Certified Nursing Assistant Hourly Pay (2026): How Much Do CNAs Make Per Hour?

CNA hourly pay varies meaningfully by state, setting, shift, and certification. The national median sits at $21.64/hour, but CNA hourly rates reach $29.79 in top markets like Sunnyvale, CA and exceed $25/hour with hospital PCT roles and agency premiums.

This guide breaks down the five biggest drivers of CNA hourly pay differences across 1686+ U.S. metropolitan areas. Whether you're a new state CNA certification holder, a working CNA / STNA / GNA / PCT considering setting switch, or a SNF director benchmarking competitive wages, the framework below is the central reference.

1. State and Metro Cost-of-Living

Location drives nominal CNA hourly pay:

• California ($20–$28/hour staff) — Bay Area, LA, San Diego markets lead. High COL plus state minimum wage anchoring.
• Alaska, Washington, Massachusetts, New York ($17–$25/hour staff) — high COL anchors.
• Hawaii, Oregon, Nevada ($16–$23/hour staff) — strong markets.
• Mid-Atlantic / Midwest / South $13–$20/hour staff — Texas, Florida, Tennessee, Georgia, North Carolina, Arizona, Pennsylvania, Ohio, Indiana, Michigan, Illinois.
• State minimum-wage laws — high-minimum-wage states (CA, WA, CT, NY, MA, CO, NJ, IL, IL) anchor entry-level CNA pay floors. California $20/hour minimum wage effective in healthcare sector.
• State CNA certification — federally mandated 75-hour minimum training under OBRA-87. State-specific titles: CNA (most states), STNA (Ohio), GNA (Maryland), HHA (Home Health Aide), PCT (hospital).

2. Setting: Hospital PCT / SNF / Home Care / Hospice

Setting drives 20–40% pay variation within the same metro:

• Hospital PCT (Patient Care Technician) — top tier — $3–$8/hour above SNF base. Major systems: HCA, Ascension, CommonSpirit, Trinity, AdventHealth, Kaiser, MGB, Northwell, Cleveland Clinic, Tenet, Sutter, Sentara, Atrium, Banner.
• LTACH / long-term acute care — Kindred / Curahealth / Select Specialty. Higher acuity than SNF.
• SNF / skilled nursing — largest CNA employer category. Strong shift differentials.
• Hospice CNA — VITAS, Hospice of the Valley, Compassus, Crossroads, Amedisys. Strong demand.
• Assisted living CNA — Sunrise, Atria, Brookdale, Five Star, Holiday Retirement, Capital Senior Living. Below SNF.
• Home health / home care aide — Bayada, Amedisys, BrightStar Care, Comfort Keepers, Home Instead, Visiting Angels. Mileage reimbursed.
• Adult day care — non-medical day program. Mid-range hourly.
• Corrections / state prison CNA — state correctional health. Strong base hourly plus state pension.
• School-based CNA — special needs school district CNA roles via Soliant, EBS, Procare.

3. Shift Differentials and Overtime

How you stack shifts dramatically changes effective hourly rate:

• Evening shift differential — typically $1–$3/hour at SNFs, $2–$5/hour at hospitals.
• Night shift differential — typically $2–$6/hour at SNFs, $3–$8/hour at hospitals (largest single differential).
• Weekend differential — typically $1–$4/hour.
• Holiday pay — typically 1.5× base.
• Charge / lead CNA pay — typically $1–$2/hour while serving as shift lead.
• Preceptor pay — typically $0.50–$1.50/hour while precepting new CNAs.
• California overtime — state law requires 2× pay after 12 consecutive hours.

4. Experience and Certifications

CNA experience and certification stacking add per-hour value:

• New graduate CNA ($12–$16/hour starting) — fresh state-certified CNAs at SNF or assisted living.
• 2–5 year CNA ($15–$20/hour) — most reach state median.
• 5+ year senior CNA ($18–$25/hour) — established with charge / preceptor responsibilities.
• 10+ year CNA ($20–$28/hour staff) — established with department lead roles.
• PCT (Patient Care Technician) credential — hospital-specific expanded scope (phlebotomy, EKG, point-of-care) supports $3–$8/hour premium.
• Phlebotomy certification (CPT — ASCP / NHA) — adds modest hourly premium.
• EKG certification — adds hourly premium at telemetry / cardiac units.
• Medication Aide / QMAP / TMA certification — state-specific medication-administration credential. Strong premium where authorized.
• Wound Care Certified (WCC) — modest premium.
• Dementia care certification (CDP) — modest premium at memory care units.
• Bilingual differential — Spanish, Vietnamese, Mandarin, Tagalog fluency adds $0.50–$2/hour in diverse markets.
• CNA-to-LPN bridge programs — many CNAs use the role as path to LPN / RN credential.

5. Agency / Per Diem / Travel CNA Strategy

Non-staff structures consistently outperform staff hourly:

• Agency / per diem rates — 25–50% premium over staff base. Major platforms: ConnectRN, Clipboard Health, ShiftMed, IntelyCare, Nursa, BookJane, Aya Healthcare.
• Travel CNA packages — emerging. Travel CNA rates of $18–$32/hour plus non-taxable per-diem.
• Private duty CNA — high-acuity pediatric or geriatric. Premium hourly plus close client relationships.
• Government CNA (VA, BOP, state corrections) — federal / state CNA with pension and PSLF eligibility (federal).
• Multi-facility strategy — splitting time between staff and agency.

2026 CNA Hourly Pay Outlook

CNA pay has grown at a compound annual rate of 6.50% nationally over the past five years — driven by post-pandemic CNA staffing crisis, aging-population-driven long-term care demand, expanding home health and hospice demand, agency competition driving premium rates, state minimum-wage law increases (especially California $20/hr healthcare sector), and structural CNA workforce turnover. The BLS projects CNA employment growth at 4% through 2033, with strong upward pay pressure especially at hospital PCT roles, agency / per diem, and high-minimum-wage states.