Nursing aides, also known as nursing assistants, geriatric aides, unlicensed assistive personnel, or hospital attendants, perform routine tasks under the supervision of nursing and medical staff. They answer patients' call bells, deliver messages, serve meals, make beds, and help patients eat, dress, and bathe. Aides may also provide skin care to patients; take temperatures, pulse, respiration, and blood pressure; and help patients get in and out of bed and walk. They may also escort patients to operating and examining rooms, keep patients' rooms neat, set up equipment, or store and move supplies. Aides observe patients' physical, mental, and emotional conditions and report any change to the nursing or medical staff.

Nursing aides employed in nursing homes are often the principal caregivers, having far more contact with residents than other members of the staff. Since some residents may stay in a nursing home for months or even years, aides develop ongoing relationships with them and interact with them in a positive, caring way.

Psychiatric aides are also known as mental health assistants and psychiatric nursing assistants. They care for mentally impaired or emotionally disturbed individuals. They work under a team that may include psychiatrists, psychologists, psychiatric nurses, social workers, and therapists. In addition to helping patients dress, bathe, groom, and eat, psychiatric aides socialize with them and lead them in educational and recreational activities. Psychiatric aides may play games such as cards with the patients, watch television with them, or participate in group activities such as sports or field trips. They observe patients and report any physical or behavioral signs which might be important for the professional staff to know. They accompany patients to and from wards for examination and treatment. Because they have the closest contact with patients, psychiatric aides have a great deal of influence on their outlook and treatment.

Working Conditions

Most full-time aides work about 40 hours a week, but because patients need care 24 hours a day, some aides work evenings, nights, weekends, and holidays. Many work part-time. Aides spend many hours standing and walking, and they often face heavy workloads. Because they may have to move patients in and out of bed or help them stand or walk, aides must guard against back injury. Nursing aides may also face hazards from minor infections and major diseases such as hepatitis, but can avoid infections by following proper procedures.

Nursing aides often have unpleasant duties; they empty bed pans and change soiled bed linens. The patients they care for may be disoriented, irritable, or uncooperative. Psychiatric aides must be prepared to care for patients whose illness may cause violent behavior. While their

work can be emotionally demanding, many aides gain satisfaction from assisting those in need.

Employment

Nursing aides held about 1.4 million jobs in 1998, and psychiatric aides held about 95,000 jobs. About one-half of all nursing aides worked in nursing homes, and about one-fourth worked in hospitals. Others worked in residential care facilities, such as halfway houses and homes for the aged or disabled, or in private households. Most psychiatric aides worked in psychiatric units of general hospitals, psychiatric hospitals, State and county mental institutions, homes for mentally retarded and psychiatric patients, and community mental health centers.

Training, Other Qualifications, and Advancement

In many cases, neither a high school diploma nor previous work experience is necessary for a job as a nursing or psychiatric aide. A few employers, however, require some training or experience. Hospitals may require experience as a nursing aide or home health aide. Nursing homes often hire inexperienced workers who must complete a minimum of 75 hours of mandatory training and pass a competency evaluation program within 4 months of employment. Aides who complete the program are placed on the State registry of nursing aides. Some States require psychiatric aides to complete a formal training program.

These occupations can offer individuals an entry into the world of work. The flexibility of night and weekend hours also provides high school and college students a chance to work during the school year.

Nursing aide training is offered in high schools, vocational-technical centers, some nursing homes, and community colleges. Courses cover body mechanics, nutrition, anatomy and physiology, infection control, communication skills, and resident rights. Personal care skills such as how to help patients bathe, eat, and groom are also taught.

Some facilities, other than nursing homes, provide classroom instruction for newly hired aides, while others rely exclusively on informal on-the-job instruction from a licensed nurse or an experienced aide. Such training may last several days to a few months. From time to time, aides may also attend lectures, workshops, and in-service training.

Applicants should be healthy, tactful, patient, understanding, emotionally stable, dependable, and have a desire to help people. They should also be able to work as part of a team, have good communication skills, and be willing to perform repetitive, routine tasks.

Opportunities for advancement within these occupations are limited. To enter other health occupations, aides generally need additional formal training. Some employers and unions provide opportunities by simplifying the educational paths to advancement. Experience as an aide can also help individuals decide whether to pursue a career in the health care field.

Job Outlook

Job prospects for nursing aides should be good through the year 2008. Numerous openings will arise from a combination of fast growth and high turnover for this large occupation. Employment of nursing aides is expected to grow faster than the average for all occupations in response to an emphasis on rehabilitation and the long-term care needs of a rapidly growing elderly population. Employment will increase as a result of the expansion of nursing homes and other long-term care facilities for people with chronic illnesses and disabling conditions, many of whom are elderly. Financial pressure on hospitals to release patients as soon as possible should produce more nursing home admissions. Modern medical technology will also increase the employment of nursing aides. This technology, while saving and extending more lives, increases the need for long-term care provided by aides. As a result, nursing and personal care facilities are expected to grow rapidly and to provide most of the new jobs for nursing aides.

Employment of psychiatric aides is expected to grow slower than the average for all occupations. Employment will rise in response to the sharp increase in the number of older persons-many of whom will require mental health services. Employment of aides in outpatient

community mental health centers is likely to grow because of increasing public acceptance of formal treatment for drug abuse and alcoholism, and a lessening of the stigma attached to those receiving mental health care. However, employment in hospitals-where one-half of psychiatric aides work-is likely to decline due to attempts to contain costs by limiting inpatient psychiatric treatment.

Replacement needs will constitute the major source of openings for aides. Turnover is high, a reflection of modest entry requirements, low pay, and lack of advancement opportunities.

Median hourly earnings of psychiatric aides were $10.66 in 1998. The middle 50 percent earned between $8.33 and $13.36 an hour. The lowest 10 percent earned less than $6.87 and the highest 10 percent earned more than $15.28 an hour. Median hourly earnings of psychiatric aides in 1997 were $11.20 in State government and $9.80 in hospitals.

Aides in hospitals generally receive at least 1 week's paid vacation after 1 year of service. Paid holidays and sick leave, hospital and medical benefits, extra pay for late-shift work, and pension plans also are available to many hospital and some nursing home employees.

Occupational therapy assistants and aides help disabled patients function in home settings.

Employment is projected to increase over the 19982008 period, but due to the effects of Federal limits on reimbursement for therapy services, the majority of expected employment growth is expected to occur during the second half of the projection period.

Nature of the Work

Occupational therapy assistants and aides work under the direction of occupational therapists to provide rehabilitative services to persons with mental, physical, emotional, or developmental impairments. The ultimate goal is to improve clients' quality of life by helping them compensate for limitations. For example, occupational therapy assistants help injured workers re-enter the labor force by helping them improve their motor skills or help persons with learning disabilities increase their independence, by teaching them to prepare meals or use public transportation.

Occupational therapy assistants help clients with rehabilitative activities and exercises outlined in a treatment plan developed in collaboration with an occupational therapist. Activities range from teaching the proper method of moving from a bed into a wheelchair, to the best way to stretch and limber the muscles of the hand. Assistants monitor an individual's activities to make sure they are performed correctly and to provide encouragement. They also record their client's progress for use by the occupational therapist. If the treatment is not having the intended effect, or the client is not improving as expected, the therapist may alter the treatment program in hopes of obtaining better results. In addition, occupational therapy assistants document billing of the client's health insurance provider.

Occupational therapy aides typically prepare materials and assemble equipment used during treatment and are responsible for a range of clerical tasks. Duties can include scheduling appointments, answering the telephone, restocking or ordering depleted supplies, and filling out insurance forms or other paperwork. Aides are not licensed, so by law they are not allowed to perform as wide a range of tasks as occupational therapy assistants do.

Working Conditions

Occupational therapy assistants and aides usually work during the day, but may occasionally work evenings or weekends, to accommodate a client's schedule. These workers should be in good physical condition, because they are on their feet for long periods of time and may be asked to help lift and move clients or equipment.

Employment

Occupational therapy assistants and aides held 19,000 jobs in 1998. About 4 out of 10 assistants and aides worked in offices of occupational therapists; and about 3 out of 10 worked in hospitals. The remainder worked primarily in nursing and personal care facilities, offices and clinics of physicians, social services agencies, outpatient rehabilitation centers, and home health agencies.

Training, Other Qualifications, and Advancement

Persons must complete an associate's degree or certificate program from an accredited community college or technical school to qualify for occupational therapy assistant jobs. In contrast, occupational therapy aides usually receive most of their training on the job.

There were 165 accredited occupational therapy assistant programs in the United States in 1999. The first year of study typically involves an introduction to healthcare, basic medical terminology, anatomy, and physiology. In the second year, courses are more rigorous and usually include occupational therapy courses in areas such as mental health, gerontology, and pediatrics. Students must also complete supervised fieldwork in a clinic or community setting. Applicants to occupational therapy assistant programs can improve their chances of admission by taking high school courses in biology and health and by performing volunteer work in nursing homes, occupational or physical therapist's offices, or elsewhere in the healthcare field.

Occupational therapy assistants are regulated in most States, and must pass a national certification examination after they graduate. Those who pass the test are awarded the title of certified occupational therapy assistant.

Occupational therapy aides usually receive most of their training on the job. Qualified applicants must have a high school diploma, strong interpersonal skills, and a desire to help people in need. Applicants may increase their chances of getting a job by volunteering their services, thus displaying initiative and aptitude to the employer.

Assistants and aides must be responsible, patient, and willing to take directions and work as part of a team. Furthermore, they should be caring and want to help people who are not able to help themselves.

Job Outlook

Employment of occupational therapy assistants and aides is expected to grow much faster than the average for all occupations through 2008. Growth will result from an aging population, including the baby-boom cohort, which will probably need substantial occupational therapy services. Demand will also result from advances in medicine that allow more people with critical problems to survive and then need rehabilitative therapy.

Employment growth would be even faster, except for Federal legislation imposing limits on reimbursement for therapy services. However, at the same time, third-party payers, concerned with rising health care costs are beginning to encourage occupational therapists to delegate more of the hands-on therapy work to occupational therapy assistants and aides. By having assistants and aides work more closely with clients under the guidance of a therapist, the cost of therapy should be more modest than otherwise.

Earnings

Median annual earnings of occupational therapy assistants and aides were $28,690 in 1998. The middle 50 percent earned between $20,050 and $36,900 a year. The lowest 10 percent earned less than $15,000 and the highest 10 percent earned more than $45,740 a year. Median annual earnings of occupational therapy assistants and aides in 1997 were $32,200 in offices of other health care practitioners and $27,000 in hospitals.

Related Occupations

Occupational therapy assistants and aides work under the direction of occupational therapists. Other occupations in the healthcare field that work under the supervision of professionals include dental assistants, medical assistants, optometric assistants, pharmacy assistants, and physical therapy assistants and aides.

Sources of Additional Information

Information on a career as an occupational therapy assistant and a list of accredited programs can be obtained by sending a self-addressed label and $5.00 to:

The American Occupational Therapy Association, 4720 Montgomery Ln., P.O. Box 31220, Bethesda, MD 20824-1220. Internet: http://www.aota.org

Physical Therapist Assistants and Aides

(O*NET 66017)

Significant Points

Employment is projected to increase over the 19982008 period, but due to the effects of Federal limits on reimbursement for therapy services, the majority of expected employment growth is expected to occur during the second half of the projection period. Most licensed physical therapist assistants have an associate's degree, but physical therapist aides usually learn skills on the job.

Two-thirds of jobs for physical therapist assistants and aides were in hospitals or offices of physical therapists.

Nature of the Work

Physical therapist assistants and aides perform components of physical therapy procedures and related tasks selected and delegated by a supervising physical therapist. These workers assist physical therapists in providing services that help improve mobility, relieve pain, and prevent or limit permanent physical disabilities of patients suffering from injuries or disease. Patients include accident victims and individuals with disabling conditions, such as low back pain, arthritis, heart disease, fractures, head injuries, and cerebral palsy.

Physical therapist assistants perform a variety of tasks. Treatment procedures delegated to these workers, under the direction of therapists, involve exercises, massages, electrical stimulation, paraffin baths, hot and cold packs, traction, and ultrasound. Physical therapist assistants record the patient's responses to treatment and report to the physical therapist the outcome of each treatment.

Physical therapist aides help make therapy sessions productive, under the direct supervision of a physical therapist or physical therapist assistant. They are usually responsible for keeping the treatment area clean and organized and preparing for each patient's therapy. When patients need assistance moving to or from a treatment area, aides push them in a wheelchair, or provide them with a shoulder to lean on. Because they are not licensed, aides perform a more limited range of tasks than physical therapist assistants do.

The duties of aides include some clerical tasks, such as ordering depleted supplies, answering the phone, and filling out insurance forms and other paperwork. The extent to which an aide or an assistant performs clerical tasks depends on the size and location of the facility.

Working Conditions

The hours and days that physical therapist assistants and aides work vary, depending on the facility and whether they are full or part-time employees. Many outpatient physical therapy offices and clinics have evening and weekend hours, to help coincide with patients' personal schedules.

Physical therapist assistants and aides need to have a moderate degree of strength, due to the physical exertion required in assisting

patients with their treatment. For example, in some cases, assistants and aides need to help lift patients. Additionally, constant kneeling, stooping, and standing for long periods are all part of the job.

Employment

Physical therapist assistants and aides held 82,000 jobs in 1998. They work alongside physical therapists in a variety of settings. Over twothirds of all assistants and aides work in hospitals or offices of physical therapists. Others work in nursing and personal care facilities, outpatient rehabilitation centers, offices and clinics of physicians, and home health agencies.

Training, Other Qualifications, and Advancement

Physical therapist aides are trained on the job, but physical therapist assistants typically have earned an associate's degree from an accredited physical therapist assistant program. As of January 1997, 44 States and Puerto Rico regulated assistants. Additional requirements include certification in CPR and other first aid and a minimum number of hours of clinical experience.

According to the American Physical Therapy Association, there were 274 accredited physical therapist assistant programs in the United States as of 1999. Accredited physical therapist assistant programs are designed to last 2 years, or four semesters, and culminate in an associate's degree. Admission into physical therapist assistant programs is competitive, and

A physical therapy aide prepares a pack for moist heat therapy.

it is not unusual for colleges to have long waiting lists of prospective candidates. Programs are divided into academic study and hands on clinical experience. Academic coursework includes algebra, anatomy and physiology, biology, chemistry, and psychology. Before students begin their clinical field experience, many programs require that they complete a semester of anatomy and physiology and have certifications in CPR and other first aid. Both educators and prospective employers view clinical experience as an integral part of ensuring that students understand the responsibilities of a physical therapist assistant.

Employers typically require physical therapist aides to have a high school diploma, strong interpersonal skills, and a desire to assist people in need. Most employers provide clinical on-the-job training.

Job Outlook

Employment of physical therapist assistants and aides is expected to grow much faster than the average through the year 2008. However, Federal legislation imposing limits on reimbursement for therapy services may continue to adversely affect the job market for physical therapist assistants and aides in the near term. Because of the effects of these provisions, the majority of expected employment growth for physical therapist assistants and aides is expected to occur in the second half of the projection period.

Over the long run, demand for physical therapist assistants and aides will continue to rise, with growth in the number of individuals with disabilities or limited function. The rapidly growing elderly population is particularly vulnerable to chronic and debilitating conditions that require therapeutic services. These patients often need additional assistance in their treatment, making the roles of assistants and aides vital. The large baby-boom generation is entering the prime age for heart attacks and strokes, further increasing the demand for cardiac and physical rehabilitation. Additionally, future medical developments should permit an increased percentage of trauma victims to survive, creating added demand for therapy services.

Licensed physical therapist assistants can enhance the cost-effective provision of physical therapy services. Once a patient is evaluated, and a treatment plan is designed by the physical therapist, the physical therapist assistant can provide many aspects of treatment, as prescribed by the therapist.

Barbers, Cosmetologists,

and Related Workers

(O*NET 68002, 68005A, 68005B, 68005C, and 68008)

Significant Points

Job opportunities for cosmetologists should be excellent, as employers report difficulties finding qualified workers to meet the growing demand for cosmetology services.

• All barbers and cosmetologists must be licensed. Very high proportions of these workers are self-employed or work flexible schedules.

Nature of the Work

Looking your best has never been easy. It requires the perfect hairstyle, exquisite nails, a neatly trimmed beard, or the proper make-up to accent your coloring. More and more, it also requires the services of barbers and cosmetologists. As people increasingly demand styles that are better suited to their individual characteristics, they must choose from a vast array of cosmetic products and rely on these professionals to help them make sense of the different options. Although tastes and fashions change from year to year, the basic task of barbers and cosmetologists has remained the same-helping people to look their best.

Barbers cut, trim, shampoo, and style hair. Many people still go to a barber for a haircut, but an increasing number seek more personalized hairstyling services, such as perms or coloring. In addition to these services, barbers may fit hairpieces, provide hair and scalp treatments, shave male customers, or give facial massages. Barbers in most States are licensed to perform all the duties of cosmetologists except skin care and nail treatment, but a growing number of barbers are trained to perform these services as well.

Cosmetologists primarily shampoo, cut, and style hair, but they also perform a number of other services. These workers, who are often called hairstylists, may advise patrons on how to care for their hair, straighten or permanent wave a customer's hair, or lighten or darken hair color. In addition, most cosmetologists are trained to give manicures, pedicures, and scalp and facial treatments; provide makeup analysis for women; and clean and style wigs and hairpieces. Cosmetologists are licensed to provide all the services of barbers except shaving

men.

A growing number of workers in cosmetology offer specialized services. The largest and fastest growing of these is manicurists, who work exclusively on nails and provide manicures, pedicures, and nail extensions to clients. Another group of specialists is estheticians, who cleanse and beautify the skin by giving facials, full-body treatments, head and neck massages, and offer hair-removal through waxing. Electrologists use an electrolysis machine to remove hair. Finally, shampooers specialize in shampooing and conditioning patrons' hair in some larger salons.

In addition to their work with customers, barbers and cosmetologists are expected to keep their work area clean and their hairdressing implements sanitized. They may make appointments and keep records of hair color and permanent wave formulas used by their regular patrons. A growing number also actively sell hair products and other cosmetic supplies. Barbers and cosmetologists who operate their own salons have managerial duties that include hiring, supervising, and firing workers, as well as keeping records and ordering supplies.

Working Conditions

Barbers and cosmetologists work in clean, pleasant surroundings with good lighting and ventilation. Good health and stamina are important because these workers are on their feet for most of their shift. Prolonged exposure to some hair and nail chemicals may be hazardous and cause irritation, so special care must be taken.

Most full-time barbers and cosmetologists work 40 hours a week, but longer hours are common in this occupation, especially among self-employed workers. Work schedules may include evenings and weekends, when beauty and barber shops and salons are busiest. Although weekends and lunch periods are usually very busy, barbers and cosmetologists are able to take breaks during less popular times. Nearly half of all cosmetologists work part time or have variable schedules, double the rate for barbers and for all other workers in the economy.