Overview
Certified Nurse Aides (CNAs) are essential members of the healthcare team. They provide direct patient care, assist with daily activities, and support the nursing staff in a variety of settings, including hospitals, longterm care facilities, and homehealth agencies. Because of the critical nature of their role, both training and competency evaluation are strictly regulated in the United States.
The purpose of this page is to outline the core components of CNA training programs, describe the required competency evaluations, and summarize how states enforce these standards.
Training Content
Federal guidelines, administered by the U.S. Department of Health and Human Services (HHS) through the National Council of State Boards of Nursing (NCSBN), define a minimum curriculum of 75 hours of classroom instruction plus 16 hours of supervised clinical practice. The curriculum typically covers:
- Fundamentals of nursing care
- Infection control and universal precautions
- Patient rights and confidentiality (HIPAA)
- Basic anatomy and physiology
- Vital signs measurement
- Assistive techniques for mobility and transfers
- Nutrition, feeding, and hydration support
- Skin integrity and wound care basics
- Communication skills and documentation
- Emergency procedures and basic life support (BLS)
Many programs incorporate simulation labs, skills labs, and clinical rotations in skilled nursing facilities or hospitals to give students handson experience.
State Requirements
While the federal baseline is consistent, each state may add requirements such as:
- Additional classroom hours (often 3040 extra hours)
- Statespecific laws on patient privacy, elder abuse reporting, or cultural competency
- Mandatory background checks and drug screening
- Stateapproved training providers only
Prospective CNAs should verify that the program they choose is accredited by the Commission on Accreditation for Health Informatics and Technology (CAHIT) or a similar recognized agency, and that it is listed on the states healthdepartment website.
Competency Evaluation Requirements
After completing an approved training program, the candidate must pass a twopart competency exam administered by the state board of nursing or a delegated agency.
1. Written (or Oral) Examination
| Component | Typical Format | Passing Score |
|---|---|---|
| Knowledge of patient care basics | Multiplechoice (7090 questions) | 70% or higher |
| Legal and ethical standards | True/false or scenariobased | 70% or higher |
| Safety and infection control | Multiplechoice | 70% or higher |
2. Skills (Performance) Examination
The skills exam validates the ability to perform core CNA tasks under observation. Candidates are assessed on:
- Measuring and recording vital signs
- Transferring a client using proper body mechanics
- Providing perineal care while maintaining dignity
- Demonstrating proper handwashing and glove use
- Applying a simple dressing
- Communicating with a patient and documenting the interaction
Each skill is scored on a checklist; a minimum of 70% of the items must be performed correctly for the candidate to pass.
Most states allow a maximum of three attempts per testing cycle. If a candidate fails, they must complete remedial training before retaking the exam.
Maintaining Competency and Renewal
After certification, CNAs must renew their credentials every two years (some states use a threeyear cycle). Renewal typically requires:
- Continuing Education Units (CEUs) usually 1215 hours, with at least 1 hour in infection control.
- Proof of employment as a CNA (most states require recent work experience).
- Payment of a renewal fee.
Many employers offer inhouse training sessions that count toward CEU requirements, and state health departments often provide online courses at no cost.
