US CNA Requirements

Certified Nurse Aide (CNA) training & certification requirements vary considerably across the U.S. In some states, the requirements go beyond the federal minimum while in other states requirements are nearly identical to the federal standards. This page provides background on federal CNA requirements and an outline detailing training and curriculum requirements.

To see requirements in other states, visit nursinghome411.org/cna-reqs. For a comparison of federal vs. state requirements, visit https://nursinghome411.org/cna-reqs/states/.

Minimum CNA training requirements are set by the federal government with implementation largely left to the states. Federal rules require that all nurse aide certification training programs provide “no less than 75 clock hours of training,” including at least 16 hours of supervised practical training. This practical training means “training in a laboratory or other setting in which the trainee demonstrates knowledge while performing tasks on an individual under the appropriate supervision.

The federal regulations specify that prior to any direct patient contact, individuals must complete at least 16 hours of training in: “Communication and interpersonal skills; Infection control; Safety/emergency procedures, including the Heimlich maneuver; Promoting residents’ independence; and Respecting residents’ rights.” In addition to these skills, the federal regulations mandate that every CNA training and competency program curricula cover a range of topics, including:

1. Basic nursing skills (such as recognizing abnormal changes in body functioning and the importance of reporting such changes to a supervisor);
2. Personal care skills (such as mouth care, grooming, and skin care);
3. Mental health and social service needs (such as how to appropriately respond to resident behavior);
4. Care of cognitively impaired residents (including appropriate methods of communicating with cognitively impaired residents and techniques for addressing the unique needs and behaviors of individual with dementia);
5. Basic restorative services (including proper turning and positioning in bed and chair); and
6. Resident rights (such as providing resident privacy, maintaining care and security of residents’ personal possessions, and promoting the resident’s right to make personal choices).

Competency evaluations must be completed prior to being certified as a nurse aide. Aides must be allowed to choose between a written or oral examination. The examination must address every requirement specified in the requirements for curricula. There also must be a “skills demonstration” portion of the exam. Though the skills to be performed should be randomly chosen, they must include all of the personal care skills enumerated in the federal curriculum requirements.

To maintain certification, CNAs must complete “in-service” education. Nursing homes must provide this “in-service education” and “regular performance review[s]” to ensure nurse aides are competent to perform services. They are also required to have training on providing care to residents with cognitive impairments. If “since an individual’s most recent completion of a training and competency evaluation program,” there were a “continuous period of 24 consecutive months during none of which the individual performed nursing or nursing-related services for monetary compensation,” that person is required to complete a new training and competency evaluation program.

Underlying the federal requirements is the expectation that CNAs (and all staff who provide services to residents) will have the skills and knowledge necessary to meet the care and quality of life needs of residents as identified in their individualized assessment and care plans. To ensure that this is fully implemented, “[t]he State survey agency must in the course of all surveys, determine whether the nurse aide training and competency evaluation requirements of [the federal rules] are met.”