Certified Nursing Assistants (CNAs) are basic care providers who perform a number of support functions for employers ranging from hospitals to nursing homes and assisted care facilities. This is a popular entry-level position in healthcare because of the fact that no college degree is required, and training and certification prerequisites can usually be met in just a few months.
There is also a strong nationwide demand for CNAs throughout the country, with the Bureau of Labor Statistics projecting a 17% growth in new jobs for nursing assistants through 2024. The opportunity to work directly under Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) also makes this job ideal as a stepping stone to other careers in nursing.
What does a CNA do?
The CNA’s responsibilities focus on basic patient care. This generally involves monitoring the patient’s condition and providing assistance with activities such as bathing, dressing and feeding.
As was mentioned above, the CNA works in a supporting role under the direct supervision of an RN or LPN.
Specific examples of tasks performed by certified nursing assistants follow.
Typical certified nursing assistant duties
- Assist patient with personal hygiene including: bathing, shampooing, shaving, bedpans, urinals, and travel to the bathroom
- Provide assistance with meals and feeding, and ensure that patient remains hydrated with water and other liquids
- Keep the patient’s room and living quarters orderly and sanitized
- Turn and position patients in their beds as needed
- Assist with non-sterile dressings, ice and heat packs, surgical preps, enemas, douches, and other prescribed forms of adjunct care
- Monitor and record vital signs and weight, changes in urine, etc.
- Transport patient as required, and provide basic comfort support
- Maintain documentation of all patient interactions and actions performed during a shift
What is the process to become a CNA?
The process to becoming a certified nursing assistant consists of five steps.
- Complete your high school diploma or GED
- Enroll in a state-approved CNA training program
- Complete the program and all training hours required in your state
- Pass your state’s nursing assistant certification exam
- Become listed on the state nursing aide registry
Step 1: Complete your high school diploma or GED
This first step really just involves making sure that you can meet the minimum admission requirements for most CNA training programs. The majority of them require that you are either a high school graduate or have a GED prior to enrolling for classes.
Due to the hands-on nature of the nursing assistant’s work, many schools will also require applicants to undergo a screening for TB (tuberculosis) and a background check. These prerequisites vary from school to school, however, so it’s best to ask the program representative about them when you first inquire about classes.
Step 2: Enroll in a state-approved program
Step two is to choose a nursing assistant program and sign-up for classes recognized by your state board of nursing or the appropriate body. This is important because completion of an approved program is required before you can sit for your state’s certification exam.
Choosing a program can be a difficult task for many students, thanks to the large variety of options available. These options range from taking a course from an organization like the American Red Cross, to community colleges and for-profit schools. Each of these has its own advantages and drawbacks, in terms of cost, schedule and format (e.g. many for-profit schools offer online CNA classes).
To help simplify the process of choosing a program, and narrow down your choices, you should factor each of the following issues into your decision.
1. State approval
As we’ve pointed out, any CNA program you decide to attend should be recognized by the appropriate body in your state. A school’s approval status can usually be found by contacting your state board of nursing. The National Council of State Boards of Nursing (NCSBN) provides contact information for the boards in all 50 states. This resource can be found here.
2. Certification exam pass rates
Your state nursing board usually has information available on the historic certification exam pass rates for students from every program it has approved. As a baseline, you should look for schools with no less than a 70% pass rate.
By comparing the pass rates of students from each program it is possible to get an idea of the quality of training that each provides. Higher pass rates usually mean that the program is more effective at teaching. It can also reflect on the quality of instructors, training materials, etc.
3. Course availability
Whether you are a parent, work full-time, or have some other obligation that competes for your time, finding a program with courses that fit your schedule is a must. For this reason, be sure to review the course schedule at any school you consider.
About online CNA classes
As distance learning has become more popular with students over the years, many nursing assistant programs have responded to increased demand by offering CNA classes online. This popular format allows students to complete their required classroom hours whenever and wherever they have the time for study.
Many online programs are also accelerated, allowing you to complete your training much faster than would normally be possible in a traditional on-campus class. Your state’s required clinical hours will still need to be completed in-person, of course.
For most students, one of the biggest factors that goes into choosing a school is the cost of tuition and required materials. This is no different when it comes to certified nursing assistant training.
The cost of tuition can range from several hundred dollars up to $3,000, depending on the program. Some of the difference in cost is attributable to the required hours in your state (i.e. more required training equates to higher tuition costs). Whether or not the course is offered online or in an accelerated format also factors into the cost.
Ultimately, how much you are able or willing to pay for your training is up to you. As long as you are confident that the program you choose will give you the education you need to become a CNA, you should feel free to spend the amount that best fits your budget.
Step 3: Complete the program and state-required hours
The third step in the process of earning your nursing assistant certification is completing your approved program and all of your state’s required training hours. Passing your classes and completing these mandatory hours are a prerequisite for taking the certification exam in every state.
While the requirements for passing your program will depend on the school, the required minimum classroom hours and clinical hours are established by the state.
The following table illustrates each state’s nursing assistant training requirements as of 2016.
Nursing assistant training requirements by state
|State||Required Classroom Hours||Required Clinical Hours|
|District of Columbia||120||75|
Step 4: Pass the state certification exam
Once you’ve completed your training program and hours, you’ll be ready to challenge your state exam for certification. In the 22 states listed below, the exam administered will be the National Nurse Aide Assessment Program (NNAAP). This exam consists of both an oral portion and skills demonstration. You will be required to post a passing score on both sections in order to pass the exam.
States that use the NNAAP Exam
District of Columbia
Preparing for your CNA exam
While your state-approved training program will have covered all of the content on the CNA exam, it’s still a good idea to do some additional preparation before test day.
Written exam preparation
There are a number of practice tests available online, as well as the CNA practice exam we offer here on this site. Using these to test your knowledge can be helpful as you get ready to sit for the exam.
You may also want to use flash cards and other study aids to quiz yourself on the different areas of basic nursing skills that were covered in your course. The important thing is to prepare for the exam until you’re confident that you know the material inside and out.
Clinical skills demonstrations
It’s important to remember that perhaps the most-crucial part of the exam is the skills demonstration. During this portion of the test, you will be required to demonstrate a number of the skills used by nursing assistants on a daily basis. This often involves the use of an “actor” who plays the role of a patient during the exam.
Make sure that you have adequately practiced each of these and are able to perform them correctly when asked.
CNA skills you may be asked to demonstrate
Measuring a patient’s vitals
Ambulation with Gait Belt
Toileting with a bedpan
Transferring patient to a wheelchair
Changing positions in a bed
Hand and nail care
Application of dressings and support stockings
Range of motion exercises for all joints
Where to take the CNA exam
There are three primary test providers (see below) who administer CNA exams across the United States. There are some states who use their own test centers instead of one of these national providers, as well.
The contents of the exam administered in each state will vary somewhat according to local requirements. As mentioned, 22 states use the NNAAP exam for certification. The other states either use their own test, or one provided by one of the national testing providers.
Each test provider can supply you with the specific information for your state, as well as testing center locations and available dates.
Test providers and locations by state
American Red Cross, public and private universities – Illinois, Indiana, Kentucky, Massachusetts, Maine, Utah, West Virginia
Headmaster LLP – Arizona, Montana, New Hampshire, Nevada, North Dakota, New Jersey, Ohio, Oklahoma, Oregon, South Dakota, Tennessee, Utah
PearsonVUE – Alabama, Alaska, California, Colorado, District of Columbia, Georgia, Louisiana, Maryland, Minnesota, Mississippi, New Hampshire, North Carolina, North Dakota, Pennsylvania, Rhode Island, South Carolina, Texas, Vermont, Virginia, Washington, Wisconsin, Wyoming
Prometric – Alabama, Arkansas, Connecticut, Delaware, Florida, Hawaii, Idaho, Michigan, New Mexico, New York, Oklahoma
Being ready on test day
It’s natural to be nervous as test day approaches. Don’t let your nervousness distract you from being fully prepared when the big day arrives however. To make sure this doesn’t happen, it’s useful to put together a checklist (like the one below) that you can refer to as the day approaches.
- Practice for written test using a timer
- Practice demonstrating clinical skills while verbally explaining each step
- Dress for the exam as if it’s your first day on the job (i.e. wear a scrub uniform with clinical shoes)
- Know where the test center is located and plan to arrive at least 20 minutes early on test day
How long does it take to get your test results?
Depending on the test provider and regulations in your state, the amount of time you’ll have to wait for your score can vary from one hour after finishing the exam to 10 days. Expected timeframes from Prometric and PearsonVue are listed below.
Note: Headmaster LLP does not provide specific timeframes by state, but does indicate that preliminary scores are available within 24 hours through their website.
PearsonVUE: Most testing centers provide a preliminary score (i.e. pass/fail) to the test taker on the day of the exam. Final scores are sometimes mailed thereafter, depending on the specific center.
Prometric: Scores are available within 24 hours of completing the exam in the following states: AL, AR, CT, DE, FL, HI, ID, NV, MI, NM, NY and OK.
When will you receive your CNA certification?
After you’ve passed the state exam, the testing center will notify the state board responsible for certifications. The amount of time you will then have to wait for the certificate to arrive depends on the state you live in.
The typical wait time in most parts of the continental United States is five business days. This can vary, however. For example, the State of Arkansas typically requires two-to-three weeks from the test date before mailing out certifications.
Step 5: Get listed on the nurse aid registry
The final step you’ll need to take in order to become a certified nursing assistant is to get your name listed on your state’s nurse aid registry. Appearing on your local registry is important because employers use this list to verify whether or not applicants for nursing assistant jobs are certified in the state.
Fortunately, the process for getting listed on a state CNA registry is automatic for new nursing assistants. Once you have successfully passed your certification exam, your test center will notify the local registry of your new status as a certified nursing assistant. All you have to do is wait for confirmation of the listing before applying for jobs!
How long does it take to get on the nurse aid registry?
The amount of time required to have your name added on your local registry varies slightly according to your state and the test provider you used. In general, however, it takes no more than 10 days after your test date to see your name listed. You can contact your state registry in order to find out what to expect in your area.
Contact information for each state’s registry is available through NCSBN here.
Finding a job as a certified nursing assistant
With your training completed, a certification in-hand, and your name on the state nurse aid registry, you’re ready to look for your first job as a CNA. You may already have a good idea of how to approach this process, but we’ve provided a few helpful tips you can follow nonetheless.
Where to start your search
There are a few ways you can begin the process of finding your first job as a nursing assistant. Since you will likely be coming from a local training program, you may have already made some contacts with prospective employers. Even if you have, it’s still worth looking at everything that’s out there to find the best available position.
What type of healthcare setting is right for you?
It’s also important to find the type of job that fits you personally. For example, if you’re a high energy person who likes to be challenged with multiple tasks simultaneously and a fast pace, you should consider looking for openings at a local hospital.
On the other hand, if you prefer a more subdued work environment and closer interaction with fewer patients, a home healthcare agency may be a better fit. Wherever you start your career, you’ll want to learn as much as possible and enjoy your work – so choose a situation that will provide you with both!
As is the case with most job openings today, you can get a good idea of what’s out there by searching online job sites such as Indeed.com, Monster.com and Careerbuilder.com. You can also look on the websites for local employers such as those listed below.
Places to look for CNA jobs
LTCF and nursing homes
The majority of nursing assistants are employed by LTCFs (long-term care facilities) and nursing homes. According to the Bureau of Labor Statistics, 41% of CNAs worked in one of these skilled nursing facilities in 2014.
Pros: Low-stress environment with lots of opportunities.
Cons: Pay is generally lower and the slower pace may not be for everyone.
Home healthcare agencies
Home healthcare agencies employ CNAs, but more often use Home Health Aides (HHAs). Only 5% of all CNAs worked for an agency as of 2014.
Pros: Pay is similar to nursing homes and LTCFs, but the patient-to-CNA ratio is better. The CNA cares for a client in his or her home, meaning less job-related stress.
Cons: It may take awhile to be assigned to a patient, and it is not uncommon to lose patients.
Approximately 1-in-4 nursing assistants are employed by hospitals according to the Bureau of Labor Statistics. Competition for these positions is usually strong because they are good stepping stones to other healthcare jobs.
Pros: Wide range of available shifts, good job security, and comparatively higher pay.
Cons: The fast-paced environment can be stressful.
What should be on your resume?
It’s impossible to overstate the importance of having a good resume when looking for a job. When it comes to finding a position in nurse assisting, this is no different.
Your resume is your introduction to employers and your first chance to make an impression. As we all know, first impressions are important, so take the time to make sure you have the type of resume that will grab the employer’s attention. It should also show that you are a serious, professional person – regardless of the fact that you may not have any prior work experience in healthcare.
A good CNA resume should include:
- Contact information – full name, address, phone number and emai
- Your career goals – one or two sentences describing who you are, and why you want the job
- Skills and qualifications – list out your personal skills that would make you a good CNA, as well as any qualifications you earned during training
- Education – list each school you’ve attended in reverse chronological order – starting with the CNA program you just completed
- Work experience – list your clinical experience and dates, as well as any intern experience and dates
- Personal references – list at least two professional references
Prepare for interviews
After submitting your job application and resume, you should start preparing to sit down for job interviews. Following are a few simple guidelines you should follow as part of this preparation.
Be ready to answer common questions
Almost all employers have a list of common questions that they ask job applicants. Giving a little thought to how you’ll answer these questions not only helps calm your nerves, but can also impress the employer with your professionalism and preparedness.
Examples of common interview questions
“Tell us about yourself”
“Why did you decide to become a CNA?”
“What are your strengths and weaknesses?”
“Tell us about a time you had to do something difficult”
Be ready to ask questions
Most of us head into a job interview thinking about what we’ll say when the interviewer asks us questions. However, employers are usually more impressed by the questions an applicant asks than how he or she answers a question. For this reason, you should prepare several questions to ask the employer during the interview.
It is not recommended that you ask the interviewer about salary, benefits, etc. It’s usually better to allow them to give this information to you during the interview.
Examples of questions to ask the employer
“How long is the training period here?”
“What is the staff-to-patient ratio here?”
“Are there opportunities for additional education and professional development?”
“Can I see the facility?”
How to dress and what to bring
On the day of the interview, you’ll want to be sure to present the right image. Doing this involves a combination of not only what you say, but how you present yourself.
Because nursing assistants do not work in a professional office setting, you won’t need to worry about wearing formal business attire. You should however, wear clean, well-maintained “business casual” style clothing that fits well. This will show that you prepared for the interview by giving thought to presenting an image that is professional and appropriate to the setting.
You will also want to bring several items with you that can be used to further display your preparedness and thoughtfulness.
Things to bring to the interview
- A notebook and pen
- Several additional copies of your resume
- Your CNA certification information
- Proof of any additional qualifications you carry (e.g. a CPR card)
- Letters of recommendation
Following up after the interview
Because the person or people who interview you will probably talk to several applicants each day, it’s a good idea to follow-up with them after the interview. Be sure to get the name of each interviewer before you leave, and to thank them for their time.
If the position is one that you really want, it’s a good idea to then follow-up with a formal “thank you” letter a day or two after the interview. Be sure to reiterate what was discussed during the interview and to repeat your excitement and qualification for the position.
This simple step helps remind the interviewer of their conversation with you, and to show a level of respect and professionalism that will create another good impression.
About CNA salary
As mentioned, it’s generally a good idea not to bring up salary during a job interview. This means that you will need to do some research on your own to have an understanding of how the pay offered by a job compares to other employers.
What is the average salary for a certified nurse assistant?
According to the latest figures available from the Bureau of Labor Statistics, the national median salary for nursing assistants was $26,590 as of May 2016. As shown by the following tables, this figure can vary considerably according to the state you work in, your experience, and your employer.
CNA salary by state
|State||Hourly mean wage||Annual mean wage|
Salary by employer type
|Employer Type||Median Hourly Wage||Median Annual Salary|
|Skilled nursing facilities||$12.84||$25,670|
|Assisted living facilities||$12.42||$24,830|
|Home healthcare services||$12.20||$24,390|
Salary by experience
|Experience||Median Hourly Wage||Median Annual Salary|
What is the job outlook for nursing assistants?
Thanks to the continuing expansion of the national healthcare system, and the growing need for elderly care, the job outlook for nursing assistants remains historically strong. The Bureau of Labor statistics projects that more than 1.7 million nursing assistants will be employed in the United States by 2024, making the CNA position one of the largest in healthcare.
What does this potential mean to you? Quite simply, it means that now is one of the best times ever to start a career in nursing assisting.
As is the case with salary, the outlook for certified nursing assistants varies somewhat from state to state. The following table illustrates the growth rate in new CNA positions in each state through 2024.
CNA job outlook by state through 2024
|State||CNA Jobs 2014||Projected CNA Jobs 2024||Percent Change|
|District of Columbia||3,540||3,990||13%|
|Idaho||No Data Available||No Data Available||No Data Available|
Not sure if you want to become a CNA?
If you’re still interested in working in healthcare, but aren’t sure if the certified nursing assistant position is for you, there are several similar career options. There are also bridge programs which allow nursing assistants to transition into different positions if you choose.
We’ve included comparisons between nursing assistants and other popular entry-level healthcare positions for you to consider.
CNA vs Medical Assistant (CMA)
The medical assistant, or CMA (certified medical assistant), is another basic care provider who works in many of the same facilities as the CNA. Also like the nursing assistant, medical assistants are required to earn a certification prior to becoming eligible to work in most parts of the country. Their responsibilities, training and salary are all quite different, however.
Differences in responsibilities
Whereas the nursing assistant provide basic patient care under the supervision of higher-level nurses such as RNs and LPNs, medical assistants usually work directly with doctors or in administrative support roles that provide them with more independence. Unlike certified nursing assistants, they also administer medications, give patients injections, and handle blood samples for testing.
Since technology has become heavily integrated into healthcare facilities, many medical assistants have also become responsible for maintaining electronic health records (EHRs). This change has created even more opportunities for medical assistants to work in varied, interesting positions that fit their skills and interests.
Differences in training and pay
Medical assistants are required to complete more education and training than certified nursing assistants. Most medical assistant programs last for approximately one year, and it is not uncommon for some medical assistants to pursue two-year associate’s degrees prior to starting their careers.
Medical assistant salaries are typically higher than those paid to CNAs. The median pay for medical assistants in the U.S. was $31,450 in May 2016 per the Bureau of Labor Statistics.
CNA vs Licensed Practical Nurse (LPN)
Licensed Practical Nurses (LPNs), or Licensed Vocational Nurses (LVNs) as they are called in California and Texas, fill a spot in the nursing hierarchy between the CNA and the Registered Nurse (RN). They are employed in many of the same facilities as nursing assistants, where the CNA sometimes reports directly to them.
Differences in responsibilities
There is sometimes crossover in the responsibilities of the LPN and nursing assistant. This occurs less often, however, in settings where both are employed, as most of the basic patient care duties are delegated to the CNA. In these cases, LPNs will instead focus on reporting patients’ status to the physicians or RNs to whom they report.
Practical and vocational nurses are also allowed to perform a greater number of patient care tasks (e.g. start IV drips) than CNAs.
Differences in training and pay
As their title states, LPNs and LVNs must be licensed by their state in order to be eligible for employment. The education required to become eligible to test for licensure generally takes about one year to complete. Practical nursing candidates are required to pass the nationally-administered NCLEX-PN exam in order to earn their license.
With the additional education requirements and responsibilities come significantly higher pay for LPNs. According to the May 2016 report from the Bureau of Labor Statistics, the median annual salary for Licensed Practical and Vocational Nurses was $44,090.
CNA to LPN programs
A popular career path for many in the nursing profession is to gain experience as a CNA and then transition into an LPN role. This is a fairly natural progression because the nursing assistant works directly under the licensed practical nurse.
In order to help facilitate this transition, many schools offer CNA to LPN bridge programs which provide the nursing assistant with the education required to make the leap. Because the nursing assistant will usually be employed while going through the program, most schools offer bridge programs online.
CNA vs Home Health Aide (HHA)
The home health aide (HHA) is similar to the CNA in many ways, as both provide basic patient care. However, while the nursing assistant may be employed in hospitals or other healthcare settings, the home health aide is exclusively employed by either home care agencies or long-term care homes.
Differences in responsibilities
Home health aides perform most of the same tasks that a nursing assistant would perform, but do so in a home setting. This difference means that the HHA is also required to help with such daily living activities as cleaning the living space, assisting with cooking, shopping for groceries, etc. In some states, they are also permitted to administer medication to patients.
Differences in training and pay
The differences in education and training between an HHA and CNA depend on the employer for whom the home health aide works. Because of federal regulation, any home care agency that receives reimbursement through Medicare or Medicaid must require its home health aides to be certified. In these cases, the length of training for the position closely parallels the nursing assistant.
In other cases, it is possible for an HHA to find work without being certified and after completing just a six-week online course. This is becoming less common, however, as more employers accept Medicare and Medicaid.
Pay for HHAs is slightly less than what is generally offered to a certified nursing assistant. The Bureau of Labor Statistics reports that the national median annual wage for a home health aide was $22,600 in 2016.