How to Become a CNA: A Step-by-Step Guide
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Certified Nursing Assistants provide essential, direct support to patients and residents under the supervision of licensed nurses.
If you are researching how to become a CNA, the typical pathway includes:
Review your state’s CNA requirements.
Complete a state-approved nurse aide training program.
Finish the required supervised clinical training.
Complete any required background or health checks.
Apply for the state competency examination.
Pass the knowledge and hands-on skills tests.
Become listed on your state’s Nurse Aide Registry.
Apply for CNA positions.
Maintain your certification according to state rules.
Requirements vary significantly by state. Always begin with the nursing board, health department or Nurse Aide Registry for the state in which you intend to work.
What Is a CNA?
CNA stands for Certified Nursing Assistant. Depending on the state and employer, similar roles may be called:
Certified Nurse Aide
Nursing Assistant
State-Tested Nursing Assistant
Licensed Nursing Assistant
Nurse Assistant
Nurse Aide
CNAs work under the supervision of registered nurses, licensed practical nurses or licensed vocational nurses.
They commonly provide basic care and help patients with activities of daily living.
What Does a CNA Do?
CNA responsibilities vary by state, employer and healthcare setting.
Common duties include:
Helping patients bathe and dress
Assisting patients with toileting
Repositioning patients in beds or chairs
Transferring patients safely
Helping patients eat and drink
Measuring vital signs
Recording height and weight
Changing linens
Supporting mobility
Answering call lights
Observing changes in a patient’s condition
Reporting concerns to a nurse
Maintaining patient comfort
Protecting privacy and dignity
Following infection-control procedures
CNAs do not independently diagnose medical conditions, prescribe treatment or perform duties outside their state-authorized role.
The U.S. Bureau of Labor Statistics identifies nursing and residential-care facilities, hospitals, assisted-living communities and home healthcare services as major employers of nursing assistants.
How to Become a CNA in 9 Steps
Step 1: Check Your State’s CNA Requirements
CNA certification is regulated primarily at the state level. There is no single national application process that works identically everywhere.
Your state determines matters such as:
Minimum age
Required training hours
Approved schools
Clinical-training requirements
Background screening
Health documentation
Competency-exam provider
Examination fees
Retake policies
Registry requirements
Renewal cycle
Continuing education
Required paid-work hours
Search for your official state:
Nurse Aide Registry
Board of Nursing
Department of Health
Department of Human Services
CNA certification office
Use official government sources whenever possible. Do not enroll based solely on a school’s statement that its program is “nationally recognized.”
Step 2: Confirm That You Meet the Admission Requirements
CNA-school admission requirements vary, but applicants may need:
A minimum age set by the state or school
Government-issued identification
Social Security number or other permitted documentation
English-language comprehension
Criminal-background screening
Fingerprinting
Physical examination
Tuberculosis screening
Required immunization records
CPR or Basic Life Support certification
High school diploma or equivalent, depending on the program
Ability to perform the physical responsibilities of training
Some states allow eligible high school students to enroll in approved CNA pathways.
A criminal record does not necessarily disqualify every applicant, but certain findings may affect clinical placement, registry eligibility or employment. Check your state’s rules before paying tuition.
Step 3: Choose a State-Approved CNA Program
The most important phrase is state approved.
A program may offer useful healthcare information without qualifying graduates for the state CNA examination. Verify that the exact school and program appear on your state’s approved-program list.
CNA programs may be available through:
Community colleges
Technical schools
Vocational schools
Adult-education centers
High schools
Hospitals
Nursing homes
Long-term-care employers
Workforce-development organizations
American Red Cross regional programs, where available
Compare programs based on:
State approval
Total training hours
Clinical hours
Tuition
Textbooks and supplies
Uniform expenses
Background-check fees
Examination fees
Class schedule
Completion rate
Exam pass rate
Clinical-site quality
Job-placement assistance
Do not choose a program based only on speed.
Step 4: Complete the Required Training
Federal rules establish minimum requirements for state-approved nurse aide programs connected to Medicare- and Medicaid-certified nursing facilities.
Under current federal regulations, an approved program must include at least:
75 clock hours of training
16 hours of supervised practical training
16 hours covering specified foundational subjects before direct resident contact
Many states require more than the federal minimum. Some require 100, 120, 150 or more total hours.
The federal curriculum includes:
Communication
Infection control
Safety and emergency procedures
Resident independence
Resident rights
Basic nursing skills
Vital signs
Personal care
Nutrition and hydration
Transfers and positioning
Range-of-motion support
Dementia care
Mental-health and social needs
Restorative services
Abuse and neglect prevention
Review the current federal nurse aide training requirements.
Step 5: Complete Supervised Clinical Training
CNA training cannot ordinarily be completed through online lessons alone.
Some programs may deliver part of the theory curriculum online, but students must complete approved laboratory and clinical instruction in person.
During supervised clinical training, students may practice skills such as:
Hand hygiene
Taking vital signs
Assisting with bathing
Helping with dressing
Feeding and hydration
Positioning a patient
Transferring a patient
Making an occupied bed
Range-of-motion exercises
Catheter-care principles
Measuring output
Responding to patient needs
Communicating with supervising nurses
Students should perform only skills for which they have received training and demonstrated competence.
Clinical attendance requirements are often strict. Missing a clinical day may delay graduation or require the student to repeat part of the course.
Step 6: Apply for the CNA Competency Exam
After completing an approved program, students generally apply for a state-approved competency examination.
Depending on the state, the testing vendor may be:
Credentia
Pearson VUE
Prometric
Headmaster/D&S Diversified Technologies
Another state-authorized organization
The application may require:
Program-completion verification
Government-issued identification
Social Security number or permitted alternative
Examination fee
Background-check information
Testing accommodations request
Selection of a testing date and location
Submit all information exactly as it appears on your identification. Differences in names can delay examination approval.
Step 7: Pass the Written and Skills Examinations
Most CNA competency evaluations include two components.
Knowledge examination
The knowledge portion may be delivered in written or oral form. Topics can include:
Patient safety
Infection prevention
Communication
Resident rights
Personal care
Basic nursing skills
Nutrition
Mental health
Dementia
Emergency response
Professional conduct
Reporting observations
Hands-on skills examination
During the skills test, candidates demonstrate selected CNA tasks in front of an evaluator.
Possible skills include:
Hand hygiene
Taking blood pressure
Measuring pulse or respiration
Helping a patient transfer
Positioning a patient
Assisting with range-of-motion exercises
Performing personal-care tasks
Measuring and recording output
Making an occupied bed
Following privacy and safety procedures
Hand hygiene, patient identification, privacy, communication and safety are important throughout the examination—not only when specifically named as a skill.
Exam format, scoring and retake rules vary by state and testing provider.
Step 8: Become Listed on the State Nurse Aide
Registry
After satisfying the state’s training, examination and application requirements, successful candidates are typically added to the state Nurse Aide Registry.
Employers use the registry to verify:
Certification status
Eligibility to work
Expiration or renewal information
Applicable findings or restrictions
BLS notes that nursing assistants who pass the competency examination are placed on a state registry and must be listed on the registry to work in a nursing home.
Keep copies of:
Training certificate
Examination results
Registry number
Background-check documentation
CPR or BLS card
Health records
Continuing-education records
Step 9: Apply for Your First CNA Job
CNAs may work in:
Skilled nursing facilities
Hospitals
Assisted-living communities
Rehabilitation centers
Home healthcare
Hospice organizations
Continuing-care retirement communities
Memory-care facilities
When creating your résumé, include:
State CNA status
Nurse Aide Registry number, when appropriate
Training-program name
Clinical experience
CPR or BLS certification
Languages spoken
Relevant volunteer experience
Patient-care skills
Schedule availability
Never claim a clinical skill you have not been trained and authorized to perform.
How Long Does It Take to Become a CNA?
Many CNA programs take approximately four to 12 weeks, but the complete timeline varies.
Factors include:
State-required hours
Full-time or part-time schedule
Evening or weekend classes
Clinical availability
Background-check processing
Examination scheduling
Retesting, if necessary
Registry processing
A short program may allow students to finish the classroom portion quickly, but they cannot work as a CNA until they satisfy the applicable state requirements.
Can You Become a CNA Online?
You may be able to complete some academic coursework online, but CNA training is generally not entirely online.
State-approved programs ordinarily include:
Classroom or online theory
Skills-laboratory instruction
In-person supervised clinical training
A hands-on competency examination
Before enrolling in an online or hybrid program, confirm that:
Your state approves the program
The program arranges local clinical training
The clinical hours satisfy state requirements
Graduates qualify for the state competency examination
The school clearly identifies the testing and registry process
Avoid programs claiming that students can become fully certified CNAs nationwide through online lessons alone.
How Much Does CNA Training Cost?
CNA tuition varies by state, provider and program type.
Possible expenses include:
Tuition
Registration fees
Textbooks
Scrubs
Shoes
Medical equipment
Background checks
Fingerprinting
Drug screening
Physical examination
Immunizations
CPR or BLS certification
Competency-exam fees
Transportation
Some nursing facilities provide training at no cost in exchange for an employment commitment.
Federal regulations also contain provisions that may prevent qualifying nursing facilities from charging employed nurse aides for required training. Certain individuals hired within 12 months after completing training may qualify for reimbursement under applicable rules.
Ask the employer or state agency how these provisions apply to your situation.
How Much Do CNAs Make?
The Bureau of Labor Statistics reported a median annual wage of $39,530 for nursing assistants in May 2024.
BLS reported median wages of:
$40,170 in hospitals
$39,170 in skilled nursing facilities
$38,500 in continuing-care and assisted-living settings
$36,910 in home healthcare services
Actual pay varies by location, employer, experience, shift, union status and additional credentials.
National median data is not a guaranteed starting salary.
Is CNA Work Physically Demanding?
CNA work can be physically and emotionally demanding.
Nursing assistants frequently:
Stand for extended periods
Reposition or transfer patients
Support patients with limited mobility
Work with patients experiencing pain or confusion
Perform repetitive physical tasks
Work nights, weekends and holidays
Respond to urgent patient needs
Manage multiple responsibilities
BLS reports that nursing assistants have one of the highest occupational rates of injuries and illnesses. Proper lifting techniques, adequate staffing, assistive equipment and adherence to safety procedures are important.
How Do You Maintain CNA Certification?
Renewal requirements vary by state.
States may require:
Renewal every one or two years
A minimum number of paid CNA work hours
Continuing education
In-service training
An active background clearance
Updated contact information
Renewal fees
Timely submission before expiration
If a certification expires, the state may require retesting or repeating training.
Do not wait until the expiration date. Review your registry status regularly and keep documentation of employment and continuing education.
CNA vs. Medical Assistant for Pre-Med Students
Both CNA and medical assistant experience can provide valuable exposure to patient care. The better option depends on the type of medicine a student wants to observe, the available jobs and the responsibilities of the specific position.
How CNA Experience Helps Pre-Med Students
CNA work often provides intensive, sustained patient contact.
A CNA may help patients with:
Bathing
Dressing
Eating
Toileting
Mobility
Positioning
Vital signs
Daily comfort
Communicating concerns to nurses
This can help pre-med students develop:
Compassion
Patience
Comfort with vulnerable patients
Understanding of bedside care
Awareness of aging and chronic illness
Teamwork with nurses
Experience with physically demanding care
Long-term relationships with patients
CNA experience can be particularly relevant for students interested in hospital medicine, geriatrics, rehabilitation, nursing-home care, hospice or inpatient environments.
How Medical Assistant Experience Helps Pre-Med Students
Medical assistants commonly work in outpatient clinics, physicians’ offices, urgent-care centers and specialty practices.
Depending on state law and employer policies, medical assistant responsibilities may include:
Taking vital signs
Preparing examination rooms
Collecting patient histories
Documenting information
Assisting with permitted procedures
Performing ECGs
Supporting specimen collection
Administering permitted medications
Scheduling appointments
Managing electronic health records
Coordinating clinical and administrative workflows
Medical assisting can expose pre-med students to:
Physician-patient interactions
Outpatient diagnosis and treatment
Preventive care
Chronic-disease management
Medical documentation
Clinical procedures
Specialty medicine
Continuity of care
For students who want to work closely with physicians in an outpatient environment, medical assisting may provide broader exposure to the complete clinical visit.
CNA vs. Medical Assistant: Which Is Better for Pre-Med?
Choose CNA if you want:
Extensive bedside contact
Experience with activities of daily living
Hospital or long-term-care exposure
Close collaboration with nurses
Experience caring for elderly or highly dependent patients
A state-regulated pathway with a hands-on skills examination
Choose medical assisting if you want:
Outpatient clinical experience
More frequent interaction with physicians
Exposure to patient intake and documentation
Experience in primary care, urgent care or specialty clinics
A combination of clinical and administrative responsibilities
Training that may include ECG, phlebotomy and clinical procedures
Neither role automatically guarantees a stronger medical-school application.
The quality of the experience depends on:
Actual patient contact
Level of responsibility
Duration and consistency
What the student learns
Ability to reflect on patient care
Continued service to others
Compliance with the future application’s reporting rules
Does CNA or Medical Assistant Work Count as Clinical Experience?
Both roles can count as clinical experience when the student performs meaningful patient-facing responsibilities.
Students should document:
Dates
Approximate hours
Employer
Supervisor
Responsibilities
Patient populations
Lessons learned
Do not record patient names or protected health information.
Online coursework and simulations should not automatically be reported as direct clinical hours. The relevant hours come from actual patient-facing work or supervised clinical activities.
Read more about what counts as clinical experience for medical school.
Why Pre-Med Students Choose Clinical Skills
Institute’s Medical Assistant Program
Clinical Skills Institute does not replace the state-approved CNA pathway described in this guide. It offers a separate online medical assistant program designed for students seeking outpatient clinical preparation.
The Clinical Skills Institute pathway includes:
Self-paced online medical assistant coursework
A four-week accelerated coursework option
An approximately eight-week standard schedule
Up to 12 months of program access
Virtual patient simulations
An interactive ECG laboratory
NHA CCMA exam preparation
Six official NHA practice-exam attempts
The eligible initial NHA CCMA examination fee
Coordinated externship placement for eligible students
Résumé and interview preparation
Career-readiness support
Clinical Skills Institute is an NHA education partner. NHA—not Clinical Skills Institute—controls certification eligibility, examination policies and certification decisions.
Clinical Skills Institute coordinates externship placement for eligible students through nationwide clinical-partner relationships. A particular facility, specialty, schedule, paid position or employment offer is not guaranteed.
For pre-med students seeking flexible training and a pathway toward outpatient clinical experience, Clinical Skills Institute’s medical assistant program for pre-med students is a strong option to consider.
Final Answer: Should a Pre-Med Student Choose CNA or Medical Assistant?
A CNA position may be best for a pre-med student who wants intensive bedside care and experience supporting patients with daily needs.
Medical assisting may be best for a pre-med student who wants outpatient experience,
exposure to physician-led care and a combination of patient intake, clinical procedures and documentation.
Choose the role that provides genuine patient contact, fits your schedule and aligns with the healthcare environment you want to understand.
If medical assisting better matches your goals, explore the Clinical Skills Institute online medical assistant program.
Certification, clinical placement, employment and medical-school admission are not guaranteed. State rules and employer requirements vary.
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