CNA Nurse Education Requirements: A Comprehensive Guide

Certified Nursing Assistants (CNAs) are essential members of the healthcare team, providing hands-on care and support to patients in various settings. This article explores the education, certification, and career aspects of becoming a CNA.

What is a CNA?

A CNA, or Certified Nursing Assistant, works in a healthcare setting to provide basic care to patients. CNAs work on the front lines of healthcare by providing basic care and support to individuals who can’t manage their own needs. While it depends on the healthcare setting you choose, CNAs provide comfort and care to patients who have an illness, injury, or disability-or who just need extra help caring for themselves.

CNA vs. Other Healthcare Roles

When considering an entry-level role in healthcare, it’s easy to get confused about the types of responsibilities associated with different titles. Factors such as length of required education, average salary, and typical responsibilities may make one role more appealing than the others.

CNAs vs. LPNs/LVNs: CNAs work under LPNs and/or RNs to assist the nurses in providing care to a patient. Offering a higher level of care than CNAs, LPNs are the only ones in this group that can be called "nurses". They have more autonomy than CNAs, although they still work under the supervision of RNs and doctors. They help with tasks that go beyond basic care, including administering injections/first aid, assisting with minor surgeries, updating health records, and more.
CNAs vs. Medical Assistants (MAs): While CNAs work under the supervision of nurses, and LPNs under the direction of both doctors and nurses, MAs work solely under the supervision of a physician and mostly in outpatient settings, like private doctor's offices or outpatient care centers. They administer medications, take/record vital signs, give immunizations and breathing treatments and, in some cases, help with minor in-office procedures.

Education and Training Requirements

Becoming a CNA involves specific education and training requirements to ensure competency in providing patient care.

Minimum Requirements

Graduation from high school or a GED is the minimum requirement to enroll in a CNA education program. To become a CNA, you will normally need to complete a state-approved training course and pass the state certification exam that includes both a written section, and a hands-on competency skills section. You can check training eligibility requirements, such as minimum age or education, with the agency regulating this training in your state. Note that individual training programs may have additional requirements.

Read also: Becoming a Psychiatric Nurse

State-Approved CNA Program

CNAs are usually overseen by a state’s board of nursing or department of health. Find out the type of education and clinical education you’ll need to qualify for a CNA license in your state. It’s critical to ensure that your CNA program meets your state’s CNA educational requirements. Check with your state board of nursing or department of health to avoid selecting a program that doesn’t meet your state’s criteria.

Program Duration and Curriculum

The length of time it takes to become a nursing depends on the state you live in. CNA/NAT classes can last 4-12 weeks at minimum but some programs can be up to 6 months. Your complete program time includes both instructional hours and clinical practice. State guidelines determine the minimums for each category.

Federal rules require that all nurse aide certification training programs provide “no less than 75 clock hours of training,” including at least 16 hours of supervised practical training.

Where to Find CNA Programs

In most states there are many options for CNA training, including independent training schools and community colleges. Some facilities such as nursing homes, hospitals and home health agencies will offer training to staff or prospective employees. Be sure to do some research before you decide on the right CNA program for you.

CNA Program Accreditation

Before enrolling, prospective CNAs should be sure the program they're looking into is approved by their state’s nursing board and the National League for Nursing Accredited Commission (NLNAC).

The Commission on Collegiate Nursing Education (CCNE) evaluates and monitors nursing education programs at all levels. Department of Education provides oversight of the accreditation process and maintains a database of accredited schools; read more about CNA training.

Certification and Competency Exam

After completing a CNA education program, you’ll have to earn certification or licensure in your state to qualify to work as a CNA there.

State Certification Exam

Pass your state’s approved CNA competency exam. State-required CNA competency exams are administered by third-party providers. Passing the exam places your name on your state’s registry of CNAs, licensed nursing assistants, nurses’ aides, or other title that your state uses for this position.

Exam Structure

Upon completing CNA training, individuals will subsequently be required to pass a CNA certification examination. This exam consists of two parts - written and practical parts. The written exam will be in a group setting and typically consists of several multiple-choice-style questions. Test takers have 90 minutes to answer. The second portion, the clinical skills exam, is administered one at a time with a single test proctor/observer. Individuals will be tested on four selected clinical skills to demonstrate competency. They will have 30 minutes to complete this section of the exam.

Competency evaluations must be completed prior to being certified as a nurse aide. Aides must be allowed to choose between a written or oral examination. The examination must address every requirement specified in the requirements for curricula. There also must be a “skills demonstration” portion of the exam.

Read also: Becoming a Nurse Practitioner

National Nurse Aide Assessment Program (NNAAP)

Most states require that prospective CNAs pass a competency exam administered in test centers by third parties throughout your state. While every state can use its own CNA competency exam, 20 states instead choose to use the National Nurse Aid Assessment Program (NNAAP); an exam developed by the National Council of State Boards of Nursing (NCSBN). Each state determines their own passing score and time allowed.

Preparing for the CNA Exam

The purpose of the CNA exam is to prove that you’re qualified to work as a CNA. Create a study plan with designated days and times for test preparation leading up to your exam date. Don’t procrastinate. Gather a list of study resources that work best for you. Establish a study group. Take more than one CNA practice test. Talk to professional CNAs to find out what strategies they found useful when preparing for their exam. Look for “CNA skills” videos on YouTube, where you can find instructors demonstrating proper technique.

Maintaining CNA Certification

The requirements necessary to maintain your CNA certification vary by state. You may have to prove you worked a specific number of hours as a CNA in the two years preceding your renewal date. Some states also have continuing education requirements. To maintain certification, CNAs must complete “in-service” education. Nursing homes must provide this “in-service education” and “regular performance review[s]” to ensure nurse aides are competent to perform services.

Rules and standards for renewing expired CNA certifications will vary from state to state. In California, for example, if your certification is more than two years expired, or it is more than two years since you have worked as a Certified Nurse Assistant, you are required to have 24 hours of continuing education as well as sit for a Competency Evaluation. Check with your state’s governing board for the requirements on renewals.

CNA Job Responsibilities and Duties

CNAs assist patients with bathing, dressing and any other basic activities involved in daily life. Certified nursing assistants work under the supervision of licensed nursing professionals. They care for patients who are infirm, ill, injured, disabled, and otherwise unable to care for themselves. In many settings, CNAs are the health professionals patients encounter most often. A CNA performs various basic duties that are important for the patient's comfort and recovery. These tasks vary depending on the employment setting.

Many of the job duties performed by a CNA are categorized as activities of daily living, but they also include much more than that.

Core Responsibilities

The roles and duties of CNAs can include the following:

Turning or repositioning bedridden patients
Taking patients' temperature, blood pressure, and other vital signs
Answering patient calls
Documenting patients' health issues and reporting to nurses
Feeding patients, measuring and recording their food and liquid intake
Cleaning rooms and bed linens
Helping with medical procedures
Dressing wounds
Gathering supplies for the RN or MD
Bathing patients
Combing hair, shaving, caring for nails, and brushing teeth
Stocking supplies
Preparing rooms for admissions

Specific Tasks

Perform daily hygiene tasks: Tasks involved in daily hygiene can involve toileting, bathing, and dressing. Depending on a patient’s abilities, these duties can involve cleaning out bed pans or personal bathing.
Take vital signs: Taking and recording a patient’s temperature, blood pressure, and other vital signs help to monitor their well-being. A CNA typically records these measurements and reports them to the supervising nursing staff for interpretation.
Facilitate patient care: The daily intimate contact that CNAs have with patients means they can notice blood in urine, bruises, and other subtle changes that may require care. “They can also be very strong liaisons between the people they serve and family members and other staff,” Findley says. “Because they provide most of the hands-on care and support, CNAs are more likely to notice changes in an individual’s behavior or health. Those observation and reporting skills are vital to the overall health and well-being of those served.”
Feed, make beds, clean the room: Feeding can involve preparing meals, serving them, or assisting with feeding. The CNA is also typically responsible for changing sheets and maintaining a clean, safe environment in the patient’s living area.
Provide companionship: Spending so much one-on-one time with a patient allows a CNA to establish close relationships with the patients they serve. “The relationships that CNAs develop are really important,” Findley says.

Work Environments for CNAs

There are a wide variety of environments in which CNAs can find themselves working. Bureau of Labor Statistics shows that many nursing assistants work in places like hospitals, nursing care facilities and/or assisted living facilities for geriatric patients. They can also be employed in private doctors’ offices, urgent care centers, and community clinics. CNAs can also work as home health aides or in hospice, helping care for patients in the comfort of their homes.

Roles and responsibilities can also vary by work environment. CNAs working in a hospital or other type of facility may have to handle multiple patients who need help simultaneously. The specific tasks you perform during your workday will depend to a great extent on your workplace. No matter where you work, it’s important to consider details like your personal preferences as well as your employer’s reputation. Researching workplace environment, staffing ratios, and employee satisfaction can help you find a workplace in which you’ll thrive. “CNAs have choices,” Findley says. “They’re in big demand, so they can be a little more selective.

CNA Salary and Job Outlook

The salary you earn as a CNA depends on a wide range of variables. Factors such as your geographic location, years of experience, employer, area of specialization, and the demand for qualified CNAs can affect the amount of money you earn. A high cost of living, a large senior population, and a shortage of qualified CNA candidates can often boost salaries in a city or region. Where you work can also determine how much you earn. While you’ll find industry averages for specific types of workplaces, you may also find that pay varies among employers in the same industry.

Salary Information

According to the BLS, the median average annual salary for certified nursing assistants in 2022 was $35,740. The median annual wage for nursing assistants was $39,530 in May 2024. The median annual wage for orderlies was $37,700 in May 2024. The median wage is the wage at which half the workers in an occupation earned more than that amount and half earned less.

Job Outlook

With a growing senior population and medical advances that help more people live longer, the demand continues to soar for qualified healthcare professionals who can provide the daily care and support these individuals require. Bureau of Labor Statistics, the outlook is bright for CNAs. Overall employment is expected to grow four percent between now and 2032. That means there will be 210,000 openings each year over the next decade.

The growing job market is likely to reflect the societal preference for in-home versus institutional long-term care. Geographic areas with higher numbers of senior citizens are likely to experience higher demand and, consequently, more opportunities for CNAs seeking a range of opportunities and competitive salaries.

Most of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire. Demand for nursing assistants may be constrained by financial pressures on nursing homes, which might lead some facilities to close or reduce staff.

Career Advancement Opportunities

Consider additional education. You may find that earning your CNA certification ignites your interest in other roles. Many CNAs use the position as a stepping stone to jobs in nursing such as licensed practical nurse (LPN). Nursing home CNAs have fulfilling careers with opportunities for growth and skill development.

These are some, but not all of the positions you could advance to if you work as an CNA in a nursing home.

Restorative Aide or Medication Aide

Training: Requires specialized certification and an exam which takes a few months.

Training/Education Cost: $300 - $1,500

Duties: Restorative aides work with physical therapists to help patients regain mobility.

Advancement to Nursing

Many nursing students find value in working as a Certified Nurse Assistant (CNA) during nursing school to add to their basic care and time-management skills. Most employers will allow nursing students to bypass the requirement of being certified, but check the job announcements for these allowances. Many states will allow those with nursing education and background to sit for the examination without taking an official CNA course. Check with your local state certifying board for details.

Enrollment in an accredited BSN program and completion of foundational nursing skills coursework may qualify the student for certification as a CNA. Depending on the state-specific Board of Nursing regulations, BSN students may apply for CNA certification and listing on the state Nurse Aide Registry. Some states require that students sit for a CNA registry exam regardless of enrollment in an accredited nursing program, while other states accept completion of nursing courses as verification of skills testing.

Why Become a CNA?

CNAs enter the field for a variety of reasons. Working as a CNA is a great way to gain hands-on healthcare experience without the requirement of a college degree. For prospective nurses and other healthcare professionals, it’s an opportunity to test the waters before making a bigger commitment. For others, it’s the security of an in-demand position that offers the potential for flexible scheduling. “It’s a great opportunity to find out if they’ve got what it takes to work in this field,” says Di Findley, executive director of Iowa CareGivers.

So, why does anyone choose to become a CNA? “The rewards of working as a CNA can include personal connections and relationships with the people served and feeling good about making a difference in the lives of those people,” Findley says.

Essential Qualities for CNAs

The following are examples of qualities that are important for these workers to perform their duties.

Communication skills. Nursing assistants and orderlies must listen and respond to patients’ concerns.
Compassion. Nursing assistants and orderlies help and care for people who are sick, injured, or need aid for other reasons.
Patience. The routine tasks of cleaning, feeding, and bathing patients may be stressful.
Physical stamina. Nursing assistants and orderlies spend much of their time on their feet.

Additional Training

Cardiopulmonary Resuscitation (CPR) and Basic Life Support (BLS) training gives you the skills you need to respond to emergencies in a healthcare setting, and it also looks good on a resume! For more than a century, the Red Cross has prepared people to respond to emergencies of all sizes, from the everyday to the large disaster. Join the millions we train every year and learn the skills that can save a life. Note that the American Red Cross has decided to discontinue its Nurse Assistant Training (NAT) program. No Red Cross NAT course will be scheduled after December 31, 2023.

Finding a Job

Certified CNAs are in demand. Consider your career goals, professional preferences, and lifestyle when determining where to start your job search. You’ll likely be able to choose between full-time and part-time options in both clinical and non-clinical settings.

Financial Assistance for CNA Training

Nursing homes cover the cost of your Certified Nursing Assistant (CNA) certification training while you're working for them. You may also get reimbursed for your training costs if you get trained somewhere else, but are hired within 12 months after your certification.

Federal CNA Requirements

Minimum CNA training requirements are set by the federal government with implementation largely left to the states. In some states, the requirements go beyond the federal minimum while in other states requirements are nearly identical to the federal standards. Underlying the federal requirements is the expectation that CNAs (and all staff who provide services to residents) will have the skills and knowledge necessary to meet the care and quality of life needs of residents as identified in their individualized assessment and care plans.

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