Several US healthcare roles — nursing assistant, orderly, home health or personal care aide, and medical assistant — can be entered without a college degree, with training provided by the employer or through a short state-approved program. What you need depends on the role and the state: nursing assistants often must finish a state-approved education program and pass a state competency exam, while orderlies typically need only a high school diploma or equivalent (U.S. Bureau of Labor Statistics, 2025).
Below: what the work looks like, which employers hire and train, how pay is structured, and what to check before accepting.
What the Job Actually Involves Day to Day
The work is hands-on, physical and scheduled around patients rather than around you.
- Nursing assistants and orderlies help with bathing, dressing, toileting, eating, repositioning and transferring patients, take and record vital signs, and report changes to nurses. Orderlies focus more on moving patients and equipment. Tools are everyday clinical ones: gait belts, mechanical lifts, wheelchairs, blood pressure cuffs, plus an electronic health record for charting.
- Home health and personal care aides work in a client's home, often alone. Training typically covers personal hygiene, reading and recording vital signs, infection control and basic nutrition (U.S. Bureau of Labor Statistics, 2025). Driving between clients is common.
- Medical assistants split the day between clinical tasks — rooming patients, vitals, specimen handling, assisting the provider — and admin such as scheduling, insurance forms and records.
Because nursing and residential care facilities and hospitals operate around the clock, you may need to work nights, weekends and holidays; most people in these roles work full time and some part time (U.S. Bureau of Labor Statistics, 2025). Clinic-based medical assistant work is closer to business hours.
None of it is remote, and it is demanding: nursing assistants and orderlies have one of the highest rates of injuries and illnesses of all occupations, largely from moving patients (U.S. Bureau of Labor Statistics, 2025). Ask any employer how lifting is done and whether lift equipment and training are provided. ONET places nursing assistants in Job Zone Three, "Medium Preparation Needed" (ONET OnLine, U.S. Department of Labor): see the O*NET summary.
Where Companies Actually Hire From the US
These employer categories post entry-level roles and most often provide or pay for training:
- Nursing care (skilled nursing) facilities — the largest employer of nursing assistants in 2025 at 36 percent, followed by hospitals at 32 percent (U.S. Bureau of Labor Statistics, 2025).
- Hospitals and health systems, hiring nursing assistants, patient care technicians, orderlies and transporters, sometimes through in-house training cohorts.
- Assisted living and residential care communities, which often hire personal care aides with on-the-job training.
- Home health and hospice agencies. Certified agencies paid by federally funded programs such as Medicare must comply with regulations covering aides' employment and formal training requirements (U.S. Bureau of Labor Statistics, 2025), so their training tends to be structured.
- Physician offices, outpatient clinics and urgent care, the main hirers of medical assistants.
- Healthcare staffing and per diem agencies, placing certified aides into short shifts across facilities.
- Community colleges, vocational and technical schools — not employers, but the usual route in, and often the source of clinical placements.
Demand differs by role: employment of home health and personal care aides is projected to grow 18 percent from 2025 to 2035 and medical assistants 13 percent, while nursing assistants and orderlies are projected to grow 3 percent (U.S. Bureau of Labor Statistics, 2025).
How Pay Is Usually Structured
Pay is hourly in nearly all cases, with additions on top. Rates vary by state, setting and certification status, so check current figures before you negotiate.
| Pay model | What determines the rate | Where to check current numbers |
|---|
| Base hourly wage | Role, state and metro area, employer type, certification status | BLS Occupational Outlook Handbook: nursing assistants and orderlies, home health and personal care aides, medical assistants |
| Shift differential | Nights, weekends, holidays; higher-acuity units | The employer's written pay policy, requested before you accept |
| Overtime and extra-shift bonuses | Hours beyond the standard week; staffing gaps | Your state labor department's wage and hour pages |
| Per-visit rate (home care) | Visit length, task list, travel between clients | The agency's rate sheet and mileage or travel-time policy |
| Per diem / agency shift rate | Short-notice shifts, credentials held, location | The staffing agency's posted shift board |
| Training-period pay | Whether on-the-job training is paid, and at what rate | The written offer; ask before your first day |
Also ask what is not in the rate: scrubs, parking, background checks, certification renewal fees and mileage.
Frequently asked questions
Do I need a degree to start?
Usually not. Home health and personal care aides typically need a high school diploma or equivalent, and some positions do not require a formal educational credential at all (U.S. Bureau of Labor Statistics, 2025). Medical assistants more often hold a postsecondary certificate or associate's degree, though some learn through on-the-job training or an apprenticeship (U.S. Bureau of Labor Statistics, 2025).
What does "training provided" usually mean?
Two different things. Nursing assistants typically complete a brief period of on-the-job training on their employer's policies and procedures in addition to a state-approved program (U.S. Bureau of Labor Statistics, 2025), while aide training may be completed on the job or through a program (U.S. Bureau of Labor Statistics, 2025). Ask whether the employer's training satisfies your state's requirement or only supplements it.
What equipment or documents do I need?
Scrubs and non-slip shoes, a phone for scheduling apps, a reliable way to reach shifts, and a car for home care. Expect to produce identity documents, immunisation and TB screening records, a background check, and a CPR or BLS card where the employer requires one (U.S. Bureau of Labor Statistics, 2025).
Can any of this be done remotely?
No. Patient care happens in person in facilities, clinics or clients' homes. Some classroom portions of training may be online, but skills testing, the practicum and the job itself are on-site.
What about taxes, work authorisation and licensing?
This guide cannot give legal or immigration advice. Check the IRS and your state tax agency for tax questions, your state health department or nurse aide registry for licensing rules, and a qualified attorney or accredited representative for work authorisation.
Is certification worth it if my state doesn't require it?
Often yes for hiring. Although most states do not require medical assistants to be certified, employers may prefer or require it, and certification information is available from CareerOneStop (U.S. Bureau of Labor Statistics, 2025). For nursing home work, being on the state registry after passing the competency exam is not optional (U.S. Bureau of Labor Statistics, 2025).
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