What does a CNA do?
Certified nursing assistants (CNAs) provide basic care and help patients with activities of daily living. BLS lists duties such as bathing patients, helping them use the toilet and dress, turning and transferring them, measuring vital signs, helping them eat, and reporting health concerns to nurses. CNAs work in settings such as nursing homes, hospitals, assisted living communities and home health care.
The title depends on the state. BLS notes that some states use “certified nursing assistant” while others use different titles for the same role, and nursing assistants must be on their state’s registry to work in a nursing home.
How to become a CNA in 6 steps
- Check your state’s rules. Your state sets the minimum hours, exam vendor and registry process. BLS notes that some states also require a criminal background check or continuing education.
- Choose a state-approved training program. BLS says programs are offered in high schools, community colleges, vocational and technical schools, hospitals and nursing homes. Ask nursing homes near you whether they sponsor training for new hires.
- Complete classroom and clinical training. Expect lessons on nursing principles plus supervised clinical work. Federal rules require at least 16 hours on core safety and communication topics before you have any direct contact with a resident.
- Pass the competency evaluation. You must pass both a written or oral exam and a skills demonstration.
- Get listed on your state’s nurse aide registry. After you pass, federal rules require the state to add you to the registry within 30 days.
- Get hired and stay active. Nursing homes must check the registry before you start, provide at least 12 hours of in-service training a year, and review your performance at least once every 12 months.
What are the federal CNA training requirements?
Federal rules in 42 CFR Part 483 set the floor for nurse aides who work in nursing homes that take part in Medicare or Medicaid. States approve programs and can require more.
| Requirement | Federal minimum |
|---|---|
| Total training | At least 75 clock hours |
| Supervised practical training | At least 16 hours, performing tasks on a person under the direct supervision of a registered nurse or licensed practical nurse |
| Before any resident contact | At least 16 hours covering communication and interpersonal skills, infection control, safety and emergency procedures (including the Heimlich maneuver), promoting residents’ independence and respecting residents’ rights |
| Instructor | Training is done by or under the general supervision of a registered nurse with at least 2 years of nursing experience, at least 1 of them in long-term care |
| Competency evaluation | A written or oral exam plus a skills demonstration, with at least three chances to pass |
| Registry | The state must list you within 30 days after you pass |
| Training cost | Free if a nursing home employs you or has offered you a job on the day training begins |
| Ongoing training | At least 12 hours of in-service education per year |
What will you learn in CNA training?
Federal rules list the subjects every approved program must cover, in addition to the 16 hours of safety and communication topics you learn before meeting residents:
- Basic nursing skills: taking and recording vital signs, measuring height and weight, caring for the resident’s environment, recognizing and reporting abnormal changes in body functioning, and caring for residents when death is near.
- Personal care skills: bathing, grooming and mouth care, dressing, toileting, help with eating and drinking, skin care, and transfers, positioning and turning.
- Mental health and social needs: responding to resident behavior, understanding the aging process, supporting personal choices and dignity, and involving family for emotional support.
- Care of residents with dementia: communicating with cognitively impaired residents, understanding their behavior and reducing the effects of cognitive impairment.
- Basic restorative services: self-care training, assistive devices, range of motion, turning and positioning, bowel and bladder training, and prosthetic and orthotic devices.
- Residents’ rights: privacy and confidentiality, personal choices, help with grievances, protecting personal possessions, freedom from abuse and neglect, and avoiding restraints.
The skills demonstration on the competency exam asks you to perform nurse aide tasks in front of an evaluator, so treat every lab and clinical session as test preparation.
CNA training hours by state
Many states go well beyond 75 hours. These examples come from each state’s statute or regulation.
| State | Minimum training | How the hours break down | Worth knowing |
|---|---|---|---|
| Federal floor | 75 hours | At least 16 hours of supervised practical training | Applies to aides in nursing homes in Medicare or Medicaid |
| California | 160 hours | 60 classroom hours plus 100 hours of supervised clinical practice | Set by state law, more than twice the federal floor |
| Illinois | 120 hours | 62 hours of theory, 18 hours of skills lab and 40 clinical hours | Breaks, meals and orientation do not count toward the 120 hours |
| Texas | 100 hours | 60 classroom hours plus 40 clinical hours | Classroom hours can be taught online or through the state’s computer-based training |
| Florida | An approved training program, or the exam alone if you qualify | Exam has a written portion and a skills demonstration | You can test without training if you have a high school diploma or equivalent or are at least 18 |
Texas also requires at least 16 introductory classroom hours before trainees have direct contact with residents, matching the federal rule. Florida requires certified nursing assistants to complete 24 hours of in-service training every two years.
What is on the CNA competency exam?
The federal competency evaluation has two parts, and you must pass both:
- A written or oral exam that checks what you learned in the classroom.
- A skills demonstration where you perform nursing assistant tasks in front of an evaluator.
Your state names the testing vendor and publishes a candidate handbook with the skills list. Some states use the National Nurse Aide Assessment Program (NNAAP). NCSBN no longer develops its content and refers content and scheduling questions to the vendor Credentia.
Federal rules give you at least three chances to pass. Some states add limits. In Florida, an applicant who fails three times is not eligible to retest without completing an approved training program.
Study tips:
- Practice every skill on the handbook list until you can do it from memory, including handwashing and infection control steps.
- Say each step out loud during practice, then do it silently.
- Take timed practice tests for the written portion so the format feels familiar.
Before your interview for a first CNA job, try our CNA interview quiz to practice common questions about patient care and teamwork.
How long does it take to become a CNA?
| Stage | Time required | Rule |
|---|---|---|
| Training program | 75 hours federal minimum; 100 hours in Texas, 120 in Illinois, 160 in California | Program schedules vary, so ask about day, evening and weekend options |
| Competency exam | After training, or right away in Florida if you qualify | At least three attempts allowed |
| Registry listing | Within 30 days after you pass | Required before a nursing home lets you work as a nurse aide, with limited exceptions |
| Working while in training | Up to 4 months full time | A nursing home cannot use you as a nurse aide for more than 4 months full time unless you complete training and show competency |
How much does CNA training cost?
Costs depend on the program. Federal rules can make it free:
- Employer-sponsored training. If a nursing home employs you, or has offered you a job, on the day your training starts, it cannot charge you for any part of the program, including textbooks and required materials.
- Reimbursement after you pay. If you pay for training and then a nursing home hires you or offers you a job within 12 months after you finish, the state must reimburse your costs on a prorated basis for the time you work as a nurse aide.
Ask schools and nursing homes about total cost, including tuition, books, uniforms, background checks and exam fees, before you enroll.
How much do CNAs make?
BLS reported a median annual wage of $42,260 for nursing assistants in May 2025. The lowest 10% earned less than $33,940, and the highest 10% earned more than $51,980.
| Industry | Median annual wage (May 2025) |
|---|---|
| Government | $47,050 |
| Nursing care facilities (skilled nursing facilities) | $43,000 |
| Hospitals (state, local and private) | $42,310 |
| Continuing care retirement communities and assisted living facilities | $39,490 |
| Home healthcare services | $38,040 |
Nursing assistants held about 1.5 million jobs in 2025. BLS projects 3% growth for nursing assistants and orderlies from 2025 to 2035, about as fast as average, with about 203,300 openings a year, many of them to replace workers who change occupations or retire.
What can a CNA do next?
A CNA job can lead to other healthcare roles. Options to grow include:
- Medication aide. BLS notes that some states offer a Certified Medication Assistant credential, which allows you to dispense medication.
- Licensed practical nurse. LPN programs typically take about 1 year, followed by a licensing exam, and BLS reported median pay of $64,400 for LPNs in May 2025. Our guide to trade school jobs compares LPN and other short healthcare programs.
- Pharmacy work. If you like health care but want less hands-on patient care, read how to become a pharmacy technician.
Is being a CNA right for you?
CNA work may suit you if you like helping people directly and can stay calm on a busy shift. Our guide to the Social personality type lists nursing assistants among careers for people who like hands-on care. If you are still deciding, the free Holland Code career test matches your interests to career types.
When you are ready to apply, list your training hours, clinical site and registry status near the top of your resume. Our CNA resume example shows how.
CNA rules change and differ by state. Check your state’s nurse aide registry or health department for current requirements before you enroll.