How to Become a CNA: Training, the State Exam and Getting Hired

Becoming a certified nursing assistant is the quickest way into hands-on patient care in the United States. You can go from deciding to do it to getting a paycheck in a couple of months, and in some states in a few weeks. You don't need a college degree. In many cases you won't even pay for the training yourself.

But a fast route is not the same as an easy job. CNAs do some of the most physical and personal work in healthcare, and the good ones are worth their weight in gold to every nurse on the unit. This guide covers what CNAs really do, how to choose a training program, what's on the certification exam, and how to land a job you'll actually want to keep.

What does a CNA do?

Certified nursing assistants provide basic care under the supervision of a licensed nurse. On a typical shift you might:

• Help residents or patients bathe, dress, groom and use the bathroom
• Assist with meals and record how much someone ate and drank
• Reposition people who can't move on their own, to prevent pressure injuries
• Help with walking and transfers between bed, chair and wheelchair, often with a gait belt or mechanical lift
• Take vital signs and weights and report anything unusual
• Make beds, keep rooms safe and answer call lights
• Notice changes, like confusion, a new bruise or someone who stopped eating, and tell the nurse right away

That last point is the part people underestimate. CNAs spend more time with patients than anyone else on the care team. A CNA who says "Mrs. Lopez isn't herself today" is often the first warning sign of an infection, a fall risk or a stroke. You're the team's eyes and ears.

Where CNAs work

Nursing homes and skilled nursing facilities employ the largest share of CNAs. You'll also find CNA jobs in hospitals (sometimes titled patient care technician or nurse aide), assisted living, memory care, rehab centers, hospice, home health agencies and adult day programs. Each setting feels different. A long-term care hall has the same residents every day, while a hospital floor turns over patients constantly.

Requirements to become a CNA

Federal law sets minimum standards for nurse aides who work in Medicare- and Medicaid-certified nursing homes, and each state builds its own rules on top. In general you'll need to:

1. Be at least 16 to 18 years old, depending on the state and program
2. Have a high school diploma or GED for many programs, though not all require it
3. Pass a criminal background check and, often, a drug screen
4. Show proof of immunizations and a negative TB test
5. Complete a state-approved training program
6. Pass your state's competency exam
7. Be listed on your state's nurse aide registry

Certain criminal convictions can disqualify you from working as a nurse aide, particularly those involving abuse, neglect or theft. If you have a record, contact your state's nurse aide registry before paying for training. Some states have waiver or review processes.

CNA training: how long it takes and what you'll learn

Federal rules require at least 75 hours of training, including at least 16 hours of supervised hands-on clinical practice. Many states require more. California, for example, requires 160 hours. Depending on your state and the program's schedule, training usually takes anywhere from four to twelve weeks. Full-time day programs finish fastest. Evening and weekend programs take longer but let you keep your current job.

Training is a mix of classroom work, skills lab practice and clinical hours in a real facility. Expect to cover:

• Infection control and hand hygiene
• Residents' rights, privacy and dignity
• Safe body mechanics, transfers and positioning
• Measuring vital signs, height, weight and intake and output
• Personal care skills: bathing, oral care, dressing, toileting and catheter care
• Caring for people with dementia and communication challenges
• Emergency procedures, fall prevention and when to call the nurse
• Basic anatomy and common conditions in older adults

Where to take CNA classes, and how to get them for free

CNA programs are offered by community colleges, technical schools, the American Red Cross in some areas, private training schools, high school career programs and nursing homes themselves.

Free and paid-for CNA training

Many people don't realize this. Nursing homes that take Medicare or Medicaid generally can't charge nurse aides they employ for required training. And if you take a program on your own and are hired by such a facility within a year, you may be entitled to reimbursement for at least part of your cost. Because of this, many long-term care facilities run their own free CNA classes or pay you while you train, in exchange for agreeing to work there for a period afterward.

Other ways to cut costs:

• State workforce programs and American Job Centers often fund CNA training through WIOA grants
• Hospitals sometimes sponsor training for patient care tech roles
• Community colleges may offer financial aid or payment plans

If you pay out of pocket, total costs commonly range from a few hundred to a couple of thousand dollars once you add tuition, textbook, scrubs, background check and exam fees.

The CNA certification exam

Most states use a two-part competency exam, run by a testing company such as Credentia (which delivers the widely used NNAAP exam), Prometric or Headmaster, depending on the state.

Part 1: Written or oral knowledge test

A multiple-choice test covering the topics from your training. You can usually request an oral version if reading in English is a barrier. Most candidates find this part manageable if they studied their textbook and took practice tests.

Part 2: Skills evaluation

This is the part that makes people nervous. An evaluator watches you perform several randomly chosen skills, often three to five, on a manikin or a volunteer acting as the patient. Common skills include handwashing, measuring a radial pulse or blood pressure, transferring from bed to wheelchair, giving a partial bed bath, catheter care, range of motion exercises and measuring urinary output.

Each skill has "critical steps," and missing one can fail you on that skill even if everything else was perfect. The critical steps are usually things like handwashing, locking the bed or wheelchair brakes, or giving privacy.

How to pass the skills test

• Get your state's official candidate handbook. It lists every skill and every step the evaluator checks.
• Practice each skill out loud, saying each step as you do it. Narrating helps you remember and shows the evaluator what you're doing.
• Build habits you'll do automatically: knock, introduce yourself, explain the procedure, provide privacy, lock brakes, and wash or sanitize your hands at the start and end.
• Practice on family members at home. Measuring a real blood pressure ten times is worth more than reading about it.

If you fail one part, most states let you retake just that part, usually up to three attempts within a set period after training. After that, you may need to retrain.

Getting on the registry and keeping your certification

After you pass, your name is added to your state's nurse aide registry. Employers check it before hiring you. To stay active, you generally need to work for pay as a nurse aide. Federal rules say that if you go 24 consecutive months without paid nursing-related work, you must retrain or retest. Many states also require in-service training hours each year, which employers typically provide.

Moving to another state? Most states let you transfer by reciprocity if your certification is active and in good standing. You'll apply to the new state's registry, and you may need a new background check.

Landing your first CNA job

Demand for CNAs is high in most of the country, so the question is less "will I get hired" and more "will I get hired somewhere good." A few tips:

• Ask about ratios. How many residents does a CNA usually have on day, evening and night shift? It shapes your whole day.
• Ask about orientation. A good facility gives new CNAs several shifts with an experienced aide before they work alone.
• Watch the staff during your interview or tour. Do people seem rushed but supported, or burned out and short-tempered? Are call lights going unanswered?
• Keep your resume simple and specific. List your certification number, training program, clinical site and any extra skills such as Hoyer lift experience, dementia care, CPR or bilingual communication. Our nursing resume guide has examples.

You can browse open CNA jobs on TheNurs.com by state and city, and creating a free profile lets employers contact you directly.

What CNAs earn

The BLS reported a median annual wage for nursing assistants of roughly $39,500 in May 2024, or about $19 an hour. Pay is higher in states like Alaska, California, New York, Massachusetts, Washington and Oregon, and lower across much of the South. Night and weekend differentials, overtime and per diem work can raise what you take home. Our nurse salary guide covers pay in detail.

Where to go from here

Plenty of people find their calling as a CNA and stay in the role for decades. It's meaningful work, and great CNAs are always in demand. Many others use it as the first rung on the nursing ladder. A year or two as a CNA makes nursing school easier, because the clinical environment already feels familiar. Many employers offer tuition help for CNAs who go on to become LPNs or RNs.

If that's your plan, read our guides on becoming an LPN and becoming a registered nurse. Or compare all three roles side by side in RN vs LPN vs CNA.