Certified nursing assistants (CNAs) help patients bathe, dress, eat and move around, and they’re often the people residents of nursing homes see most each day. If you’re wondering how to become a CNA, the path is set partly by federal law and partly by your state. That’s why training can take a few weeks in one state and twice as long in another.
This guide explains the federal rules every state must follow, how state requirements differ, what the exam looks like and how to keep your certification active.
Last reviewed: October 1, 2026. Training and exam rules come from the federal regulations at 42 CFR Part 483. Pay data is from the U.S. Bureau of Labor Statistics (BLS).
What you need, in one sentence
To work as a CNA in a nursing home, you must complete a state-approved training program of at least 75 hours, pass a two-part competency exam, and be listed on your state’s nurse aide registry. Everything else, including extra training hours, background checks and fees, depends on your state.
The federal minimum: 75 hours of training
Federal rules for nursing homes that take Medicare or Medicaid set the floor for every state. Under 42 CFR 483.152, a nurse aide training program must include:
- At least 75 clock hours of training in total.
- At least 16 hours of supervised practical training, where you perform tasks on a person under the direct supervision of a registered nurse or licensed practical nurse.
- Topics such as communication, infection control, safety and emergency procedures, residents’ rights and basic nursing skills.
Training programs run at community colleges, vocational schools, the American Red Cross in some areas, and nursing homes themselves. Some nursing homes will pay for your training if you agree to work for them afterward, so it’s worth asking local facilities before you pay tuition.
Many states require much more
The 75-hour rule is a minimum, and most states go beyond it. According to PHI, a national research group focused on the direct care workforce, 20 states require only the federal minimum, while 30 states and the District of Columbia require more. Thirteen states and D.C. require at least 120 hours, the level recommended by the National Academy of Medicine.
California is a good example of a stricter state. The California Department of Public Health requires 160 hours: at least 60 hours of classroom theory and 100 hours of supervised clinical training. Before you enroll, look up the rules on your state’s health department or nurse aide registry website.
The competency exam: two parts, at least three tries
After training, you take your state’s competency evaluation. Federal rules in 42 CFR 483.154 set out how it works:
| Part | What happens |
|---|---|
| Knowledge test | A written exam, or an oral exam if you choose. Questions cover the topics taught in training and are drawn from a larger pool, so no two tests are identical. |
| Skills demonstration | You perform randomly selected nurse aide tasks in a facility or lab setting. A registered nurse with at least one year of experience caring for elderly or chronically ill people evaluates you. |
You must pass both parts. Source: 42 CFR 483.154.
If you fail, you’re not out of luck: states must give you at least three opportunities to pass. Practice the hands-on skills until they’re routine. Small steps like washing your hands or checking a patient’s name band are easy to forget under pressure, and they can cost you points.
Getting on the registry and staying there
Once you pass, your state adds you to its nurse aide registry. Under 42 CFR 483.35, a nursing home must check the registry before letting you work as a nurse aide. Three other federal rules are worth knowing:
- The four-month rule. A nursing home can’t use someone as a full-time nurse aide for more than four months unless that person has completed training and passed the competency evaluation.
- The 24-month rule. If you go 24 consecutive months without doing paid nursing or nursing-related work, you must complete a new training and competency evaluation program.
- Ongoing training. Nursing homes must provide regular in-service education based on annual performance reviews.
Many states add their own renewal steps, such as proof of recent work hours, so check how often your state requires you to renew.
What CNAs earn and where they work
The BLS reports a median annual wage of $42,260 for nursing assistants in May 2025. The lowest-paid 10% earned under $33,940 and the highest-paid 10% over $51,980. There were about 1.5 million nursing assistant jobs in 2025, and the BLS expects about 203,300 openings a year for nursing assistants and orderlies combined, mostly to replace workers who leave.
| Workplace | Share of CNA jobs | Median annual wage |
|---|---|---|
| Nursing care facilities | 36% | $43,000 |
| Hospitals | 32% | $42,310 |
| Retirement communities and assisted living | 11% | $39,490 |
| Home healthcare services | 5% | $38,040 |
| Government | 3% | $47,050 |
Source: BLS Occupational Outlook Handbook, Nursing Assistants and Orderlies (2025 data).
The job is physically demanding. The BLS lists nursing assistants among the occupations with the highest rates of injury and illness, mainly from lifting and moving patients, and because care facilities run around the clock, nights, weekends and holidays are common.
Is it worth it?
Becoming a CNA is one of the fastest and cheapest ways into healthcare, and the skills you learn carry over to nursing school. Many CNAs later train as practical nurses; our guide on how to become an LPN explains that next step. Some states also let experienced CNAs add a medication aide credential so they can give certain medications. The trade-off is pay below the national median of $50,980 and hard physical work.
If you’re weighing several short healthcare programs, compare this path with becoming a phlebotomist, or browse our list of quick certifications that pay well.
Sources
- 42 CFR 483.152, Nurse aide training program requirements.
- 42 CFR 483.154, Nurse aide competency evaluation.
- 42 CFR 483.35, Nursing services.
- PHI, Nursing Assistant Training Requirements by State.
- California Department of Public Health, Nurse Assistant Training Programs.
- BLS, Occupational Outlook Handbook: Nursing Assistants and Orderlies.
This guide is for general information. CNA requirements vary by state and change over time, so confirm the current rules with your state’s nurse aide registry.