Certified Nursing Assistant (CNA)

What is a Certified Nursing Assistant (CNA)?

Certified nursing assistants (CNAs) provide basic support in medical environments, performing duties such as dressing, bathing, feeding, or transporting patients in need. Unlike licensed practical nurses and registered nurses (LPNs and RNs), nursing assistants are not qualified to provide direct care to patients, such as administering medication, drawing blood, or performing diagnostic tests. To become a CNA, no college degree is required. Credentials are issued by state, so prospective nursing assistants just need to enroll in a state-sanctioned training program and then pass a state certification exam.

Common Responsibilities for a CNA:

  • Recording weight, height, and patient symptoms for physicians before a physical exam
  • Dressing, bathing, and feeding patients
  • Helping patients with range-of-motion exercises and walking
  • Transporting patients
  • Monitoring and reporting changes of patient’s vital signs, behaviors, or personality to nurses

Who Should Consider Becoming a CNA?

Becoming a CNA is good starting point for students who want to become RNs or work in healthcare. By becoming a nursing assistant, students have the chance to make a difference in someone’s life, and certification can lead to a satisfying occupation.

Many daily tasks require physical strength: CNAs must be able to lift patients, often repositioning them in bed or assisting them while walking short distances. CNAs must deliver care that is compassionate, respectful, and sympathetic to their patient’s vulnerability. A positive attitude is also crucial in an environment that is intended to promote healing.

An effective CNA should have strong time-management skills and be able to quickly switch between patients without sacrificing focus or attention to detail. Individuals with observational skills make excellent CNAs; the close nature of their patient care often leads them to spot problems before their colleagues have noticed. Nursing assistants should also be good communicators, not only with coworkers but with patients and their family members.


Educational Paths to Becoming a CNA

There are employers who hire unlicensed CNAs, but official credentials carry more weight and are more valuable to hiring managers. By investing about four weeks of time, students see considerable returns. Earning licensure from an accredited CNA program online generally leads to higher-paying positions. For CNAs seeking RN licensure, better pay can shorten the time spent saving for nursing school. The certification is also a natural stepping stone to other credentials in healthcare. Admission officers in LPN and RN programs know that applicants who hold the CNA have already met rigorous training standards and are serious about their future career plans.

What Education is Needed to Become a CNA?

Many states require prospective nursing assistants must have a high school diploma to begin their CNA training, but not all. One should verify the requirements in their area before applying to a program. Graduating from college is not necessary to become a CNA, but nursing assistance is a popular choice for students who are currently enrolled in nursing school or are considering pursuing a nursing degree. If you already hold an associate or bachelor’s degree, your education will make you a more competitive applicant and will likely earn you a higher starting salary. Degree-holders are also better positioned to pursue certification as a registered nurse.

How Long Does It Take to Become a CNA?

Training is brief for many CNA programs, usually requiring four to twelve weeks. All certified nursing assistant programs combine CNA classes online or on campus with practical skills training and supervised clinical experiences. CNA programs online and on campus vary in length due to variances in clinical requirements, but they all qualify graduates to sit for state certification exams. Some schools split courses and hands-on training evenly, while others devote up to 75% of credits to classes and the remaining time to clinicals. Most accredited CNA programs take place in traditional brick-and-mortar learning environments. CNA programs online are rare, occasionally existing as hybrid offerings that require on-campus attendance for clinicals. Because CNA programs are short, students commonly progress through CNA classes online and offline together. This is known as cohort learning.

What Will I Learn in an Online CNA Certification Program?

  • Basic Patient Care and Safety: Bathing and dressing, personal care, feeding a patient, vital signs, activities of daily living (ADLs), and bed making
  • Patient Rights and Medical Ethics: Patient dignity and patient rights
  • Medical Terminology: Anatomy and physiology and bodily systems
  • Record Keeping and Documentation: Incident reporting, charting, and admission and discharge
  • Patient Transport, Movement and Safety: Proper positioning, body mechanics in lifting and turning a patient, and transport best practices
  • Observation and Treatment of Common Ailments: Abuse and neglect signifiers, how to recognize depression, dementia signifiers, range of motion exercises, wound care, respiratory procedures, and diabetes patient care
  • Taking and Recording Patient Vital Signs: Range of normal vital signs, proper measurement and assessment, and documentation
  • Hygiene Procedures and Infection Control: Catheter care, hand-washing, specimen collection, sterilization techniques, ostomy care, and irrigations

CNA Certification and Licensing Requirements

Each state has its own licensure requirements. Any accredited CNA program online should meet its particular state requirements, but aspiring CNAs are advised to research their state’s requirements to confirm eligibility before committing to a program. The first step in the process is to determine initial eligibility for licensure. In most states, this means being at least 18 years of age and holding a high school diploma or GED. Some states do grant eligibility to students who have completed 8th grade and are at least 16; in these states there is no mandate for employers to hire minors. Finally, eligibility requires that all students be free of chemical dependency and medical or mental health conditions that affect the ability to perform job duties, including criminal convictions.

Eligible students may then enter a CNA training program, either through an accredited school, a CNA program online, or the Red Cross. When all schooling is complete, graduates must apply for their state’s certification exam within 24 months. An application must be submitted along with a fingerprint, and a fee must be paid. Each state varies in price; in Illinois, CNAs pay $65.

The examination itself includes written and clinical components. The written portion consists of 60 multiple-choice questions that must be answered within 90 minutes. The clinical portion measures student’s skills on nursing competencies. This includes hand-washing, indirect care, and five skills chosen from a list of over 20 possible tasks. Students may take the CNA exam up to three times. Upon passing the exam, certification is immediate; hard copy certificates will be received in two to three weeks. Certification must be renewed every two years.

Accreditation

When any school or individual program is accredited, that means that its curriculum and admissions process has been vetted by an impartial body. The vetting process is designed to ensure a standard of academic rigor and fairness that students can expect at accredited schools. A school can be nationally, regionally, or programmatically accredited, or even all three, but each of these accreditations means something different.

National accrediting bodies are focused on a specific type of education, such as technical or vocational. Students who are seeking CNA classes online should seek out schools that are nationally accredited by the Distance Education and Training Council (DETC) accrediting commission. Regional accreditation is geographically based and emphasizes academic rigor more than national accrediting bodies do. Generally, regional accreditation carries more weight than national accreditation does, especially when it comes to graduate school admissions. Program-specific, or specialized accreditation, is a useful tool for measuring the worth of academic offerings in certain fields. The Commission on Collegiate Nursing Education (CCNE) evaluates and monitors nursing education programs at all levels. Any nursing program that carries this accreditation can be assumed to have met the standards of the nursing industry itself.

Though the federal government does not involve itself at the accreditation level, the U.S. Department of Education does provide oversight of the accreditation process, it also maintains a database of accredited schools. The Council for Higher Education Accreditation is an independent association of accredited degree-granting institutions; it also offers a database of accredited schools.


Career Outlook

The need for certified nursing assistants in nursing homes, hospitals, and long-term care is growing since the size and average age of the U.S. patient population is set to rise over the next decade.

Source: BLS

Work Environments

Holding CNA licensure opens the door for employment in a wide variety of healthcare facilities. Many RNs begin their careers as CNAs because the credential offers the opportunity to work in diverse environments. Below is just a sampling of employment options for recent graduates of certified nursing assistant schools.

Average Hourly Rate for CNAs by Workplace Environment

Environment Description Average Hourly Rate for CNA
Hospitals Acute care facility where patients are recovering from surgery, disease, or trauma. May be small community hospitals (~75 beds) or large regional hospitals (~1500 beds) $13.20
Nursing homes Skilled care facility for patients who don’t require hospital care but are unable to be cared for at home. Medical care, physical therapy, occupational therapy, and speech therapy are typical. RNs and CNAs are often staffed 24 hours per day. $11.84
Community / Home Health Multidimensional health care services that are delivered in the home or in a community-based setting. Skilled care includes wound care, IV therapy, chronic disease monitoring, injections, minor illness, and patient/caregiver education. $11.45
Ambulatory Care / Surgery Center Outpatient setting that delivers high-level care without hospital admission. Care delivery includes same-day surgery, dialysis treatment, radiologic testing, blood testing, and chemotherapy and hematology therapy. Staff includes physicians, anesthesiologists, RNs, LPNs, and CNAs. $13.95
Physician’s Office/Private Practice A home office where an individual or group of physicians see patients for non-acute follow-up. They are often adjacent to a hospital complex. Physicians, RNs, and CNAs perform routine checkups and assessments. Care delivery may include injections, blood testing, measurement of vital signs, and long-term care plan management. $13.93
Other care facilities Standalone urgent care facilities, sometimes referred to as a “doc-in-a-box,” deliver care during off-hours for mild illness or injury that does not require hospitalization or emergency care. Physicians or physician assistants assess and treat, prescribe medication, and provide minor wound care. $12.52

Source: Payscale

CNA Salary

Source: BLS

The chart above details the top five employers of CNAs and their average annual salaries according to the U.S. Bureau of Labor Statistics. According to the same data set, the top five paying states are California, New York, Florida, Texas, and Pennsylvania.

CNA to RN Bridge Programs

Bridge programs are designed to enable working students to either switch industries entirely or earn a more advanced degree in their current field. All bridge programs build on a student’s prior educational achievements. Students in CNA-to-RN programs can obtain RN licensure quickly because they’ve already completed the groundwork in CNA courses, clinical training, and on-the-job experience. A typical RN program requires about two years of full-time study; a CNA can complete a bridge program in 12 to 18 months. Because classes are generally structured around student’s work schedules, CNAs can pursue higher licensure without taking time off. Many also find that they are able to immediately apply new information and skills at work. Registered nurses enjoy greater career mobility and higher pay. Returning to school to complete a degree also signifies to employers that you’re serious about your career.

Career Paths For a CNA

For many healthcare professionals, CNA licensure was the first step to a long and satisfying career. If you’re interested in the many opportunities the industry offers but unsure which path suits you best, a stint as a CNA can offer a good look at the many facets of this field. Below is a list of lucrative careers that can begin with CNA certification.

  • Registered Nurse (RN): RNs provide and coordinate patient care, conduct patient education, communicate with patients and their family members, and assist physicians and physician assistants with procedures. RN is the highest tier of nursing licensure and job growth is expected to grow by 16% through 2024.
  • Family Nurse Practitioner (NP): NPs are advanced practice registered nurses (APRNs) who coordinate and conduct patient care in supervisory roles. In some states, APRNs may practice independently and prescribe medication. A master’s degree must be earned to obtain this certification.
  • Pediatric Nurse: Pediatric nurses specialize in children’s healthcare. The work environment includes emergency rooms, pediatric and neonatal intensive care units, pediatric rehabilitation, and private practice. Requires a master’s degree.
  • Psychiatric Nurse: APRNs who specialize in psychiatric and mental health disorders. Assess, diagnose, and treat patients; develop and implement patient care plans; prescribes medication. A master’s degree must be earned to obtain this certification.
  • Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN): LPNs and LVNs occupy the space between CNAs and RNs. LPNs provide routine care, observe and chart, assist physicians and RNs, and communicate with patients and families.

For more information, read about the different paths to becoming a nurse.