How to Become a Certified Nursing Assistant (CNA)

Certified nursing assistants (CNAs) are essential members of medical and patient care teams. They work directly with patients, helping them navigate daily activities and improve their quality of life. A CNA’s work can be difficult, but CNAs tend to report high job satisfaction. Prospective CNAs can follow a range of career paths, each leading to different job duties and work environments.

How Long Does It Take to Become a CNA?

Because CNAs work with patients with a wide range of needs and conditions, they must receive specialized training. This training usually entails completing a state-approved education program, completing a predetermined number of supervised clinical hours, and passing an exam. CNA education programs typically last between 4 and 16 weeks, including clinical hours.

Programs and requirements vary by state, so it’s important to check with your state board of nursing for specific information and program guidance. Nursing assistant program graduates are not fully certified until they pass a state-specific certification exam; however, after you graduate, you may be able to work without certification for up to four months if you are waiting to take your CNA exam. When figuring out your CNA timelines, remember to factor in exam preparation and study time

Related: CNA Training and Course Cost

What Does a CNA Do?

CNAs can be found in almost every type of healthcare field, so job duties can be quite varied depending on your work environment and the needs of your individual patients. Getting familiar with required tasks and expectations can help you determine whether being a CNA is right for you, and which type of work environment best aligns with your goals and interests.

CNA Duties

Regardless of your work setting, you’ll be interacting directly with patients. Here are a few examples of patient-centered tasks common to most certified nursing work environments:

• Help with non-invasive medical procedures: CNAs may help nurses and patients alike by tending to small medical procedures, such as dressing wounds.
• Help patients with daily activities: Helping patients navigate their day-to-day lives with dignity is a significant part of CNA work. This can include assisting with cleaning, bathing, eating, getting dressed, and using the bathroom. It can also involve pleasant activities like taking walks, exercising, and doing personal enrichment activities.
• Reposition and transfer patients: Many patients have mobility issues, so certified nursing assistants often reposition residents in their beds to prevent bedsores. They may also help move patients between beds and wheelchairs.
• Listen to patients’ health concerns: CNAs spend a lot of time with their patients, building bonds of trust. A CNA may be a patient’s first line of communication when voicing personal or medical concerns. Listening to those concerns, documenting them, and relaying them to the supervising nurse are important duties.
• Report to nurses: CNAs must pay attention, make careful observations, and report any notable changes or red flags to nurses. This requires learning to interpret non-verbal cues, plus timely, accurate, written and verbal communication skills.
• Take vital signs: Checking blood pressure, heart rate, and other vitals are common CNA responsibilities.
• Serve meals and help with feeding: For many patients, eating may be difficult. CNAs are there to serve meals and help residents get the nutrition they need.
• Housekeeping tasks: Housekeeping helps ensure patients’ health and wellbeing. CNAs may be responsible for cleaning rooms, changing bed linens, and other tidying tasks.

Where Can a CNA Work?

From general hospitals to cancer clinics to assisted living facilities, from urban to suburban locations, CNAs have many choices.

• Skilled nursing facilities

Many CNAs start their careers in skilled nursing facilities because those facilities tend to regularly have job openings. Patient stays are often covered by Medicare, ensuring a large potential patient base.

CNAs in skilled nursing facilities generally care for multiple residents at a time, so working quickly and efficiently is a must. Working in these facilities can be mentally and physically taxing, but also serves as a great starting point for new CNAs. Experienced CNAs who thrive in bustling environments may find that skilled nursing facilities are a good long-term fit.

• Nursing homes

Nursing homes are similar to skilled nursing facilities with regard to work environment, and many of the services provided are the same. However, nursing homes generally do not provide nursing services. Instead, CNAs in these facilities focus on custodial care and other types of assistance to residents.

• Hospitals

Hospitals tend to offer good schedules, employee benefits, and highly trained coworkers, making them very desirable and sought-after work environments for CNAs. Hospital positions are usually difficult to get, but establishing a relationship with a hospital as a volunteer or intern can be a good way to get your foot in the door.

• Assisted living facilities

Assisted living facilities are often more relaxed than other CNA work environments because residents tend to need far less assistance than those in skilled nursing facilities, nursing homes, or hospitals. Most residents can do many of their day-to-day activities with little to no help. Your job duties thus might include charting, monitoring and recording vital signs and other factors, and responding to call bells from residents. Many CNAs find that working in these settings is rewarding due to the low-stress environment and the opportunities to build meaningful relationships with residents.

• Home health aide agencies

In-home care is also a popular route for many CNAs. You get the benefit of working with fewer patients — often just one — which allows you to build stronger connections. Your range of duties will depend on the specific needs of the patient.

Qualities of a Good CNA

Like any other profession, succeeding as a CAN — and enjoying the work — is more likely if you have certain job-specific qualities. For a CNA, those include:

• Empathy and compassion: CNAs often work with people going through difficult life changes, including physical and cognitive deterioration, which can make life challenging and frustrating. Being empathetic and compassionate is essential to providing care and improving patients’ quality of life.
• Patience: The challenges patients and residents face can be as frustrating for their CNAs as they are for the patients themselves. Those who can’t be patient in physically and mentally taxing circumstances may have a difficult time with CNA work.
• Physical strength and stamina: CNAs often have to help their patients move, which can involve lifting them, turning them, or moving them to a wheelchair or another bed. CNAs do this type of physical activity daily, often for multiple patients, so staying fit and building endurance is helpful.
• Discretion: CNAs often deal with sensitive, personal information. Thus, they need to be able to maintain confidentiality and avoid sharing the particulars of their work with others. This can be difficult for some people.
• Strong communication skills: CNAs need to be able to use different methods of communication with patients, as their needs, temperaments, and comprehension can vary widely. CNAs must also be able to communicate effectively with nurses and other staff.
• Active listening skills: Whether they’re dealing with patients, families, nurses, or other staff, good CNAs must be excellent listeners. It’s important to hear and understand detailed information shared by residents, their relatives, or coworkers.
• Problem recognition: CNAs need to be able to use their training to recognize when something isn’t right with a patient so they can alert the supervising nurse or other medical staff.
• Comfort working in close proximity with patients: Many common CNA responsibilities require physical contact with patients. Those who are uncomfortable with such contact might have difficulty with some of the tasks they will have to perform.

How Much Does a CNA Make?

According to the Bureau of Labor Statistic (BLS), the mean average salary for CNAs in May 2018 was $29,580.

Certified nursing assistant salaries vary by geographic location and work setting. The following tables show breakdowns for these two factors.

Breakdown By State (BLS, May 2018)

State	CNA Mean Annual Wage
Alabama	$24,110
Alaska	$39,830*
Arizona	$31,450
Arkansas	$25,080
California	$35,220*
Colorado	$32,610
Connecticut	$33,390
Delaware	$30,780
Florida	$26,840
Georgia	$25,870
Hawaii	$35,770*
Idaho	$27,400
Illinois	$28,810
Indiana	$27,210
Iowa	$29,120
Kansas	$26,210
Kentucky	$26,800
Louisiana	$22,750
Maine	$28,710
Maryland	$31,310
Massachusetts	$33,630
Michigan	$30,130
Minnesota	$33,710
Mississippi	$23,100
Missouri	$25,930
Montana	$29,110
Nebraska	$28,730
Nevada	$35,130*
New Hampshire	$32,200
New Jersey	$30,380
New Mexico	$28,310
New York	$37,010*
North Carolina	$25,570
North Dakota	$33,990
Ohio	$27,570
Oklahoma	$25,690
Oregon	$33,230
Pennsylvania	$30,630
Rhode Island	$31,340
South Carolina	$25,390
South Dakota	$26,820
Tennessee	$26,400
Texas	$27,030
Utah	$27,880
Vermont	$30,730
Virginia	$28,770
Washington	$32,130
West Virginia	$26,410
Wisconsin	$29,590
Wyoming	$30,910

*Top five states

Breakdown By Work Setting (BLS, May 2018)

Industry	Annual mean wage (2)
Specialty (except Psychiatric and Substance Abuse) Hospitals	$32,020
General Medical and Surgical Hospitals	$31,540
Nursing Care Facilities (Skilled Nursing Facilities)	$28,560
Home Health Care Services	$28,130
Continuing Care Retirement Communities and Assisted Living Facilities for the Elderly	$27,780

Job Outlook for CNAs

Demand for qualified CNAs is growing. Nearly 1.7 million CNA jobs are expected by 2026—an increase of about 170,000 positions since 2016, or 11%, per the Bureau of Labor Statistics. This growth is faster than the average for all careers, which averages about 7%.

As the baby boomers age, more caretakers are needed to help this large population go about their lives as comfortably as possible; that’s a big factor in the growing demand for CNAs.

Where you choose to work — both geographically and by work setting — also affects career outlook.

The top five employment levels are found in the following work settings:

Industry	Employment Level
Nursing Homes	581,140
Hospitals	372,320
Assisted Living Facilities	163,950
Home Healthcare Services	80,150
Individual and Family Services	39,080

The top five states for CNA employment are:

State	Employment Level
California	99,440
New York	91,400
Florida	89,860
Texas	87,750
Pennsylvania	76,260

CNA Related Careers and Career Advancement

Training and working as a CNA can be a stepping stone to related and advanced careers.

• Certified Medical Assistant (CMA): Medical assistants provide patient care in clinical environments. They may perform administrative duties, clinical duties, or both, depending on the job. Duties may include reception work, administering shots, drawing blood, performing lab tests, and taking X rays. CMAs need special training and certification.
• Emergency medical technician (EMT): Emergency medical technicians (EMTs) give care to ill or injured people in emergency situations. If patients need more care, they drive them to medical facilities.
• Patient Care Technician (PCT): Patient care technicians do many of the same job tasks as certified nursing assistants in exam rooms and hospital settings. However, training to become a PCT can provide you with the skills you need to perform additional specialized duties. Patient care in patients before they go in to the exam room. They may confirm a patient’s identity, take their blood pressure, check heart rate, and record pulse.
• Licensed Practical Nurse (LPN): LPNs generally have an associate or bachelor’s degree and perform a range of nursing and patient care tasks. They work with physicians and registered nurses to provide care to patients, and may perform tasks like checking vitals, administering medications, and filling out medical charts.

Related: LPN vs. CNA

• Registered Nurse (RN): RNs have advanced training in patient care, often at the associate or bachelor’s degree level. RNs may supervise other medical and care team members, like LPNs, CMAs, and CNAs. RNs may specialize their training to an area of interest or expertise, such as public health, addiction nursing, or neonatal nursing.

Certified Nursing Assistant Schools By State