Want to Become a Nursing Assistant? Here’s How CNA Certification Works

Thomas Broderick
Updated June 29, 2023
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Certified nursing assistants (CNAs) perform many tasks in healthcare settings. They check vital signs, change simple dressings, help patients with mobility and bathing, and sanitize patient rooms. Entering this profession requires completing a state-approved CNA program and earning certification.

The CNA certification process varies by state. You can start your CNA certification journey by researching your state’s Department of Public Health website.

What Is CNA Certification?

Nursing assistant certification shows that you know how to check patients’ vital signs and help them eat, bathe, and groom.

You typically pursue state certification after completing a state-approved CNA program lasting 4-12 weeks. CNA programs feature a mix of coursework and clinical rotations.

You can also look for online programs, which typically entail online CNA classes and in-person clinicals.

Requirements beyond finishing an academic program vary by state. Each state uses a CNA exam. You’ll also have to pay an initial application fee and maintain your certification by recertifying every two or so years.

Did You Know…

CNA positions in the San Francisco Bay Area offer the highest average salaries for CNAs in the country, according to the Bureau of Labor Statistics (BLS). This is because San Francisco has one of the highest costs of living in the country.

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How to Get CNA Certification: 4 Essential Steps

While CNA certification requirements vary by state, here are the basic steps you’ll need to take to get — and stay — certified.

Step 1: Enroll in an Accredited CNA Program

To start your CNA certification journey, you’ll need to enroll in an accredited CNA program.

Research local community, junior, and technical colleges to see which programs meet your needs. Online CNA certification programs can offer more flexibility and be more affordable than traditional in-person programs.

A typical CNA certificate program lasts around two months. Coursework usually includes clinical rotations at local healthcare facilities. Some assignments may focus on the CNA exam, which you must pass before you can legally work as a CNA.

Step 2: Take the CNA Exam

Several states use the National Nurse Aide Assessment Program (NNAAP) to assess your competency as a CNA.

This exam consists of a 90-minute written or oral section covering physical care skills, psychosocial care skills, and the role of the nurse aide. You must also complete a 30-minute skills test in front of a proctor.

Currently, 14 states require aspiring CNAs to take the NNAAP:

  • Alabama
  • Alaska
  • California
  • Colorado
  • District of Columbia
  • Georgia
  • Maryland
  • Mississippi
  • North Carolina
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • Virginia
  • Washington

If you live in a different state than the ones listed above, visit your state government website to determine what your CNA exam looks like.

Step 3: Apply for CNA Certification

Once you pass your state’s CNA exam, you can earn your CNA certification by submitting an application to your state’s public health department. You may also need to complete a criminal background check, provide fingerprints, and pay a small fee.

Requirements vary by state, so pay close attention when reviewing application steps.

Your state may take up to 30 days to issue your certification. You can use your CNA certification to apply for CNA jobs in your state and in neighboring states with reciprocity agreements.

Step 4: Recertify as Needed

CNA certification isn’t a one-and-done deal — you need to apply for recertification, usually every two years, depending on your state. Without recertification, you cannot legally work as a CNA in that state.

In California, for example, CNAs must earn 48 continuing education units every two years to maintain their CNA certification.

Check your state’s Department of Public Health website to learn more about recertification requirements for CNAs.

CNA Certification Requirements by State

CNA certification involves researching your state’s requirements, which may include:

  • A criminal background check
  • A written and practical exam
  • Fingerprinting
  • Fees

CNA program length varies by state. States like Alabama, Iowa, and Nebraska require just 75 hours, which is the lowest number of hours required by states.

States that do not use the NNAAP develop their own exams to assess your competency to become a CNA. You can learn more about your state’s CNA exam by contacting your school’s career center or checking your state’s Department of Public Health website.

Did You Know…

In 2021, CNAs working for a government agency earned nearly 30% more than CNAs working for a home healthcare services agency, according to the BLS.

CNA Practice Exams

Although CNA exams vary by state, CNA practice exams like the ones below can help you identify areas of improvement and come up with an effective test prep plan. Be sure to research vendors’ credibility and reputations before paying for any CNA practice exams.


You’ll take your CNA exam at a Prometric testing center. Prometric offers the latest study materials, including three written CNA practice exams for $15 each and one supersized practice test for $35.

CNA Plus Academyarrow-circle-right

CNA Plus Academy offers free CNA practice questions covering an array of relevant topics, like basic nursing skills and restorative services. You can unlock all questions by signing up for a premium account.

CNA Training Helparrow-circle-right

This site provides two free downloadable CNA practice exams. You can also read blog posts on CNA best practices, professionalism, and continuing education classes.

Union Test Preparrow-circle-right

At Union Test Prep, you can access 235 CNA practice questions for free. Questions cover basic nursing skills, communication, legal and ethical behavior, and client rights, among other major exam topics. Premium users can unlock even more questions.


Tests.com offers a free 63-question CNA practice exam. You can also buy the company’s CNA Practice Exam Kit, which consists of 750 questions.

Practice Quizarrow-circle-right

Practice Quiz hosts a free 340-question CNA practice exam with answer explanations. You can learn in study mode, try a free daily question, or take the exam in test mode.

Frequently Asked Questions About CNA Certification

question-mark-circleWhat is the best state to be a CNA?

CNAs working in Alaska earned a median annual salary of $43,080 in May 2021 — the highest among CNAs in the U.S. Other states where CNAs make more include New York and California; however, these states also have a higher-than-average cost of living.

question-mark-circleCan you transfer CNA certification to another state?

Many states maintain reciprocity agreements, letting you continue working as a CNA if you move across state lines and without having to take another CNA exam or apply for a new certification.

After moving, you must submit an initial or reciprocity application to the correct state government agency. The form may ask questions about your education, experience, and criminal history.

question-mark-circleIs the CNA exam hard?

The CNA exam can be hard for some, but generally should not pose much of a challenge if you did well in your program and studied in advance. CNA practice exams can help you review essential topics and identify areas of improvement.

Ask your CNA program teachers for additional advice or study materials.

question-mark-circleWhat are CNAs not allowed to do?

CNAs cannot perform the duties of a registered nurse, such as administering medications and using most medical equipment. Their role primarily involves ensuring patients’ comfort and keeping records. That said, CNAs may perform the Heimlich maneuver or CPR in an emergency.

You can learn more about what CNAs can and can’t do in your state by visiting your state government’s Department of Public Health website. Government documents describe the profession’s scope, functions, and limitations.

question-mark-circleWhat type of CNA gets paid the most?

A 2023 report from ZipRecruiter shows that some nursing technicians earn more than $130,000 per year. This figure far exceeds the national median salary for CNAs, which is $30,310 as of May 2021.

Other well-paying careers for CNAs include nursing unit clerk and nurse aide evaluator.

Keep in mind that many factors can affect your salary, such as location and experience. Expect to earn an entry-level salary in your first job.

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