If you are weighing a career as a certified nursing assistant, the first thing you probably want to know is how much it pays per hour. The honest answer is, it depends. Where you live, what kind of facility you choose, what shift you take, and how many years you have under your belt can mean the difference between a $14 paycheck and a $28 paycheck for the exact same job title.
The national CNA hourly average sits between $17 and $21 in 2026, with the Bureau of Labor Statistics pegging the median at roughly $18.85 per hour. That works out to about $39,200 a year for full-time work. Real-world rates stretch from $12 in rural Mississippi nursing homes to $30 or more in big-city hospitals. Travel CNAs routinely clear $40 to $50 an hour once stipends are counted.
This guide breaks down every variable that moves a CNA paycheck. You will see cna hourly pay averages by state, by setting, by shift, and by years of experience. We will also cover shift differentials, agency bumps, union scales, sign-on bonuses, and the five most reliable ways to push your cna pay per hour from entry-level to top-tier without leaving the bedside.
Three forces drive your hourly rate. First, geography. A CNA in San Francisco earns nearly double what a CNA in Tupelo earns, because both wages and labor demand swing with cost of living. Second, setting matters enormously. Hospitals pay more than nursing homes, and travel agencies pay more than both. Third, your credentials and tenure stack on top.
A CNA II with telemetry training and five years on a cardiac floor earns several dollars more per hour than a brand-new graduate of free cna classes. Knowing how each lever works lets you stack them. Move to a higher-paying state, target a hospital instead of a nursing home, take the night shift, pick up an EKG cert, and your hourly rate can jump 40 to 60 percent in under two years.
Most CNAs do not realize how much room there is to grow their hourly pay without going back to school. The path from $14 entry-level to $26 hospital telemetry CNA is purely tactical. It rests on choosing the right employer, the right shift, the right state, and the right add-on certifications. The next sections walk through each lever with real 2026 numbers.
The Bureau of Labor Statistics publishes annual Occupational Employment and Wage Statistics for nursing assistants (SOC code 31-1131). The 2024 data, released in spring 2025, shows a median hourly wage of $18.85 and an annual median of $39,200. The 10th percentile sits at $13.85 and the 90th percentile at $26.05.
BLS data lags real wages by 12 to 18 months, so 2026 actual rates are slightly higher than published figures. Indeed, ZipRecruiter, and Glassdoor publish faster-moving market data that often shows current rates 5 to 10 percent above the latest BLS release. When researching, blend BLS for the baseline with job board listings for current openings near you.
The average CNA earns $18.85 per hour nationally in 2026, but actual rates run from $12 to $30+ depending on state, setting, shift, and experience. Hospitals pay the most ($19-$24/hr), nursing homes the least ($16-$20/hr), and travel CNAs the highest of all ($30-$50/hr with stipends). Night shifts add $1-$4/hr, weekends add $1-$3/hr, and holidays often pay time-and-a-half or double time.
Highest-paying states: Alaska $22/hr, California $21/hr, Massachusetts $20/hr, New York $20/hr, Washington $20/hr, Hawaii $20/hr, Oregon $19/hr, Minnesota $19/hr, Connecticut $19/hr, New Jersey $19/hr.
Lowest-paying states: Mississippi $13/hr, Louisiana $14/hr, Alabama $14/hr, Oklahoma $14/hr, Arkansas $14/hr, West Virginia $14/hr, Kentucky $14/hr, Tennessee $14/hr, South Carolina $15/hr, North Carolina $15/hr.
Middle ground: Texas $15/hr, Florida $15/hr, Georgia $15/hr, Ohio $16/hr, Pennsylvania $17/hr, Illinois $17/hr, Colorado $18/hr, Arizona $17/hr, Virginia $16/hr, Nevada $17/hr.
State medians shift each year as minimum wage laws update. California pushing toward $25/hr for healthcare workers under SB 525 will lift CNA pay further in 2026 and 2027.
Hospitals: $19 to $24 per hour on average. Acute-care floors, telemetry units, and ICUs sit at the high end. Nursing homes / long-term care: $16 to $20 per hour. This is the largest CNA employer, but pay lags hospitals by $2-$4/hr. Home health: $14 to $22 per hour, with wide swings. Private agencies pay more than Medicaid waiver programs.
Hospice: $17 to $22 per hour, often with mileage reimbursement on top. Assisted living: $15 to $19 per hour, generally lower because acuity is lower. Mental health and psych facilities: $17 to $21 per hour, with hazard pay on some units. Dialysis centers: $19 to $23 per hour for trained patient care techs.
School nurse aide: $14 to $20 per hour, but you get summers and school holidays off. Correctional facility CNA: $18 to $25 per hour, with state benefits. Travel CNA: $25 to $50 per hour all-in (taxable wage plus housing and meal stipends).
Day shift (7am-3pm or 7am-7pm): base rate, no differential. Evening shift (3pm-11pm): +$0.50 to $2.00 per hour. Some facilities pay $1.50 across the board. Night shift (11pm-7am or 7pm-7am): +$1.00 to $4.00 per hour, the most common bump.
Weekend differential: +$1 to $3 per hour, often Friday 7pm through Sunday 11pm. Baylor weekend programs: 24 hours weekend work paid as 36 or 40 hours. Holiday pay: time-and-a-half (1.5x) is standard, double time (2x) at union and hospital facilities. Stacking night + weekend + holiday differentials can push a $17/hr base to $26-$28/hr for a single shift.
0-1 years (entry-level): $14 to $17 per hour. New grads often start at or just above state minimum wage. 2-4 years: $16 to $20 per hour, after annual raises of 1-3% and one job change. 5-9 years: $19 to $23 per hour. Most CNAs hit a ceiling here unless they specialize or move into agency/travel.
10+ years: $22 to $28 per hour, especially in hospitals, unions, or with CNA II/III progression. 15+ years with specialty: $25 to $32 per hour. Long-tenured CNAs in 1199 SEIU or Kaiser contracts in California can clear $33/hr at top of scale.
The five highest-paying states for CNAs in 2026 are Alaska, California, Massachusetts, New York, and Washington, all averaging $20 or more per hour. Alaska tops the list at roughly $22 per hour, driven by labor shortages in remote facilities and a cost-of-living adjustment baked into healthcare wages. California has been climbing fast since SB 525 phased in a $25 per hour healthcare minimum. Most acute-care CNAs in California are already at $24 to $26 per hour in 2026.
City-level pay tells the real story. San Francisco CNAs average $26 per hour. San Jose is close behind at $25. Boston sits at $23 and New York City around $23, climbing to $26 or more in union hospitals. Seattle and Washington DC both pay $22, while Honolulu, Anchorage, Portland, and Minneapolis round out the top tier.
If you are willing to relocate, moving from a low-paying state to a coastal metro can nearly double your cna salary per hour overnight. Cost of living offsets some of the gain, but not all of it. A San Francisco CNA earning $26 per hour still has more disposable income than an Alabama CNA earning $14 per hour, even after housing and groceries.
Setting is the second biggest pay lever after geography. Hospitals consistently top the chart for three reasons. They handle higher acuity patients. They have larger HR budgets and union contracts. And they receive federal Medicare reimbursement that flows directly into wages.
A hospital cna averages $21 per hour, climbing to $24 or more on specialty units like telemetry, oncology, and the emergency room. In contrast, a long-term care CNA in the same city often averages $17 to $18 per hour for harder physical work and higher patient ratios. The pay gap exists because of how the work is funded, not because hospital CNAs work harder.
Home health and hospice sit in the middle of the pay range. They offer scheduling flexibility that nursing homes do not. A home health cna can earn $14 to $22 per hour, with private-pay clients on the high end and Medicaid waiver work on the low end. A hospice cna averages $19 to $22 per hour and frequently picks up mileage reimbursement, paid drive time between patients, and small per-visit bonuses.
Shift differentials are the easiest path to a higher hourly rate without changing employers. Most facilities offer at minimum a night differential of $1 to $3 per hour. Hospitals are more generous, with night differentials of $3 to $4 per hour and weekend differentials stacking on top.
A CNA earning a $17 per hour base who works the 11pm-to-7am shift on Saturday could see an effective rate of $21 to $23 per hour just by choosing when to work. Holiday pay adds even more. Most facilities pay time-and-a-half on six federal holidays, and hospitals often pay double time for Christmas, Thanksgiving, and New Year's Day. Picking up a single holiday shift can add $80 to $200 to your paycheck.
Baylor weekend programs are another underused option. You commit to working every Saturday and Sunday, typically two 12-hour shifts totaling 24 hours, and the facility pays you for 32 to 40 hours plus full benefits. That works out to roughly $25 to $30 per hour effective rate, with five weekdays free. Many cna jobs in california offer Baylor programs as a recruiting tool, especially in high-acuity hospitals struggling to fill weekend coverage.
Travel CNA contracts have become the highest-paying option for nursing assistants since the pandemic-era nursing shortage. A typical contract pays $1,200 to $2,800 per week in taxable wages. On top of that, you receive a housing stipend of $1,000 to $2,500 per week and a meals-and-incidentals stipend of $200 to $500 per week. When you do the math on a 36-hour-per-week contract, that works out to an effective rate of $30 to $50 per hour.
Crisis contracts in shortage markets like Alaska, North Dakota, or remote California pay even more. Some hit $4,000 weekly for short-term assignments. The catch is you have to be willing to relocate every 8 to 13 weeks, pass new state-by-state credential checks, and live without traditional benefits. Most travel CNAs save aggressively during contracts and take 2 to 4 weeks off between assignments.
If this path interests you, a travel cna jobs guide walks through agencies, housing, contract negotiation, and what to watch for in fine print. The biggest beginner mistake is signing with the first recruiter who calls. Top travel CNAs work with three or four agencies simultaneously, force them to bid against each other, and never accept the first offer. The pay difference between a casual and a strategic traveler is often $5 to $8 per hour on the same contract.
Unionized CNAs consistently out-earn their non-union peers by 15 to 30 percent. The largest healthcare union in the United States, 1199 SEIU, represents about 450,000 healthcare workers including thousands of New York CNAs. Top-of-scale 1199 CNAs in NYC hospitals earn $26 to $33 per hour. They also get full pension, retiree health insurance, tuition vouchers, and 25 or more paid days off.
Kaiser Permanente CNAs in California are unionized through the Alliance of Health Care Unions and earn similar rates with even better benefits. National Nurses United and AFSCME also represent healthcare workers in some markets. Non-union facilities cap raises at 1 to 3 percent per year and rarely offer pensions. If union work is available in your market, the lifetime pay difference is often six figures.
Beyond your hourly rate, total compensation can swing thousands of dollars based on bonuses. Sign-on bonuses for CNAs in 2026 range from $500 at small assisted living facilities to $5,000 at hospitals desperate for night-shift staff. The catch: most require a 1 or 2 year commitment, and you usually have to repay a prorated amount if you leave early. Retention bonuses, paid quarterly or annually for sticking around, add another $500 to $3,000 yearly.
Benefits packages add real value too. A typical hospital CNA benefits package is worth $3,000 to $10,000 a year. That includes health insurance with $150 to $400 monthly employer share, dental at $30 to $60 monthly, and vision at $10 to $20 monthly. Add PTO of 10 to 25 days, a 401(k) match of 3 to 6 percent, tuition reimbursement of $2,500 to $5,250 yearly, plus CEU stipends and uniform allowances.
When comparing two offers, always add benefits to the hourly wage before deciding. A $19 per hour hospital job with full benefits often pays more all-in than a $22 per hour agency role with none. Run the math on health insurance alone. If you would otherwise pay $400 per month on the marketplace, employer coverage saves you roughly $2.30 per hour worked at 40 hours per week.
CNAs are often told the rate is fixed, but that is rarely true at the offer stage. Three negotiation tactics work consistently. First, research the market. Use Bureau of Labor Statistics state and metro data, plus Glassdoor and Indeed company pages, to find the median rate for your zip code and setting. Walk in knowing what other employers pay.
Second, ask about shift differentials, weekend premiums, and Baylor programs even if the base rate will not budge. Many hiring managers have flexibility there. Third, mention competing offers truthfully. Hospitals routinely match or beat agency offers to retain trained CNAs, especially during the current shortage. If you hold a cna license in two reciprocity states and can start within two weeks, you have meaningful leverage.
A fourth tactic that few CNAs use: ask for a sign-on bonus instead of a higher hourly rate. Facilities often have separate bonus budgets that hiring managers can tap when their hands are tied on base pay. A $3,000 sign-on bonus over a 1-year commitment works out to about $1.50 per hour. Some hospitals will pay it as $1,500 at hire and $1,500 at the one-year mark, which doubles as a retention bonus.
CNA program (4-12 weeks). Some employers pay $13-$15/hr during clinicals or apprenticeship. State CNA exam fee $90-$140.
$14-$17/hr typically at a nursing home or assisted living. Day shift. Get one year of bedside experience before chasing hospital jobs.
Move to a hospital floor: $19-$22/hr base. Add BLS and EKG certs. Pick up evening or night shift for $1-$3/hr differential.
Earn CNA II or medication aide credential (where state allows). Move to telemetry, ICU step-down, or dialysis: $22-$25/hr.
Optional: take an agency or travel contract for 1-2 years. Effective rate $30-$45/hr. Save aggressively for bridge program tuition.
Use tuition reimbursement to bridge to LPN ($28-$35/hr) or RN ($35-$50/hr). Most hospitals will pay for your schooling if you sign a 2-3 year commitment.
Per diem CNAs work as needed, with no guaranteed hours. In exchange for that flexibility, hospitals and nursing homes pay $25 to $40 per hour, often 30 to 50 percent more than staff rates. The downside is no benefits, no PTO, no guaranteed schedule, and you are often the first canceled when the census drops. Per diem works best as a side gig stacked on top of a staff job, not as your only income.
Private duty CNAs care for one client in a home setting, usually paid directly by the family or through a non-Medicare home care agency. Rates range from $18 to $30 per hour cash. The highest-paying private duty work is for affluent elderly clients with complex care needs. Some families pay $35 per hour for live-in care with experienced CNAs. The risks: no employer protection, irregular hours, and reliance on the client's continued health and willingness to pay.
School nurse aide positions pay less per hour at $14 to $20, but include summers off and school holidays, which can make the effective annual rate competitive. Correctional facility CNAs in state prisons and county jails earn $18 to $25 per hour with strong state benefits and pension eligibility. Both options offer stability that private duty and per diem cannot match.
Most CNA programs are unpaid. Students cover tuition of $300 to $2,000 and complete clinical hours as part of the coursework. However, some pathways pay you to train. Nursing home chains like Genesis HealthCare and Brookdale operate paid apprenticeships where you earn $13 to $15 per hour during training in exchange for a 1 or 2 year work commitment. Hospital-based programs at HCA, Ascension, and Kaiser do the same.
Workforce development programs offer another route. Goodwill, the American Red Cross, and state grants like WIOA cover tuition for eligible students. Some include a small training stipend. After certification, first-year CNAs earn $14 to $17 per hour on average, with hospital orientation rates trending higher at $17 to $20 per hour during the 6 to 12 week onboarding period.