How to Become a Certified Nursing Assistant

The role of Certified Nursing Assistant, or CNA, is quickly becoming one of the fastest growing careers in healthcare. This is largely due to the increasing age of the Baby Boomer generation and advancements in medical care which allows for a longer lifespan. According to the US Bureau of Labor Statistics, CNA job growth is expected to be 21% for the 2012-2022 decade. To meet the demand, many schools are offering CNA programs to prepare the student for the federally mandated state exam.

CNA program options range from 100% online courses to 100% classroom courses and can cost anywhere between $400 and $3000. With so many options available, getting started in a career in healthcare has never been easier!

About the CNA Role

The role of the CNA is to support the licensed practical nurse and the registered nurse by providing patients with basic care. They are employed primarily by hospitals, long­term care facilities, acute care facilities, and home health agencies. The pay rate ranges greatly by state and type of facility as well as by shift preference. But in whichever facility the CNA chooses to work the primary job duties remain somewhat consistent.

While the CNA's job duties include a wide range of tasks, primary responsibilities include obtaining vital signs and recognizing and reporting abnormal values, answering call lights, setting up and removing medical equipment, and assisting the patient with activities of daily living (ADL's). As the name implies, activities of daily living include basic activities that an individual engages in to maintain their daily health and wellbeing.

CNA's Role in Assisting the Patient with Activities of Daily Living Include:

  • Meal preparation and delivery
  • Assisting the patient in ambulating to the bathroom for the elimination of bowels and/or bladder
  • Providing or assisting with hygiene, including showers and baths Assisting with ambulation
  • Assisting the nurse with repositioning the patient in bed and/or range of motion for the immobile patient
  • Grooming the patient
  • Maintaining a clean patient environment

CNA's must be compassionate, caring, empathetic, kind, and have patience with others. They are sometimes the only person a patient will see in a day, such as with home health care, and they can bring tremendous joy and happiness to this person through companionship. In some situations, the CNA may know the patient and family better than any other member of the healthcare team, and often their expertise is appreciated when discussing and determining the plan of care.

Considerations When Choosing a CNA Program

Certified Nursing Assistant programs are sweeping the nation. Every state now has at least one CNA program and more are being established every day. From online programs with on­site clinical requirements to 100% classroom models, potential CNA students have many options for obtaining CNA education. When considering a program, be sure it complies with state and federal requirements.

The 1987 Nursing Home Reform Act requires the CNA student to have at least 75 hours of training, 16 of which are required to be clinical hours, or "hands­on" training. A quality program should provide at least these minimum requirements, however the actual hours a program requires to graduate may vary greatly from school­to­school. When considering a CNA program, it's best to choose one that fits the schedule of you and your family.

Some Issues to Consider When Selecting a CNA Program Include:

  • Do you have a preference for day or evening classes?
  • If you plan on working your current job during the CNA program be sure you will have time to study, maintain family life, and, don’t forget, sleep! With so many programs available, a suitable program for your lifestyle is likely available.
  • Are you an effective online learner?
  • Some students are excellent at online learning. Characteristics for a great online learner include being a self ­starter, highly motivated to learn and complete the program, good reading comprehension skills, and time to complete each class. Find out exactly how many hours of studying the school recommends for each online class and be sure you are able to comply. This may not always be accurate but it’s a great place to start.
  • Is childcare an issue?
  • Finding quality daycare during school hours is necessary for many parents. If unable to find affordable daycare, perhaps online programs or evening classes are a better fit than daytime classroom. Don’t forget the federally required 16 clinical hours and ask the school at what point during the program and where these hours are fulfilled. Some schools may even offer daycare.
  • How fast do you wish to complete your CNA education and start working?
  • Certain schools may offer a fast ­track program to expedite CNA education. These courses are usually offered as long days for a short while instead of shorter days for a long period of time.
  • Fast­track programs are sometimes more expensive than traditional or online program because of their convenience.
  • How much money can you afford to spend?
  • Be sure the program matches your budget and pay schedule. Some schools allow a pay ­over­time option and may even offer financial aid. Fast­ track programs and online programs may be more expensive because they are more convenient than traditional programs. So be sure to weigh all options before committing to a program.
  • General program requirements vary by program but usually require the student to be at least 16 years of age, hold a state driver’s license or social security card, be able to pass a physical exam, background check and drug screen, have proof of vaccinations including a tuberculosis test, and have completed basic English and math courses. Being fluent in English is required by most schools, as well.
  • To qualify for graduation, the CNA student must demonstrate knowledge of basic patient care while performing tasks while under the direct supervision of a licensed nurse and pass the state exam. Good attendance in the classroom and at clinicals as well as passing scores on tests are program requirements.

Choosing a Quality CNA Program

Choosing any school for healthcare positions takes special consideration to choosing a career not in healthcare. Similar to choosing an LPN program, choosing a CNA program must be carefully researched.

State Exam Pass Rates: Each state posts a list of CNA schools along with their state exam pass rates. Choosing a school with at least a 75% pass rate is ideal. Pass rates demonstrate the effectiveness of the program in teaching its students. If pass rates are low, the school may not provide qualified instructors or educational materials to facilitate learning.

Social Media: Websites such as AllNurses, Facebook, Twitter, and LinkedIn may provide some feedback to you from students at the school.

Required Hours: The state mandates at least 75 hours of classroom, or didactic, instruction and 16 hours of clinical experience. A legitimate program must provide these requirements to allow the student to qualify to take the state board exams.

Cost: The cost of a CNA program can vary greatly from state­ to ­state, by type of program, and by school. CNA programs can cost anywhere from $400 up to $3000. Reasons for the variation include offering more clinical or classroom hours than the federal requirement, convenience of online courses, and reputation of the school. Some programs may require college courses in English or math and if you have already completed these courses the program cost may be less than advertised. Also, some schools may include the cost of textbooks and other education material with the tuition fees while others charge extra once enrolled.

Preparing for the State CNA Exam

Attending a quality CNA program should prepare its students for the state exam. In addition to classroom materials the student may benefit from online sources. Searching the internet for “CNA state exam practice questions” will provide some additional resources. Flashcards, practice exams, and study topics are available both free and for a nominal fee.

Working as a CNA

After successfully passing the state board exam the newly certified nursing assistant can now apply for positions. While the acute care hospital positions are often highly sought after this role may not be a good fit for every CNA.

CNA’s working in a hospital environment primarily obtain vital signs and sometimes point ­of ­care blood sugar test using a glucometer, answer call lights when patients need assistance, help patients get to the bathroom, help patients walk around the hallways, assist the patient in eating meals, and assist the nurse with dressing changes or treatments. Patients in the hospital usually do not stay for extended periods of time, so the relationship a CNA forms with the patient is often short­ lived.

CNA’s working in acute care or long ­term care facilities focus mainly on distributing and assisting with meal consumption, showers, helping patients with getting to the bathroom as well as checking to be sure incontinent patients are clean, and helping patients get ready for the day in the morning. This may include performing oral care and dressing the patient then helping them get into their wheelchair for the day. Vital signs and blood sugars are not usually checked as often in this setting as in the hospitals environment.CNA’s in this setting may feel a great sense of joy and pride as they bond with their patients and are able to provide them with dignity and friendship over a long period of time. Patients in these settings usually remain there for extended periods of time.

CNA vs LPN

When deciding a career path in nursing, CNA, LPN and RN are the options to consider to get started. Master’s level education can be achieved , if desired, but usually a nurse practitioner works as a CNA, LPN, or RN first.

Similar to considering the LPN vs RN path, the CNA vs LPN career should also be compared:

  • CNA’s work under the direction of a licensed nurse, either RN or LPN, depending on the healthcare setting
  • CNA’s are not licensed, they are certified
  • CNA’s attend less hours of school than the LPN to become certified and start working faster
  • CNA’s earn less money than LPN’s in the same setting
  • The CNA role focuses on completing tasks and activities of daily living and LPN’s consider overall goals and plan of care
  • CNA’s do not usually hold supervisory positions

Many CNA’s use this role as a platform to gain experience in the healthcare field and discover what the LPN and RN role consists of. While the CNA position is entry ­level, it is a vital role in the healthcare field. CNA’s provide a personal level of care which LPN’s and RN’s may not be able to provide. RN’s and LPN’s often look to the expertise of the CNA for certain aspects of patient care.

Many CNA’s later return to school and complete licensed practical nursing (LPN) or registered nursing (RN) education while working as a CNA. In many states, CNA to LPN bridge programs are offered, as well as LPN to RN bridge programs. These programs credit the student with courses already completed so they may be less expensive than the full traditional course.

Wait lists for a CNA bridge program are usually shorter than for a non ­CNA. RN wait lists can be as long as 5 years in some places, so it makes sense to work as a CNA while attending LPN school then work as an LPN while attending RN school. And in the meantime, instead of working in a job unrelated to healthcare, the student is gaining a lot of healthcare experience while attending school.

Finding a CNA Job after Graduation

Once a student graduates from CNA school and successfully passes the state CNA exam they will want to find a job, and fast! But where should the search begin?
Most facilities post job openings online along with job requirements and sometimes hourly pay rates. Completing the online application and sending an updated resume and cover letter will hopefully illicit a response. Helpful resume and interview tips can be found online or from experts willing to create your resume for maximum effectiveness.

CNA’s have a crucial role in the healthcare team and a career as a CNA can be very rewarding. With job growth expected to increase through the next decade and schools offering flexible programs to meet a variety of schedules and budgets the time has never been better to become a CNA.

CNA Salary

StateCNA Median Salary
 Alabama       21,180
 Alaska       35,120
 Arizona       27,440
 Arkansas       21,030
 California       28,210
 Colorado       27,560
 Connecticut       31,030
 Delaware       27,570
 District of Columbia       28,520
 Florida       23,140
 Georgia       21,280
 Guam       23,580
 Hawaii       29,810
 Idaho       22,230
 Illinois       23,840
 Indiana       22,720
 Iowa       23,810
 Kansas       22,540
 Kentucky       22,790
 Louisiana       19,910
 Maine       23,810
 Maryland       27,620
 Massachusetts       29,070
 Michigan       26,380
 Minnesota       26,830
 Mississippi       20,250
 Missouri       22,140
 Montana       23,940
 Nebraska       23,830
 Nevada       30,850
 New Hampshire       28,050
 New Jersey       27,410
 New Mexico       24,550
 New York       32,700
 North Carolina       22,340
 North Dakota       27,680
 Ohio       23,740
 Oklahoma       21,490
 Oregon       27,100
 Pennsylvania       27,330
 Puerto Rico       18,610
 Rhode Island       28,030
 South Carolina       21,650
 South Dakota       22,680
 Tennessee       22,520
 Texas       22,980
 Utah       22,580
 Vermont       26,570
 Virgin Islands       24,760
 Virginia       23,380
 Washington       27,920
 West Virginia       21,810
 Wisconsin       25,770
 Wyoming       27,310

Source: U.S. Bureau of Labor Statistics, May 2012

Angela Ebel, MSN, RN

Angela Ebel, RN, MSN is a clinical nurse specialist currently in outpatient clinical practice and research. She is a graduate of Yale University and a Fellow in Patient Safety from Virginia Commonwealth University. Her nursing experience ranges from critical care, emergency, outpatient, and home health care. She has designed and implemented hospital error reporting software, implemented computer-based training, authored several CBTs, authored several book chapters and journal articles, been an educator for a trach speaking valve product, served as a nursing instructor, written several video scripts for a national patient safety provider, is a nurse blogger, and has been an instructor in an online patient safety fellowship using Blackboard. She is married with boy/girl twins, volunteers for local performing arts center, and volunteers for Camp Twitch and Shout for kids with Tourettes syndrome.