How to Become a Certified Nursing Assistant (CNA)

Certified nursing assistants earn a median salary of $39,530 while completing training programs that take as little as four weeks. But the work is physically demanding—nursing assistants have one of the highest injury rates of all occupations, primarily from lifting and repositioning patients, according to the Bureau of Labor Statistics. If you can handle the physical toll and irregular schedules, this role offers the fastest entry into health care and a clear path to higher-paying nursing positions.

The timeline matters because many people considering this career need income quickly. Federal law requires a minimum of 75 hours of training, though most states mandate significantly more. You'll spend roughly half that time in clinical settings, learning to safely lift patients, monitor vital signs, and provide personal care under the supervision of licensed nurses.

How Long Does It Take to Become a CNA?

You can complete CNA training in 4 to 12 weeks depending on your state's requirements and whether you attend full-time or part-time. The federal minimum is 75 hours of training, including at least 16 hours of supervised clinical work. Many states exceed this baseline—Texas requires 100 hours total with 40 hours of clinical training, while Maine mandates 180 hours with 90 hours of classroom theory and 90 hours of clinical work.

The timeline breaks down into three phases. Intensive full-time programs meeting federal minimums take 4-6 weeks. Part-time programs or states requiring more than 75 hours extend to 8-12 weeks. After completing training, you'll need an additional 1-2 weeks for scheduling and taking the competency exam.

After completing your state-approved program, you'll take a two-part competency exam consisting of written questions and a skills demonstration. Most states allow you to schedule the exam within days of finishing your coursework. Once you pass, you're added to your state's nurse aide registry and can begin working immediately.

Some facilities offer paid training programs where you work as a trainee while completing certification requirements. These arrangements typically extend the timeline to 12-16 weeks but eliminate out-of-pocket costs.

What CNAs Actually Do

CNAs provide the majority of direct patient care in nursing homes and hospitals. You'll spend most shifts helping patients with activities of daily living—bathing, dressing, toileting, and eating. The work is physically active. You'll regularly lift and reposition patients, often those who cannot move independently.

The Bureau of Labor Statistics reports that nursing assistants held approximately 1.4 million jobs in 2024. Your specific duties include measuring and recording vital signs like blood pressure and temperature, turning and repositioning bedridden patients every two hours to prevent bedsores, assisting with transfers between beds and wheelchairs, documenting food and fluid intake, and reporting changes in patient condition to supervising nurses.

Work settings vary significantly. Nursing care facilities employ 35% of CNAs, hospitals employ 33%, continuing care retirement communities and assisted living facilities employ 11%, and home health-care services employ 5%. Work schedules differ by setting. Nursing homes typically use 12-hour shifts with rotating weekends and holidays. Hospitals may offer 8-hour or 12-hour options across all shifts since patient care operates 24/7.

In some states, CNAs with additional training can administer medications as Certified Medication Aides. This credential typically requires 40-80 additional hours of coursework and increases earning potential.

The physical demands are real. Nursing assistants have one of the highest rates of injuries and illnesses of all occupations, primarily due to overexertion from repeated manual patient handling. The Occupational Safety and Health Administration recommends Safe Patient Handling programs that utilize mechanical lifts and assistive devices rather than manual lifting. When evaluating employers, prioritize facilities that provide lift equipment and comprehensive safety training.

State-Approved Training Programs

Only graduates of state-approved programs can take the certification exam. Do not look for traditional college accreditation when evaluating CNA programs. The Commission on Accreditation of Allied Health Education Programs (CAAHEP) does not accredit CNA programs. Instead, verify that your chosen program appears on your state's approved Nurse Aide Training and Competency Evaluation Program list through your state's Department of Health or Nurse Aide Registry.

Here's how real programs compare across cost and location:

Community colleges generally cost less than private vocational schools but may have longer wait lists. The American Red Cross offers programs in many states, typically priced between $1,000 and $1,500.

Beyond tuition, budget for hidden costs. Most programs require a criminal background check ($50-75), drug screening ($30-50), physical exam and immunizations ($100-300), uniform and non-slip shoes ($50-75), state exam fee ($120-150), and CPR certification ($50-80). Total out-of-pocket costs typically range from $1,400 to $2,200 when including all fees.

How to Get Free CNA Training

Federal law requires Medicare and Medicaid-certified nursing facilities to reimburse your training costs if they hire you within 12 months of program completion. Many facilities go further and offer free training upfront in exchange for a work commitment, typically 6-12 months.

The Omnibus Budget Reconciliation Act prohibits facilities from charging tuition to current employees or those with job offers. If you're already working in a nursing home in any capacity—dietary, housekeeping, activities—ask about sponsored CNA training.

Additional funding sources include Workforce Innovation and Opportunity Act grants through your local American Job Center, which cover training for in-demand careers. Income requirements vary by state. Some states offer health-care workforce grants. If you enroll in a for-credit CNA program at a community college, you may qualify for federal student aid including Pell Grants through the Free Application for Federal Student Aid.

The return on investment is immediate. With a median wage of $39,530 annually and training costs under $2,000, you recoup expenses within the first month of full-time employment.

State Requirements Comparison

Requirements vary significantly by state. Here's how key states compare:

Most states require candidates to be at least 16-18 years old and hold a high school diploma or GED. Background checks are mandatory in nearly all states. Texas law, for example, requires both a criminal history check and verification against the Employee Misconduct Registry.

Verify your state's specific requirements through your state health department's nurse aide registry website before enrolling in any program. You can find California's approved training programs through the California Department of Public Health, Texas programs through Texas Health and Human Services, and New York programs through the New York State Department of Health.

CNA Salary and Job Outlook

The Bureau of Labor Statistics reports a median annual wage of $39,530 for nursing assistants as of May 2024. The lowest 10% earn less than $31,390, while the highest 10% make more than $50,140.

Earnings vary significantly by work setting:

Geographic location affects pay substantially. CNAs in Alaska earn a median wage of $47,080, while those in California average $47,070. The District of Columbia pays a median of $47,860. Metropolitan areas typically pay 10-20% more than rural regions.

Employment growth is projected at 2% from 2024 to 2034, slower than the average for all occupations. Despite modest growth, the Bureau of Labor Statistics projects an average of 211,800 openings each year for nursing assistants and orderlies, largely driven by the need to replace workers who transfer to other occupations or retire.

Demand for nursing assistants may be constrained by financial pressures on nursing homes, which might lead some facilities to close or reduce staff. However, increased opportunities are expected in home- and community-based settings as patient preferences and policy changes generate demand for care in these settings. As the population ages, nursing assistants will be needed to help care for an increasing number of older people who have chronic or progressive diseases such as heart disease and diabetes.

Career Advancement Pathways

The CNA role serves as a foundational step for advanced nursing careers. Many CNAs use their experience to pursue Licensed Practical Nurse or Registered Nurse positions.

Here's how the nursing career ladder progresses:

Licensed Practical Nurses provide basic nursing care, administer medications, and perform wound care under the supervision of registered nurses or physicians. The role requires completing a diploma or certificate program, typically taking about 12 months, followed by passing the National Council Licensure Examination for Practical Nurses.

Registered Nurses assess patients, develop care plans, and have a wider scope of practice than LPNs. You can become an RN through an Associate Degree in Nursing (2-3 years) or Bachelor of Science in Nursing (4 years). Both pathways require passing the NCLEX-RN exam. BSN-prepared nurses are increasingly preferred by employers and have more opportunities for career advancement and specialization.

Bridge programs such as "CNA-to-LPN" or "CNA-to-RN" may recognize CNA experience, potentially streamlining admission or clinical requirements. Some employers offer tuition reimbursement for CNAs pursuing advanced nursing degrees.

What Makes This Career Challenging

The physical demands extend beyond occasional heavy lifting. You'll be on your feet for most of your shift, frequently bending, stooping, and working in awkward positions. The Bureau of Labor Statistics reports that nursing assistants have one of the highest rates of injuries and illnesses of all occupations.

Work schedules require flexibility. Because nursing and residential care facilities and hospitals provide care 24/7, you'll likely work nights, weekends, and holidays. Shift work can disrupt sleep patterns and make maintaining a consistent personal schedule difficult.

The emotional weight of the work affects many CNAs. You'll develop relationships with patients, particularly in long-term care settings where residents stay for months or years. Witnessing patient decline and death is a regular part of the job. Some CNAs find this aspect rewarding, while others experience burnout.

Infection control is critical. Federal regulations require infection control training before any direct patient contact. You'll follow CDC hand hygiene guidelines and standard precautions including proper use of personal protective equipment. The work involves regular exposure to bodily fluids and infectious agents.

Turnover in this field is high, which explains why job openings remain plentiful despite modest employment growth. The combination of physical demands, emotional challenges, and relatively modest pay compared to other health-care roles leads many CNAs to either advance to higher-level nursing positions or leave health care entirely.