How to Become a CNA (Certified Nursing Assistant)

A Certified Nursing Assistant (CNA) is often the first point of care for patients in hospitals, nursing homes, and home health settings. CNAs help patients with daily activities, monitor vital signs, report changes in condition, and provide the kind of hands-on personal care that makes an enormous difference in people's lives. It's one of the fastest healthcare careers you can enter — and a launchpad for many higher-level health careers.

According to the BLS, nursing assistants earn a median wage of $38,200 per year. With experience, specialization, or advancement to LPN or RN, earnings rise significantly.

What Does a CNA Do?

CNAs provide direct patient care under the supervision of registered nurses or licensed practical nurses. Typical duties include:

• Assisting patients with bathing, dressing, grooming, and feeding
• Measuring and recording vital signs (blood pressure, temperature, pulse)
• Helping patients move, transfer, and reposition to prevent bedsores
• Observing and reporting changes in patient condition to nursing staff
• Providing emotional support and companionship

CNAs work in nursing homes, hospitals, assisted living facilities, and home health agencies. Home health CNAs typically have more one-on-one patient relationships and more independent schedules.

Step 1 — Complete a State-Approved CNA Training Program

CNA training programs are offered through nursing homes (which often offer free training in exchange for a work commitment), community colleges, vocational schools, and the Red Cross. Programs typically run 4–12 weeks and include:

• Classroom instruction: anatomy, infection control, patient rights, communication
• Lab skills practice: bed baths, catheter care, transfer techniques
• Clinical hours: supervised hands-on care in an actual healthcare facility

Federal law requires a minimum of 75 hours of training before taking the certification exam, but many states require more (some up to 175 hours).

Step 2 — Pass the State Competency Exam

After completing your training, you must pass a two-part state competency exam to become a CNA:

1. Written test: Multiple-choice questions on patient care concepts, safety, and regulations
2. Skills evaluation: A proctor observes you performing 3–5 clinical skills (e.g., handwashing, taking vital signs, repositioning a patient)

Exams are administered by testing companies approved by your state's Nursing Aide Registry. After passing, your name is entered into the state's CNA registry, which employers verify when hiring.

Step 3 — Maintain Your Certification

CNA certifications must be renewed, typically every 2 years. Requirements usually include:

• Working a minimum number of paid hours as a CNA during the renewal period (often 8 hours every 2 years)
• Completing state-required continuing education hours
• Keeping your contact information updated in the state registry

CNA Career Advancement Paths

CNA is often a strategic starting point rather than a career destination. Many CNAs use the experience as a bridge to:

• Licensed Practical Nurse (LPN): 1-year program, median wage $59,730/year
• Registered Nurse (RN): 2–4 year program, median wage $86,070/year
• Medical Assistant (MA): 1-year certificate, clinic and office settings
• Physical Therapy Aide or Tech: Strong growth outlook
• Specialty CNA: Memory care, hospice, rehabilitation — often higher pay

Many hospitals and health systems offer tuition assistance for CNAs who want to advance, making the ladder very accessible.

Where CNAs Earn the Most

Location and work setting significantly affect CNA wages:

• Hospital settings pay 10–20% more than nursing homes on average
• Home health agencies offer flexible schedules and competitive pay
• States like California, Alaska, and New York consistently top the pay charts
• Night shift, weekend, and holiday differentials can add $2–$5/hour to your base rate

See our CNA career profile for training program listings in your state and salary comparisons by setting.