How to become a CNA
Nurse aide training, the state competency exam, and the registry, step by step
Certified Nursing Assistants provide hands-on patient care — helping with bathing, dressing, feeding, mobility, and recording vital signs — under the supervision of registered nurses or LPNs. They work in nursing homes, hospitals, assisted living facilities, and home health settings. CNA certification is one of the fastest entry points into healthcare, typically requiring 4–12 weeks of state-approved training and a competency exam.
Studying for the CNA exam?Free CNA practice test30 questions on the NNAAP written exam outline, with explained answers and a score by area. arrow_forward4 steps, start to finish
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1Training
Complete a state-approved nurse aide program
Federal rules set a minimum of 75 hours, including 16 hours of supervised hands-on practice; many states require more. Most programs take 4 to 8 weeks.
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2Exam
Pass the state competency exam
The exam has a written (or oral) test and a skills test. Which company runs it depends on the state: Credentia’s NNAAP, Prometric or Headmaster. Our practice test follows the NNAAP written exam, used in 18 states. Check your state in the table below.
NNAAP Written Examination (CNA): 70 questions, 2 hours
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Activities of Daily Living22%
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Basic Nursing Skills35%
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Self-Care and Independence7%
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Emotional and Mental Health Needs8%
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Spiritual and Cultural Needs2%
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Communication7%
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Client Rights8%
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Legal and Ethical Behavior5%
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Member of the Health Care Team6%
30 questions on the NNAAP written exam outline, with explained answers and a score by area.
Want the full exam experience? The CNA Exam Practice Bank has 400 more questions, 5 timed full-length practice exams and a study guide, for $29 once.
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3Registry
Get listed on the nurse aide registry
Passing puts you on your state’s nurse aide registry, which is what employers check.
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4Renewal
Stay active
Registry listings typically renew every 2 years. Under federal rules, if you go 24 months in a row without paid nursing work, you have to retrain or retest. Moving later? Check how your certification transfers. State-by-state transfer rules →
What it's actually like
A day-to-day reality check, grounded in current practitioner sources — not just the salary math.
Hours / week
Shifts: 8 or 12 hours.
Weekends
Where you work
skilled nursing facility, hospital, assisted living facility.
Physical demand
HighThe role requires frequent lifting and transferring of patients, extensive periods of standing and walking, and repeated bending or stooping.
Stress level
HighStress stems from heavy workloads, high patient-to-staff ratios, and the emotional toll of caring for ill and dying patients.
A typical shift
- Assist 8-15 residents with activities of daily living, including bathing, dressing, grooming, and toileting.
- Measure and record vital signs such as blood pressure, temperature, pulse, and respiration for all assigned patients.
- Turn and reposition bedridden patients every two hours to prevent bedsores.
- Serve meals and assist residents with eating, carefully documenting their food and fluid intake and output.
- Answer patient call lights promptly and respond to their needs or requests.
- Clean and sanitize patient rooms, change soiled bed linens, and empty bedpans.
- Transport patients between their room and other areas of the facility, such as for therapy or dining.
check_circle Best fit if
- —You have a high degree of compassion and patience for individuals who are ill, disabled, or in distress.
- —You possess significant physical stamina and are comfortable being on your feet for long shifts and lifting/moving people.
- —You can remain emotionally stable and calm when dealing with stressful situations, including medical emergencies and patient death.
- —You are highly observant and detail-oriented, able to notice and report small changes in a patient's condition.
cancel Skip if
- —You are squeamish about or uncomfortable with close contact with bodily fluids and performing personal hygiene tasks for others.
- —You require a physically easy job, as this role involves constant activity, lifting, and potential for back strain.
- —You are seeking a career with significant upward mobility without the need for additional formal education.
- —You are easily stressed or emotionally drained by heavy workloads and high-stakes environments.
Sources cited (23)
- cnaprograms.org
- carestaffingprofessionals.com
- gabrielhealth.org
- cnacertifiednursingassistant.com
- nursa.com
- cnaclassesneworleans.com
- carerev.com
- shiftkey.com
- nih.gov
- reddit.com
- northeastmedicalinstitute.com
- allnursingschools.com
- midwesttech.edu
- wgu.edu
- interimhealthcare.com
- lyndenhealthed.org
- pmi.edu
- cna.plus
- pchslive.com
- indeed.com
- cynamed.com
- quora.com
- youtube.com
The Landscape
State-to-state differences in licensing requirements are substantial. Initial training hours vary wildly, from a mere 16 hours in states like Minnesota and Colorado to a demanding 100 hours in California and Missouri. While all 51 states require a license, the ongoing renewal criteria differ significantly; most require minimal work hours, but a few, such as Oregon and Vermont, demand a substantial 400 hours of paid work every two years, which can be a significant commitment for part-time CNAs. Many states also mandate a criminal background check, which is a universal hurdle for entry into the profession. A closely-related path worth comparing is the Medical Assistant certification. If you're choosing an entry-level healthcare path, our Certified Nursing Assistant vs. Medical Assistant guide contrasts training time, clinical exposure, and starting wages. If you're thinking about advancing further, see how Certified Nursing Assistant compares to Licensed Practical Nurse in time-to-credential, pay, and scope of practice.
Certified Nursing Assistant by State
Required exam, licensing cost, reciprocity, and median pay across all 50 states.
| State | License | Exam | Licensing cost | Reciprocity | Median | vs. National |
|---|---|---|---|---|---|---|
| Alabama | Yes | National Nurse Aide Assessment Program (NNAAP) via CredentiaFree practice test → | $135 | Endorsement | $34,140 | -19.2% |
| Alaska | Yes | National Nurse Aide Assessment Program (NNAAP) via CredentiaFree practice test → | $570 | Endorsement | $46,370 | +9.7% |
| Arizona | Yes | Headmaster CNA Exam | $130 | Re-exam | $44,780 | +6.0% |
| Arkansas | Yes | Prometric CNA Exam | $150 | Endorsement | $34,430 | -18.5% |
| California | Yes | California Nurse Assistant Competency Examination via CredentiaFree practice test → | $140 | Endorsement | $47,630 | +12.7% |
| Colorado | Yes | National Nurse Aide Assessment Program (NNAAP) via CredentiaFree practice test → | $140 | Endorsement | $47,380 | +12.1% |
| Connecticut | Yes | Prometric CNA Exam | $118 | Endorsement | $44,790 | +6.0% |
| Delaware | Yes | Prometric CNA Exam | $115 | Endorsement | $42,030 | -0.5% |
| District of Columbia | Yes | National Nurse Aide Assessment Program (NNAAP) via CredentiaFree practice test → | $165 | Endorsement | $47,700 | +12.9% |
| Florida | Yes | Prometric CNA Exam | $205 | Endorsement | $37,510 | -11.2% |
| Georgia | Yes | National Nurse Aide Assessment Program (NNAAP) via CredentiaFree practice test → | $130 | Endorsement | $37,680 | -10.8% |
| Hawaii | Yes | Prometric CNA Exam | $225 | Endorsement | $45,350 | +7.3% |
| Idaho | Yes | Prometric CNA Exam | $68 | Endorsement | $38,650 | -8.5% |
| Illinois | Yes | Illinois Nurse Aide Competency Exam (INACE) via SIUC | $85 | Endorsement | $45,960 | +8.8% |
| Indiana | Yes | Indiana Nurse Aide Competency Exam via Ivy Tech | $100 | Re-exam | $38,330 | -9.3% |
| Iowa | No | Iowa Nurse Aide State Exam (written and skills components) | $175 | Endorsement | $39,350 | -6.9% |
| Kansas | Yes | Kansas NATCEP Nurse Aide State Exam | $75 | Re-exam | $38,010 | -10.1% |
| Kentucky | Yes | Kentucky Nurse Aide Test via KCTCS | $115 | Endorsement | $38,370 | -9.2% |
| Louisiana | Yes | Prometric CNA Exam | $100 | Endorsement | $30,510 | -27.8% |
| Maine | Yes | Maine CNA Competency Test via CredentiaFree practice test → | — | Endorsement | $47,070 | +11.4% |
| Maryland | Yes | National Nurse Aide Assessment Program (NNAAP) via CredentiaFree practice test → | $125 | Endorsement | $43,240 | +2.3% |
| Massachusetts | Yes | Massachusetts Nurse Aide Competency Evaluation (administered by D&S Diversified Technologies/TMU Portal) | $110 | Endorsement | $46,680 | +10.5% |
| Michigan | Yes | Prometric CNA Exam | $125 | Endorsement | $39,570 | -6.4% |
| Minnesota | Yes | Headmaster CNA Exam | $265 | Endorsement | $46,680 | +10.5% |
| Mississippi | Yes | National Nurse Aide Assessment Program (NNAAP) via CredentiaFree practice test → | $114 | Endorsement | $31,520 | -25.4% |
| Missouri | Yes | Missouri Nurse Aide Competency Exam (MO-NACE) | $135 | Endorsement | $37,680 | -10.8% |
| Montana | Yes | Headmaster CNA Exam | $97 | Endorsement | $40,900 | -3.2% |
| Nebraska | Yes | Nebraska Nurse Aide Exam | — | Endorsement | $40,000 | -5.3% |
| Nevada | Yes | Headmaster CNA Exam | $200 | Endorsement | $45,490 | +7.6% |
| New Hampshire | Yes | National Nurse Aide Assessment Program (NNAAP) via CredentiaFree practice test → | $140 | Endorsement | $47,870 | +13.3% |
| New Jersey | Yes | PSI CNA Exam | $76 | Re-exam | $46,830 | +10.8% |
| New Mexico | Yes | New Mexico CNA Competency Exam (administered by Headmaster LLP/TMU) | $132 | Endorsement | $39,390 | -6.8% |
| New York | Yes | Prometric CNA Exam | $115 | Endorsement | $48,590 | +15.0% |
| North Carolina | Yes | National Nurse Aide Assessment Program (NNAAP) via CredentiaFree practice test → | $140 | Endorsement | $38,460 | -9.0% |
| North Dakota | Yes | Headmaster CNA Exam | $275 | Endorsement | $45,820 | +8.4% |
| Ohio | Yes | Ohio STNA Exam via D&S Diversified Technologies (Headmaster) | $104 | Endorsement | $39,010 | -7.7% |
| Oklahoma | Yes | Oklahoma Nurse Aide Competency Examination (administered by Prometric or Headmaster/D&S Diversified Technologies) | $160 | Endorsement | $35,930 | -15.0% |
| Oregon | Yes | Headmaster CNA Exam | $212 | Endorsement | $49,830 | +17.9% |
| Pennsylvania | Yes | National Nurse Aide Assessment Program (NNAAP) via CredentiaFree practice test → | $121 | Endorsement | $44,590 | +5.5% |
| Rhode Island | Yes | National Nurse Aide Assessment Program (NNAAP) via CredentiaFree practice test → | $200 | Endorsement | $46,440 | +9.9% |
| South Carolina | Yes | National Nurse Aide Assessment Program (NNAAP) via CredentiaFree practice test → | $140 | Endorsement | $37,220 | -11.9% |
| South Dakota | Yes | South Dakota Nurse Aide Competency Exam (includes Knowledge Exam and Skills Evaluation) | $170 | Endorsement | $38,800 | -8.2% |
| Tennessee | Yes | National Nurse Aide Assessment Program (NNAAP) examFree practice test → | $110 | Re-exam | $37,990 | -10.1% |
| Texas | Yes | Prometric CNA Exam | $125 | Endorsement | $37,500 | -11.3% |
| Utah | Yes | Utah Nurse Aide Competency Examination (Written Knowledge Exam and Manual Skills Exam) | $110 | Endorsement | $39,840 | -5.7% |
| Vermont | Yes | Vermont Nurse Aide Competency Exam (NNAAP) administered by Credentia or Prometric.Free practice test → | $150 | Endorsement | $47,130 | +11.5% |
| Virginia | Yes | National Nurse Aide Assessment Program (NNAAP) via CredentiaFree practice test → | $140 | Endorsement | $43,200 | +2.2% |
| Washington | Yes | National Nurse Aide Assessment Program (NNAAP) via CredentiaFree practice test → | $240 | Endorsement | $49,180 | +16.4% |
| West Virginia | Yes | West Virginia Nurse Aide Exam via Professional Healthcare Development | $125 | Endorsement | $36,720 | -13.1% |
| Wisconsin | Yes | Headmaster CNA Exam | $163 | Endorsement | $45,130 | +6.8% |
| Wyoming | Yes | Headmaster CNA Exam (written/oral and skills) | $165 | Endorsement | $39,160 | -7.3% |
Related Certifications
Compare Certified Nursing Assistant head-to-head
All comparisons →Weighing a Certified Nursing Assistant career against another credential? Pay, training time, and licensing side-by-side.