Skip to main content

What Are Geriatric Nursing Assistants?

Reviewed By:

Updated On 13 Minute Read

Caring for older adults takes clinical awareness, patience, and a lot of heart. Geriatric nursing assistants, often shortened to GNAs, are frontline caregivers who help older adults with daily needs like bathing, dressing, mobility, meals, toileting, comfort, and safety. They also observe and report changes that can signal a decline or a new problem. 

If you’ve ever heard nurses say nursing assistants are the “eyes and ears” of the care team, GNA nursing is a perfect example. GNAs spend sustained, close time with residents and patients, which puts them in an ideal position to notice subtle changes early and communicate them to licensed nurses. 

Protecting Older Adults: Addressing Mistreatment and Abuse Course

View Course

What is GNA in nursing? 

GNA most commonly stands for geriatric nursing assistant. In everyday use, it can refer to either: 

  • A nursing assistant who primarily works with older adults, especially in long-term care and rehab settings.
  • A formal state designation, most notably in Maryland, where “GNA” has been used as an additional credential tied to working in continuing care retirement communities (CCRCs), assisted living facilities, skilled nursing facilities, and other long-term care facilities. 

In other words, when someone asks “what is GNA in nursing,” the most accurate answer is: a GNA is a nursing assistant focused on geriatric care, but the exact title and certification requirements vary by state.  

Is GNA nursing the same as CNA? 

Sometimes yes in day-to-day responsibilities, and sometimes no in credentialing. 

In many states 

Many employers use “geriatric nursing assistant” as a job label for a CNA who works mostly with older adults. In these states, there may not be a separate “GNA license” beyond the usual nursing assistant requirements. 

In Maryland 

Maryland historically treated “GNA” as a specific designation layered on top of CNA certification. The Maryland Department of Health explains that initial GNA certification includes completing an approved GNA course, holding Maryland CNA certification, and applying for and passing the state GNA exam process (MDGNATS). 

Important Maryland update (effective April 1, 2026) 

Maryland is in the process of changing how nursing assistant credentials are titled and used. According to the Maryland Board of Nursing materials, effective April 1, 2026, Maryland will transition to CNA-I and CNA-II terminology, and current CNA/GNA certificate holders will be administratively moved to CNA-I. The separate GNA designation will no longer appear as a standalone designation after that change.  

(For nurses working with CNAs and GNAs in Maryland, this matters for onboarding, delegation expectations, and staffing compliance.) 

Where do geriatric nursing assistants work? 

GNAs work anywhere older adults need hands-on support with activities of daily living (ADLs) and close monitoring. Common settings include: 

  • Nursing homes and skilled nursing facilities (long-term care)
  • Assisted living and CCRCs
  • Rehabilitation centers (post-acute rehab after surgery, illness, or injury)
  • Hospitals (especially med-surg, orthopedics, geri-focused units)
  • Home care (depending on local regulations and employer role designations)  

GNA duties: What does a geriatric nursing assistant do during a shift? 

GNA duties are hands-on, patient-facing, and centered on safety, dignity, comfort, and observation. While the exact task list depends on facility policy and state rules, nursing assistants commonly provide basic care and help with ADLs under the supervision of LPNs/LVNs and RNs.  

Below is a practical way to think about GNA nursing responsibilities. 

Personal care and ADLs 

Much of the shift revolves around helping older adults complete routine self-care safely: 

  • Bathing or shower assistance
  • Oral care, shaving, grooming, hair care
  • Dressing and undressing
  • Toileting support, incontinence care, brief changes
  • Perineal care and skin cleansing
  • Linen changes and basic room tidiness that support infection prevention and comfort  

These tasks may look routine, but in geriatrics, they’re also assessment opportunities. A GNA might notice decreased appetite, new confusion, a stronger urine odor, more shortness of breath with exertion, or a change in gait that suggests fall risk. 

Mobility support, transfers, and fall prevention 

Mobility is one of the highest-stakes parts of the job because falls can be life-altering for older adults. 

GNA duties may include: 

  • Assisting with ambulation using walkers, canes, or gait belts per facility protocol
  • Transferring between bed and chair or wheelchair
  • Repositioning in bed and chair to support comfort and skin integrity
  • Making sure call lights, personal items, and mobility aids are within reach
  • Keeping pathways clear and reporting hazards (spills, clutter, poor lighting) 

The Centers for Disease Control and Prevention (CDC) notes that falls among adults aged 65 and older caused over 38,000 deaths in 2021 and led to nearly 3 million ED visits in 2021, which is why everyday fall-prevention habits matter.  

Vital signs, observation, and reporting 

Depending on training and facility policy, GNAs may: 

  • Measure and record vital signs (temperature, pulse, respirations, blood pressure).
  • Obtain weight and track trends.
  • Observe intake and output (I&O) when ordered.
  • Report changes in pain behaviors, breathing, skin condition, mentation, or mobility. 

The Bureau of Labor Statistics (BLS) specifically notes that nursing assistants often measure vital signs, listen to and record patient concerns, and then report that information to nurses.  

Documentation and communication 

Documentation is a patient safety tool, not “extra paperwork.” In long-term care, especially, the story of a resident’s day-to-day functioning is told through consistent charting. 

Common documentation tasks may include: 

  • ADL completion and level of assistance required
  • Meal intake and hydration support
  • Toileting patterns and bowel movements (when tracked)
  • Skin checks per protocol and reporting concerns
  • Mobility and transfer assistance provided
  • Safety checks (rounding, bed/chair alarms if used)
  • Behavioral observations (especially with dementia or delirium risk) 

If you’re an RN or LPN/LVN supervising a GNA, consider clarifying what “good reporting” looks like. A helpful framework is:  

  • What changed
  • When it changed
  • What you observed (not assumptions) 

Comfort, companionship, and dementia-informed care 

Older adults in long-term care are at high risk for loneliness, anxiety, and distress. GNAs provide emotional support and routine human connection that directly affects quality of life. 

For individuals with Alzheimer’s disease or related dementias, communication strategies make daily care safer and more humane. The Alzheimer’s Association recommends approaches like using simple words, maintaining a calm tone, allowing extra time, and reducing distractions to support understanding.  

Practical examples of dementia-supportive GNA nursing behaviors include: 

  • Explaining each step before touching during bathing or dressing
  • Offering one-step choices (“Would you like the blue shirt or the green shirt?”)
  • Validating emotions first, then redirecting if needed
  • Watching for triggers like overstimulation, pain, hunger, or toileting needs 

Infection prevention basics 

GNAs do a lot of close-contact care, so infection prevention is part of the job every hour of every shift. 

Hand hygiene guidance reinforces cleaning hands at key moments, including when contact with blood or body fluids is anticipated and when moving from a soiled area to a clean area on the same patient, as well as between patients.  

In practice, this means GNAs need easy access to soap and water, alcohol-based hand rub, appropriate gloves, and clear facility protocols. 

Scope of practice: what GNAs can and cannot do 

The scope of practice depends on state rules, facility policy, training, and delegation. 

Common “can do” tasks in many settings 

  • ADL assistance (bathing, dressing, grooming, toileting)
  • Mobility support and transfers per facility policy
  • Vital signs and weights
  • Observation and reporting
  • Basic comfort measures (positioning, oral care, non-pharmacologic comfort support) 

Common “cannot do” tasks without additional training or credentials 

  • Independent nursing assessment and clinical decision-making (RN/LPN role)
  • Administering medications unless specifically permitted by state law and credentialed (for example, through a medication aide pathway)
  • Performing sterile procedures or complex wound care without appropriate training and policy 

The BLS notes that, depending on training level and state, nursing assistants may dispense medication, but this isn’t universal and typically requires additional credentialing.  

Training and certification: how to become a GNA 

Because “GNA” isn’t a single national license, it helps to think in layers: the nursing assistant foundation first, then geriatric-focused training as required by your state or employer. 

Nursing assistant training and the federal baseline 

Federal regulations for nurse aide training programs set minimum requirements that states must meet when approving training for nurse aides who work in nursing facilities. One key requirement is that an approved program must consist of a minimum of 75 clock hours of training, including at least 16 hours of supervised practical training.  

States can and often do require more than the federal minimum. 

The Maryland pathway (traditional model) 

Maryland’s Department of Health describes initial GNA certification steps that include: 

  1. Completing an approved GNA course
  2. Holding Maryland CNA certification
  3. Applying for the GNA exam through the state’s testing service process
  4. Passing, with results forwarded and the GNA designation appearing in verification and on renewal documentation  

Maryland also notes renewal expectations that include employer verification of work hours as a GNA in a comprehensive care facility in the two years preceding renewal.  

The Maryland pathway starting April 1, 2026 

Maryland Board of Nursing FAQs and town hall materials indicate that effective April 1, 2026: 

  • Current CNA/GNA becomes CNA-I
  • Current CNA becomes CNA-II
  • CNA-I can work in long-term care settings, CNA-II cannot
  • The separate GNA designation will be removed as a separate designation  

Background checks, registries, and ongoing eligibility 

Most states place certified nursing assistants on a state registry and may require continuing eligibility steps, such as work-hour minimums for renewal, continuing education, and background checks. BLS describes state registries and state-specific requirements for nursing assistants.  

What makes geriatric care different? 

A lot of healthcare workers can do tasks. What makes geriatric care special is the combination of task skill plus clinical awareness of aging-related risks. 

Older adults have a higher fall risk and higher harm from falls 

Even “small” falls can cause fractures, head injuries, fear of movement, and rapid loss of independence. Research around older adult fall prevention underscores the scale of this risk nationally.  

How GNAs help: 

  • Encouraging slow position changes for residents who get dizzy
  • Making sure nonskid socks and proper footwear are used
  • Using call lights and asking for help with two-person transfers when indicated
  • Reporting “near falls” and unsteady gait early 

Skin integrity and pressure injury prevention are daily priorities 

Older adults often have thinner skin, reduced mobility, and chronic conditions that raise pressure injury risk. While licensed staff set the plan, GNAs frequently carry out the day-to-day actions that make prevention work: repositioning, reducing friction and shear, moisture management, and reporting early skin changes. 

If you expand this section on the page, avoid repeating the “turn every two hours” line as a blanket rule. Facilities should follow individualized prevention plans based on risk and tolerance. 

Dementia and delirium can change how care needs to be delivered 

Residents with dementia may resist care, misinterpret touch, or become anxious with rushed communication. Dementia-informed techniques like simple phrasing, patience, and calm tone can reduce distress and improve safety for everyone.  

How GNAs support nurses and improve outcomes 

When RNs and LPNs/LVNs think of GNAs as partners in observation, care becomes smoother and safer. 

For nurses: delegation tips that set GNAs up for success 

  • Be specific about what to report: “Report any new confusion, new cough, oxygen sat below X, new skin redness, or refusal to eat more than half a meal.”
  • Explain the “why” when possible: it improves buy-in and accuracy.
  • Create a consistent check-in rhythm: quick touchpoints reduce missed changes.
  • Close the loop. If a GNA reports a concern, acknowledge it and share next steps when appropriate. 

For GNAs: Reporting in a nurse-friendly way 

A simple structure keeps communication clear: 

  • What changed?
  • When did it start?
  • What did you see, hear, measure, or smell?
  • What did the resident say?
  • What did you do already (if anything within policy)? 

This kind of reporting helps nurses act quickly without guessing. 

Pay and job outlook for nursing assistants (including GNA roles) 

National labor data typically tracks GNAs under the broader category of nursing assistants. 

The BLS Occupational Outlook Handbook reports: 

  • 2024 median pay for nursing assistants: $39,530 per year. 
  • Projected job growth 2024–2034: 2% for nursing assistants and orderlies.
  • Projected openings: about 211,800 openings each year, on average, largely from workforce replacement needs. 

Actual pay varies significantly by region, setting (hospital vs long-term care), shift differentials, and local market conditions. 

Career pathways after GNA nursing 

Many people choose GNA work because it builds a strong clinical foundation and clarifies whether they want to pursue nursing school. 

Common next steps include: 

  • Medication aide pathways (where available and desired)
  • Patient care technician (PCT) roles with additional acute-care skills
  • LPN/LVN programs
  • RN programs (ADN or BSN), especially for those who want broader scope and clinical decision-making 

Experience in geriatrics can be especially valuable for nurses who later work med-surg, orthopedics, case management, home health, hospice, or primary care. 

FAQs

References

Jennifer Oh, BSN, RN

Jennifer Oh, BSN, RN

Jennifer Oh, BSN, RN, has worked in med-surg telemetry and case management in Temple, Texas. She enjoys the opportunity to help the patients and families and wants to share her insights and experience with other nurses to help them on their journey toward success in the field.

About Nurse.com