a state-approved training program (minimum 75 hours under the federal OBRA-87 statute, though many states require 120+) and passes a written and clinical-skills competency exam — most commonly the NNAAP (National Nurse Aide Assessment Program) administered by Pearson VUE. The credential goes by different names in different states:

• CNA — most states (Certified Nursing Assistant)
• STNA — Ohio (State Tested Nursing Assistant)
• NA-C — Washington (Nursing Assistant — Certified)
• CNA II — North Carolina, Virginia, and others (advanced-scope CNA with additional procedures)
• PCT/PCA — hospital titles (Patient Care Technician / Patient Care Assistant), often a CNA with additional unit-specific training

All of these reference SOC code 31-1131 in the Bureau of Labor Statistics Occupational Employment and Wage Statistics survey — the data source used throughout this site. Note that licensed practical nurses (LPNs, SOC 29-2061), medical assistants (SOC 31-9092), and home health aides (SOC 31-1121) are tracked under separate SOC codes; this site reports nursing-assistant pay only.

Hourly Pay for Certified Nursing Assistants

CNAs are paid hourly, with no exceptions outside salaried supervisory roles. The national median equivalent of $21.64/hour assumes a full-time 36–40 hour week, but actual paychecks vary widely by region, shift, and specialty unit:

• West Coast and Northeast metros: commonly $20–32+/hour for experienced CNAs at union hospitals and high-acuity facilities; California, Massachusetts, New York, and Washington consistently lead the CNA pay scale.
• Midwest and South: $14–20/hour median range, with metro hospitals and corporate SNF chains at the upper end of that band and rural nursing homes at the lower.
• Night, weekend, and holiday differentials: typically add 10–25% to base; some SNFs run weekend-only "Baylor" plans paying 32 hours of straight time for 24 hours worked.
• Travel and agency CNAs: command 30–60% premium over staff rates; agency staffing in nursing homes filled persistent post-pandemic gaps and remains a meaningful pay route for experienced CNAs willing to switch facilities monthly.

Total compensation routinely runs 5–15% above headline base wages once shift differentials, sign-on bonuses (now common in SNFs), tuition reimbursement toward LPN or RN bridge programs, and any 401(k) match are counted in.

2026 Certified Nursing Assistant Salary Projection

CNA pay has grown at a compound annual rate of 6.50% over the past five years, driven by persistent SNF and hospital float-pool shortages, the rapid expansion of home-based care funded under Medicare Advantage and Medicaid HCBS waivers, and the steady aging of the U.S. patient population. The Bureau of Labor Statistics projects employment for Certified Nursing Assistants to grow 4% through 2033, with roughly 213,000 CNA openings each year on average — keeping upward pressure on wages, especially in SNFs, dementia and memory-care units, and high-acuity hospital units.

A telemetry-trained patient care technician at a unionized Boston hospital can earn nearly double what a newly certified nursing assistant at a rural Mississippi SNF takes home. Four factors explain almost all of that gap: location and Medicaid SNF reimbursement, practice setting, specialty endorsements and CNA II scope, and employment model.

1. Location: The Single Largest Pay Driver

Metropolitan areas with high costs of living offer the highest nominal CNA salaries. After adjusting for local cost of living using BEA Regional Price Parities, the real-dollar gap narrows — but doesn't close. California, Massachusetts, Alaska, Washington, and Oregon lead even on a purchasing-power basis. The drivers are a combination of high state minimum-wage floors, strong SNF and hospital union representation (SEIU, MNA, CWA), and Medicaid nursing-home reimbursement rates that translate directly into CNA hourly rates because of strict CMS minimum-staffing rules.

Specific local factors push pay in measurable ways:

• State minimum-wage laws — states with $15–18+/hour minimum wages (California, Washington, New York City) anchor the CNA pay floor well above the federal $7.25 baseline.
• Union representation — unionized hospitals and SNFs reliably pay $2–6/hour above non-union peers for the same role, plus stronger benefits and pension eligibility.
• CMS minimum-staffing rules and state staffing mandates — California, Florida, and several other states require minimum CNA-to-resident ratios in SNFs, driving competition for staff and supporting higher pay.
• Sign-on and retention bonuses — post-pandemic, SNFs and hospital float pools routinely offer $1,000–$5,000 sign-on bonuses, weekly attendance bonuses, and refer-a-friend payments to retain CNAs.

2. Practice Setting: Hospital vs SNF vs Home Care vs Memory Care

Where you work matters as much as how long you've worked:

• Acute care hospitals (med-surg, telemetry, ICU PCT): the highest-paying single setting for CNAs in most markets. Patient Care Technicians at union hospitals on the West Coast and Northeast lead the national pay scale.
• Skilled nursing facilities and long-term care: the single largest employer of CNAs nationally. Pay is reliable, overnight differentials substantial, and weekend Baylor schedules common.
• Memory care and dementia units: consistently pay $1–3/hour above general SNF rates because of higher acuity and behavioral-management demands.
• Assisted living facilities: typically the lowest-paying CNA setting, though scheduling and physical demands are lighter.
• Home health aides (technically SOC 31-1121, not CNAs) and home-based CNAs: hourly pay with mileage; experienced caregivers in metro markets can equal or exceed SNF compensation.
• Hospice, behavioral health, corrections, and pediatric private duty: niche settings with structurally short staffing and persistent above-median pay.

3. Specialty Endorsements and CNA II Scope

Entry-level CNAs start near the 10th percentile at $36,146. Within 1–3 years many add specialty training that supports higher pay: telemetry/EKG monitoring training opens hospital PCT roles; certified medication aide (CMA or CMT — state-specific, distinct from the AAMA medical assistant) certification adds $2–4/hour at SNFs in states that recognize the credential; dementia and memory-care certification commands a differential in specialty units; phlebotomy training expands hospital and lab opportunities; and several states (North Carolina, Virginia, Oregon) offer a formal CNA II credential that authorizes additional procedures such as catheter care, sterile dressing changes, and tracheostomy suctioning, with pay rising accordingly.

4. Employment Model: Staff vs Agency vs Travel vs Per-Diem

Staff CNAs receive benefits, retirement contributions, tuition reimbursement, and PTO on top of base pay — many SNF chains pay for an employee's LPN bridge program in exchange for a service commitment. Agency CNAs work shifts on demand for a staffing agency at 20–40% above the staff hourly rate, with no benefits and no guaranteed hours. Travel CNAs sign 8–13 week contracts at all-in weekly rates that frequently exceed staff annual equivalents by 25–45%, in exchange for variable assignment quality and self-funded retirement. Per-diem CNAs work as float-pool relief at the staff-rate plus a modest differential.

For a complete city-by-city breakdown of CNA salaries — including BLS percentile data (10th, 25th, 50th/median, 75th, 90th), local cost-of-living adjustments, and 2026 salary projections — browse the 1,686+ metro areas tracked in our dataset below.