Job Placement · Healthcare · Medical Assistant and CNA
A certified nursing assistant is governed by a federal training floor, a competency evaluation and a state registry check before the first shift. A medical assistant is not. BEG recruits both as permanent hires on Tier I milestone billing at $4,680 to $5,616, and tells you which one you actually need.
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TL;DR
These two titles get bundled together and they should not be. A nurse aide in a long term care facility sits inside a federal scheme: a training programme of at least 75 clock hours with 16 hours of supervised practical training, a competency evaluation, registry verification before the first shift and a hard four month limit on working uncertified. A medical assistant in a clinic sits outside all of that. Both share the highest turnover in healthcare, with CNA turnover at 32.5% a year. BEG places permanent hires at $4,680 to $5,616 on milestones, and will tell you when retention rather than recruitment is the real problem.
One Tier, Two Compliance Pictures
Because one of them cannot legally start until a registry has been checked and a competency evaluation has been completed, and the other has no federal training mandate at all.
The Checks That Gate A Start Date
Completion of an approved training and competency evaluation programme, registry verification across the relevant states, and a check on how long it has been since they last worked for pay.
| Check | What the rule requires | Who it catches out |
|---|---|---|
| Training and competency evaluation | A state-approved programme meeting the federal minimum of 75 clock hours, including 16 hours supervised practical training. | Candidates trained in a programme that another state approved but yours does not recognise on the same terms. |
| Registry verification | Verification that competency requirements were met, before the individual serves as a nurse aide, plus enquiries to every state registry likely to hold a record. | Facilities that treat registry checking as a first-week onboarding task. The rule places it before the individual is allowed to serve. |
| The four month limit | No individual may be used as a nurse aide for more than four months full time without meeting the competency requirements. | Buildings that hire a promising untrained candidate intending to train them later, then lose track of the four month clock. |
| The 24 month lapse rule | A continuous 24 month period with no paid nursing or nursing-related services since training requires a new training and competency evaluation programme. | Returners. The single most common surprise with an otherwise ideal candidate who stepped out of the workforce for two years. |
None of this applies in the same way to a medical assistant in an outpatient clinic, which is exactly why the two roles need separate adverts and separate shortlists even though they sit in the same pricing tier. Compliance stays with your organisation. BEG's part is asking the questions early enough that a start date holds. Full scope on the healthcare placement service page, and see LPN and LVN recruiting for the licensed tier above this one.
A Small Fee, And An Honest Word About It
At the $45,690 BLS median for medical assistants, a contingency fee of 20% to 25% is $9,138 to $11,423. At the $42,260 median for nursing assistants it is $8,452 to $10,565. BEG's Tier I milestone fee is $4,680 to $5,616, roughly half either way. The honest caveat: at this tier the fee is a small number next to the cost of the churn underneath it, so the question worth asking is not who recruits most cheaply but why the seat keeps emptying.
What The Turnover Actually Costs
At a 32.5% annual turnover rate, a department with twenty aides is replacing six or seven people a year, every year. The unworked time on one open line is roughly $850 a week at median, but that is the smallest part. The real cost is the orientation hours, the registry checks, the competency evaluations, the residents who meet a new face every month and the certified staff covering the gap on overtime. Filling one vacancy well is worth doing. Changing the rate is worth far more.
If You Are Currently Booking Agency Aides
All three appear at this level. The regulatory standard does not change between them, but the cost structure and who carries the employment relationship do.
| Model | Who employs the aide | How you pay | Right when |
|---|---|---|---|
| Per diem agency aides | The agency | Hourly bill rate, shift by shift | You are short tonight. Note that the competency and registry requirements still apply to agency staff exactly as they do to your own. |
| Temp to hire | The staffing firm, until conversion | Hourly rate, then a conversion fee on top if you keep the person | You want a trial period and accept paying a premium rate throughout it before paying again to convert. |
| BEG permanent placement | You | Tier I milestone fee of $4,680 to $5,616, fixed at the start | The line is permanent and you want the person on your payroll, your orientation and your registry file from day one. |
BEG does not employ aides, does not bill hourly and is not a staffing agency, so per diem cover is not something we sell. At this tier we will also say the unpopular thing: if the same line has been filled three times in two years, the next search will not be the one that sticks unless something about the job changes. See nurse manager recruiting, because the manager is usually where that change starts.
FAQ
No, and treating them as one job is the most common mistake here. A certified nursing assistant works under a federally specified training and competency regime and a state registry. A medical assistant typically works in an outpatient clinic, and BLS notes they usually need postsecondary education such as a certificate, with some entering on a high school diploma and on-the-job training.
A state-approved nurse aide training and competency evaluation programme must consist of no less than 75 clock hours of training and include at least 16 hours of supervised practical training, under 42 CFR 483.152. States may require more, and several do, but that is the federal floor.
In a long term care facility, yes. Under 42 CFR 483.35, the facility must receive registry verification that the individual has met competency evaluation requirements before allowing them to serve as a nurse aide, with narrow exceptions, and must seek information from every state registry it believes holds a record on that person.
The same regulation says a facility must not use any individual as a nurse aide for more than four months on a full-time basis unless that individual is competent and has completed a state-approved training and competency evaluation programme, or has been deemed or determined competent under the rules. It is a hard stop, not a guideline.
Yes. The regulation is explicit that a facility must not use on a temporary, per diem, leased or any basis other than a permanent employee any individual who does not meet those competency requirements. Outsourcing the employment relationship does not outsource the standard.
Check the gap carefully. Under 42 CFR 483.35, if there has been a continuous period of 24 consecutive months since the individual last completed training during which they provided no nursing or nursing-related services for pay, they must complete a new training and competency evaluation programme. That catches returners more often than employers expect.
This is a Tier I search at $4,680 to $5,616, billed against defined milestones. A 20% to 25% contingency fee against the $45,690 BLS median for medical assistants would be $9,138 to $11,423, and against the $42,260 median for nursing assistants would be $8,452 to $10,565.
No. Agencies employ the aide and bill you an hourly rate for shifts, which is how most providers bridge gaps at this level. BEG runs a permanent search and the person joins your payroll. At this pay grade we will be blunt with you: if your turnover is the problem, a search alone will not fix it, and we would rather say so.
It is the worst in the building. NSI reports certified nursing assistant turnover at 32.5% for 2025, and notes that CNAs and patient care technicians outpace all other job titles, turning over virtually their entire staff every three years. The one piece of good news is direction: CNA turnover fell 3.6 points year on year, the largest decrease of any position surveyed.
Expanding fast. BLS projects 13% employment growth for medical assistants from 2025 to 2035, much faster than average, with about 109,700 openings a year. That volume means every clinic in your market is recruiting from the same pool at the same time, usually with the same advert.
Usually both, in that order of urgency but the reverse order of importance. Filling the vacancy stops the immediate pressure. But at a 32.5% annual turnover rate, an organisation that hires without changing scheduling, onboarding or progression is simply buying the same vacancy again next year at the same price.
A 45-day replacement guarantee plus 50% off a repeat search for the same line. Given the turnover profile of these roles, read that term carefully in any recruiter agreement, ours included, and ask what happens on the second and third replacement rather than only the first.
Building the support layer? See LPN and LVN, registered nurse, charge nurse and clinical lead and nurse manager, or all healthcare placement.
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