{ "source": "Cooked Index — occupational AI risk register", "page": "https://cookedindex.com/jobs/nursing-assistants/", "methodology": "https://cookedindex.com/methodology", "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.", "scored_at": "2026-08-11", "model": "claude-opus-5", "occupation": { "title": "Nursing Assistants", "soc_code": "31-1131", "category": "Healthcare Support", "us_employment": 1448910, "median_annual_wage": 42260 }, "verdict": "SAFE", "risk_resistance": 68, "contested": false, "near_boundary": false, "dimensions": { "task_resistance": 16, "embodiment": 20, "liability_shield": 9, "trust_premium": 15, "judgment_accountability": 8 }, "reasoning": { "task_resistance": "The automatable slice — vitals entry into the EHR, I&O totals, ADL flowsheets — is maybe 30-45 minutes of a 12-hour shift, while incontinence care, bed baths, two-person transfers, and hand-feeding a dysphagia resident spoonful by spoonful cannot be decomposed into steps a machine executes, which is why this sits at 16 rather than in the mixed band.", "embodiment": "You work inside another person's body space in rooms you don't control: kneeling on a bathroom floor to clean a resident who has soiled themselves, catching someone whose knees buckle mid-transfer, turning a 250-pound contracted patient every two hours, absorbing scratches and bites from residents with dementia — there is no version of this performed at a screen, so 20 is the only score available.", "liability_shield": "CNA certification is a real state credential with a registry, 75+ federally mandated training hours under OBRA '87, and a competency exam, and you can be listed for abuse or neglect — but you practice under delegated nursing authority, the RN owns the care plan and the assessment, and no malpractice claim names you as the responsible clinician, which caps this at 9 instead of the 14+ a licensed nurse gets.", "trust_premium": "Residents in long-term care see the same aide for months and will let only that person touch them during peri-care, and you are the one who notices the new bruise, the refused breakfast, or the change in mood that never made it into a chart — the score stops at 15 rather than 18 because facility staffing churn, agency shifts, and floating assignments mean the institution, not you, keeps the relationship on paper.", "judgment_accountability": "Most of your shift runs on the assignment sheet and care plan — turn schedules, mechanical-lift-only orders, thickened liquids, fall precautions — and the consequential decisions get escalated to the charge nurse; the 8 reflects the discretion that genuinely is yours: deciding this transfer needs a second person today, judging that a resident's confusion is new enough to report now, calling it before a skin breakdown becomes a stage two." }, "rationale": "Nearly all of the job is physical contact work in unpredictable bodies and rooms: bathing, toileting, repositioning, transferring with a gait belt or Hoyer lift, feeding residents who choke, changing linens, walking someone who may fall. No robot does this at price, and the paperwork slice AI could take — charting vitals, intake/output logs, shift notes — is a small fraction of the hours. The real threat to this occupation is wage suppression and understaffing, not replacement.", "outlook": "Demand grows hard with the aging population and this work stays human for the next decade; the fight is over wages, staffing ratios, and injury rates, not over whether the job exists.", "what_would_raise_it": { "levers": [ { "dimension": "liability_shield", "change": "Enforcement of the CMS 2024 minimum staffing final rule (2.45 nurse-aide hours per resident day, 24/7 RN) plus state ratio laws in the mold of California's AB 394 extended to certified aides, so a facility's Medicare certification and survey standing depend on a counted number of credentialed human aide hours that no software substitution can satisfy", "plausibility": "already happening", "would_add": 4 }, { "dimension": "liability_shield", "change": "State nurse aide registry rules that make the individual CNA's credential the recordable unit for abuse/neglect findings and for countersigning AI-generated vitals and I&O entries in the EHR — i.e. the aide, not the sensor, owns the chart entry", "plausibility": "plausible", "would_add": 2 }, { "dimension": "judgment_accountability", "change": "Formal recognition of aide-initiated escalation in survey and payment protocols — INTERACT 'Stop and Watch' or sepsis change-of-condition tools written into facility policy so a documented aide report triggers mandatory nurse assessment, making the aide the accountable first detector rather than an informal reporter", "plausibility": "plausible", "would_add": 3 }, { "dimension": "judgment_accountability", "change": "Fall-risk and transfer decisions (one-person vs two-person, mechanical lift vs gait belt) delegated in writing to the aide at point of care under safe-patient-handling laws, with the aide's assessment being the operative call when a sensor or care plan disagrees", "plausibility": "plausible", "would_add": 2 }, { "dimension": "trust_premium", "change": "Growth of private-pay and consumer-directed home care (Medicaid self-direction, VA Veteran-Directed Care) where the family selects and retains a named aide and explicitly refuses monitoring-and-check-in substitution; union contracts such as SEIU 775's training-and-wage boards that market a credentialed named caregiver", "plausibility": "already happening", "would_add": 2 }, { "dimension": "task_resistance", "change": "Ambient charting and sensor-based vitals absorbing the documentation slice, leaving a residual day that is almost entirely contact work and judgment under ambiguity — a genuine two-tier shift, though the routine tier is only a small share of hours here so the headroom is small", "plausibility": "already happening", "would_add": 2 } ], "ceiling_note": "Embodiment is already maxed and task_resistance is near ceiling, so realistic upside is a handful of points from staffing-mandate and escalation-role changes. Note that none of these address the actual live risk: understaffing and wage suppression can hollow out the job's conditions while every displacement score stays high." }, "adjudication": null, "employment_history": { "points": [ { "y": 2019, "emp": 1419920, "wage": 29660 }, { "y": 2020, "emp": 1371050, "wage": 30850 }, { "y": 2021, "emp": 1314830, "wage": 30310 }, { "y": 2022, "emp": 1310090, "wage": 35760 }, { "y": 2023, "emp": 1351760, "wage": 38200 }, { "y": 2024, "emp": 1388430, "wage": 39530 }, { "y": 2025, "emp": 1448910, "wage": 42260 } ], "from": 2019, "to": 2025, "change_pct": 2, "comparable_from": 2019, "spans_soc_revision": false }, "pivots": [], "license": "https://cookedindex.com/terms" }