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J Rural Health. 2009 Summer;25(3):267-75. doi: 10.1111/j.1748-0361.2009.00229.x.

Characteristics and recruitment paths of certified nursing assistants in rural and urban nursing homes.

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  • 1South Carolina Rural Health Research Center, Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 204, Columbia, SC 29210, USA.



Most nursing home care is provided by certified nursing assistants (CNAs), but little is known about rural CNAs.


To develop a representative geographic profile of the CNA workforce, focusing on paths leading to present job.


Cross-sectional analysis of data from the 2004 National Nursing Assistant Survey (NNAS), a nationally representative survey of 3,017 CNAs; analysis was restricted to 2,897 currently working CNAs. Location was categorized as metropolitan, micropolitan, or neither (other rural county). Demographics included age, sex, race, education, income, and years at present job. Analyses were weighted to reflect the complex sampling design.


CNAs in micropolitan and other rural nursing homes were more likely to be white and US citizens than were urban CNAs. Rural or micropolitan CNAs were more likely to note "job close to home" as a reason for becoming a CNA than were urban CNAs (70.8%, 66.3%, and 43.6%, respectively; P < .001). Over half of CNAs (52.2%) entered the field from a different job category. CNAs in micropolitan and small rural counties were more likely than urban CNAs to report being trained at a nursing facility (61.4%, 65.4%, 52.5%; P < .001) rather than community college or other site. Informal means (family and friends) were the most common recruitment path.


Career-changers (individuals entering the CNA role from another job) represent a major recruitment target. The prevalence of informal networks in CNA recruitment history suggests that nursing homes seeking to become "employers of choice" will be advantaged when recruiting.

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