How to Become a Certified Nursing Assistant (CNA)


    GUIDE
    March 24, 2020
    Nurse assistant helping an elderly patient in a nursing home

    Part One What is a Certified Nursing Assistant (CNA)?

    A certified nursing assistant, or CNA, helps patients with activities of daily living and other healthcare needs under the direct supervision of a Registered Nurse (RN) or Licensed Practical Nurse (LPN). CNA’s are also commonly referred to as a Nursing Assistant, Patient Care Assistant (PCA), or a Nurse’s Aid.

    Some individuals will use their knowledge as a CNA to bridge the gap to further their career and become an LPN or RN. Interestingly, a large number of CNAs are already in a nursing school program and use this career as a chance to learn more about the healthcare world and gain additional real world application and knowledge. Others become a CNA in order to determine if they want to continue to the next step in their healthcare journey.

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    Part Two How is a CNA different from a Medical Assistant (MA) and an LPN?

    While certified nursing assistants and medical assistants (MAs) do have some similarities, such as working with patients and providing patient care, it is important not to confuse the two healthcare careers.

    Both careers assist doctors, nurses, and other healthcare providers with treatments, procedures, and tests. Medical assistants focus primarily on patient assessment, evaluation, and assisting doctors with patient care and treatment, whereas nursing assistants are generally more involved in direct patient care. Nursing assistants have specific job-related duties they are able to perform that are dictated by the state of employment. 

    LPNs, otherwise known as a Licensed Practical Nurse, require a license and passing a state-mandated exam. CNA’s on the other hand only need to obtain a certification in order to practice. LPNs often take classes similar to RNs in order to obtain additional information about health care and the human body. Additionally, there are certain tasks and procedures that LPNs are able to perform that CNA’s can not, such as inserting a peripheral intravenous catheter.

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    Part Three What Does a CNA Do?

    CNAs can help a unit run smoothly, especially for those nurses that have multiple medically complex patients. Responsibilities of a CNA include, but are not limited to:

    • Turning or repositioning patients
    • Gathering supplies for the RN or MD
    • Obtaining vital signs per protocol
    • Answering patient calls/bells
    • Bathing patients
    • Documentation of information obtained
    • Feeding patients, measuring and recording their food and liquid intake
    • Combing hair, shaving, caring for nails and brushing teeth
    • Cleaning rooms and bed linens
    • Stock supplies
    • Prepare rooms for admissions 
    • Helping with medical procedures
    • Dressing wounds
    • Assisting patients with elimination

    Direct responsibilities will vary based on the location of employment and ultimately the nurses level of need. CNA duties are determined by individual states and it is up to the individual to ensure they are following state guidelines and not performing duties outside the scope of practice. 

    CNAs can work in an inpatient hospital setting but are more commonly found in long-term residential facilities, rehabilitation centers, and adult daycare centers. They are rarely employed in outpatient office/clinic settings. These facilities all require nursing assistants to act as a liaison between the nurse and the patient. 

    Per the U.S. Bureau of Labor Statistics, in 2018, there were approximately 1,564,200 employed as certified nursing assistants. Nursing care facilities employed the greatest number of nursing assistants (38%) while only 4% currently work for the government.

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    Part Four What Qualities Should a CNA Possess?

    Nursing assistants first and foremost must enjoy interacting with people on a daily basis in order to find enjoyment and fulfillment in this career. Other attributes should include:

    • Flexibility
    • Advanced communication skills
    • Time management
    • Compassion
    • Reliability
    • Physical Strength
    • Empathy

    Part Five What is the Salary for CNAs?

    According to the U.S. Bureau of Labor Statistics (BLS), the median average annual salary for certified nursing assistants in 2019 was $29,660. It is important to note that this does vary depending on the setting and area. CNAs working in a government setting such as a VA hospital earned the highest median pay at $35,500, while home health care services have the lowest median pay at $28,590. 

    Nursing assistants can work on a variety of schedules which vary greatly based on the needs of the employer. Some work a variety of shifts throughout the course of the week while others have a set schedule and earn an annual salary. Those paid on an hourly scale are able to earn overtime pay whereas salary employees would need to discuss that with the hiring committee. An individual’s earning potential is determined by the needs of the hospital and the offer contract. 

    Currently, the following states have the highest pay scale for certified nursing assistants according to the BLS. 

    Highest Paying States For CNAs

    State Hourly Avg Annual Average
    Alaska $18.24 $37,950
    New York $16.87 $35,080
    Nevada $16.87 $34,480
    District of Columbia $16.43 $34,170
    California $16.13 $33,560

    Metropolitan areas tend to pay higher for nursing assistants. Some of the highest paying cities include:

    Highest Paying Cities for CNAs

    Metro Area Hourly Annual
    San Francisco $23.20 $48,260
    Salinas, CA $21.68 $45,100
    Fairbanks, AK $19.45 $40,450
    San Jose $18.47 $38,417

    Nonmetropolitan and/or rural areas with the highest employment of certified nursing assistants are:

    • Kansas nonmetropolitan area
    • Southeast Coastal North Carolina nonmetropolitan area
    • Piedmont North Carolina nonmetropolitan area
    • North Northeastern Ohio non-metropolitan area (non-contiguous)

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    Part Six How Do I Become A CNA?

    Certified nursing assistants must complete a state-approved training program. These programs are generally found at local community colleges, high school, vocational or technical schools, or local hospitals.

    Programs do vary so it is important that interested students research programs thoroughly to find one that best suits their needs.

    Most programs have similar requirements that must be completed prior to application and acceptance. The American Red Cross runs a popular CNA training program throughout the country which runs for 4-8 weeks depending on class size and location. Prerequisites include:

    • Attendance at an orientation information session
    • TABE (reading and math assessment) OR verification of High School diploma or GED
    • Red Cross criminal background check prior to registration
    • Completion of Red Cross physical form and TB test

    Online CNA Programs

    While the Red Cross offers in-person classes, some vocational schools and community colleges offer online CNA programs. Many programs operate clinics at local hospitals.

    There are pros and cons to the online programs. While individuals may be able to obtain their certification quicker there is concern that individuals graduating from these programs are not gaining the same core knowledge and skills as their in-classroom counterparts.

    Most programs average roughly 4 to 12 weeks for completion depending on the class schedule. Programs are comprised of class hours and clinical hours. Each state has a designated number of clinical hours that an individual must complete before applying for certification.

    After completion of a state-approved training program, an individual can take a competency exam. The exam consists of two parts: a multiple choice written exam and a practical skill based exam. Once passed, the certified nursing assistant is placed on a state registry and can begin to apply for jobs.

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    Part Seven Which Schools Have The Best CNA Programs?

    Top 10 CNA Programs

    Methodology

    This list is based on a number of factors including:

    • Reputation
    • Tuition
    • Acceptance rate, when available

    Nurse Panel

    Our selection panel is made up of 3 Registered Nurses with years of experience and multiple degrees:

    • Tracy Everhart, MSN, RN, CNS
    • Tyler Faust, MSN, RN
    • Kathleen Gaines, MSN, BSN, RN, BA, CBC

    There are numerous CNA programs and our panel of nurses ranked them based on factors mentioned in the methodology. Because individual nursing pathways and careers take various forms, the top 10 CNA programs are ranked in no particular order. 

    1. American Red Cross

    Total Program Cost: $1,250

    Online: Hybrid

    Program Length: 4-8 weeks

    The American Red Cross, well known for its education and certifications, also teaches students to become CNAs. The hybrid program lets students complete courses online while earning experience in person. As a nation-wide organization, the American Red Cross reaches numerous cities and states, so individuals across the country can enroll. The program takes 4-8 weeks to complete depending on how quickly the student completes courses. Also, program costs can vary from location to location. 

    2. Cochise College

    Program Tuition: Up to $2,000

    Online: No

    Program Length: 12 weeks

    Based in Cochise County, Arizona, Cochise College offers multiple allied health programs, including a nursing assistant certificate. Cochise College's two-course CNA program teaches skills to become a nurse assistant as well as basic CPR and First Aid skills. Graduates also become CPR and First Aid certified. Arizona residents get an in-state discount, though Cochise also extends discounts to senior citizens and charges a per-credit rate. 

    3. Hutchinson Community College

    In-State Program Tuition: $927 Out-of-State Program Tuition: $1,066

    Online: No

    Program Length: 12 weeks

    Created to educate nurses to work with elderly patients in long term healthcare settings, Hutchinson Community College's CNA program requires just 4.5 credits to graduates, making it among the shortest, and most affordable CNA programs available. Accredited by the Higher Learning Commission, students must study on-site in Hutchinson, Kansas. While the Kansas Board of Nursing doesn't disclose outcomes for CNA programs, this short program quickly prepares nurses to gain a CNA certification. 

    4. Pratt Community College

    Program Tuition: $985

    Online: Hybrid

    Program Length: 12 weeks

    Pratt Community College, another college located in Kansas, offers its CNA program in a hybrid format, allowing students to complete coursework and theory online. The program requires five credits, though students who choose to study online do not receive an in-state tuition discount. Regardless, Pratt CC's CNA program costs far less than other programs. Graduates can find positions in nursing homes, assisted living facilities, and various hospitals. 

    5. Elizabethtown Community and Technical College

    Program Tuition: $732

    Online: No

    Program Length: 12 weeks

    Elizabethtown Community and Technical College offers the best CNA program in Kentucky, and perhaps in the region. The low-cost CNA program requires completion of just 96 hours of practice, 16 of which must be supervised clinical training. Students also have the option of completing a Medicaid Nurse Aide Certificate to boost their job prospects and potential earnings. Graduates must attend 100% of courses to graduates. Elizabethtown offers courses on weekdays, Saturdays, and in the evening. 

    6. Fox Valley Technical College

    Program Tuition: $602

    Online: No

    Program Length: Up to 12 weeks

    Located in Appleton, Wisconsin, Fox Valley Technical College's CNA program is among the cheapest routes for becoming a CNA, though the school's estimated costs do not include exam fees. The full-time program consists of daytime and evening courses, and FVTC also offers an accelerated format that takes less than 12 weeks to complete. Students cannot take courses online, but they can complete courses at six different locations in Wisconsin. Graduates can also transfer their CNA credits into an associate or bachelor's degree. 

    7. Elgin Community College

    In-State Program Tuition: $1,019 Out-of-State Program Tuition: $2,772

    Online: No

    Program Length: 12 weeks

    Elgin Community College offers one of the most comprehensive nurse assistant programs. The training program requires completion of seven credit hours (double what other programs require) to increase the job prospects of graduates by increasing their potential scope of practice. By the end of the program, graduates can take the nurse assistant certification exam in Illinois, though the program might meet requirements for other states as well. 

    8. Century College

    Annual Tuition: $800

    Online: No

    Program Length: 12 weeks

    Century College, based in White Bear Lake, Minnesota, offers its four-credit nurse assistant certificate program in both part-time and full-time formats. Available year-round, the CNA program allows students to complete courses either for-credit or not-for-credit. Both options lead to program completion, though for-credit courses can be transferred into an associate or bachelor's degree. Regardless of which option students choose, Century College is among the most affordable institutions in the region. 

    9. City College of San Francisco

    In-State Program Tuition: $181 Out-of-State Program Tuition: $1,004

    Online: No

    Program Length: 6-10 weeks

    With several CNA options available, the City College of San Francisco is one of the most versatile CNA programs in California. Nurse assistant students choose to specialize in acute care or convalescent care, which take 6 and 10 weeks to complete, respectively. The convalescent care route also requires twice as many credits, meaning double the tuition cost. The City College of San Francisco is definitely more affordable for California residents who pay a fraction of what out-of-state students pay. 

    10. Miles Community College

    In-State Program Tuition: $698 Out-of-State Program Tuition: $882

    Online: Hybrid

    Program Length: 10 weeks

    Miles City, Montana-based Miles Community College offers one of the best (and most affordable) CNA programs in the region. Students complete 45 of the required credit hours online and 30 hours of clinical practice in-person. In total, the 75-hours program counts as four credits which students can transfer into another nursing program. Note that while Miles CC's CNA program prepares nurses for Montana certification, the costs associated with the exam are not included in the total tuition. 

    Part Eight How do CNAs Transition to Other Nursing Positions?

    Becoming a certified nursing assistant does not immediately translate into other nursing degrees.

    In fact, it will only provide clinical knowledge and experience which may in turn help earn entrance into an LPN or RN program. Otherwise, becoming an LPN or RN requires acceptance into those individual programs.

    Once accepted into an LPN or RN program it may make certain aspects easier because of the knowledge and experience already obtained from on the job training; however, it very rarely decrease time in those programs.

    On the other hand, having the experience and healthcare connections could potentially assist in job placement after graduation.

    Part Nine Where Can I Learn More About Being A CNA?

    For those interested in more information about becoming a CNA, professional organizations such as the National Network of Career Nursing Assistants and Nursing Association of Health Care Assistants are great resources.

    Both discuss growing trends in healthcare that impact nursing assistants. Other information includes healthcare conventions targeted for this audience, access to continuing education hours, job opportunities, and contact information for local chapters.

    While these associations are not only a great resource for new to practice CNAs, they also provide vital information for those who are already established in the career. By joining these professional organizations, vital connections are made to industry experts and managers which can lead to future employment opportunities.

    Part Ten CNA Jobs

    Currently, states such as California, Florida, Texas, New York, and Pennsylvania have the highest number of employed certified nursing assistants. Growth is expected to rise in areas with warmer climate as the older population continues to retire and move to these areas. 

    Part Eleven What is the Career Outlook for a CNA?

    Certified nursing assistants are currently in high demand and the need is projected to continue through 2028.

    This number will only increase as the baby boomer generation ages and there is an increased demand for additional long-term nursing care facilities. Nursing assistants will be needed to care for this population which is more likely to suffer from dementia and other neurologic changes.

    The BLS projects that employment for nursing assistants will grow 9 percent from 2018 to 2028.

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