What people call a CNA license is a certification: you complete a state-approved nurse aide training program, pass a two-part competency evaluation, and a record of your passing goes on your state's nurse aide registry.
Federal rules set the floor every state shares — at least 75 clock hours of training, including at least 16 hours of supervised practical training — while the hour totals, exam vendors, registries and renewal rules are set state by state.
This page walks through each step and where states differ.
Is a CNA a license or a certification?
Strictly speaking, a CNA is certified, not licensed: what makes you one is completing a state-approved nurse aide training and competency evaluation program and being listed on your state's nurse aide registry.
This page says "CNA license" too — but the thing itself is a certification a registry records, not a license a board issues.
The federal rules use their own vocabulary: they call the role "nurse aide" and the credential a state-approved training and competency evaluation program, and they require every state to keep a nurse aide registry that the public and health care providers can access promptly.
Once you pass, a record of passing must be added to your state's registry within 30 days of the date you were found competent.
That listing is what a nursing home checks: before allowing anyone to serve as a nurse aide, a facility must receive registry verification that the person met the competency evaluation requirements.
Our research found no national CNA registry — the credential exists state by state, and federal rules are built for that.
Every state must maintain its own registry, and nursing homes must seek information from every state registry they believe may hold information on an aide.
If you are still deciding whether the work itself fits you, the certified nursing assistant career guide covers the job: duties, settings, titles and pay.
What does every state require to certify a CNA?
Three things stand between you and the registry listing, and federal rules set the floor for each: a state-approved training program, the competency evaluation, and the registry record itself.
Training comes first: federal rules require a state-approved nurse aide training program to run at least 75 clock hours.
At least 16 of those hours must be supervised practical training — performing tasks on a person, under the direct supervision of an RN or LPN, in a laboratory or similar setting.
The first 16 hours, before any trainee has direct contact with a resident, must cover communication, infection control, safety and emergency procedures including the Heimlich maneuver, resident independence and residents' rights.
Who teaches it is regulated too: training must be performed by or under the general supervision of a registered nurse with at least 2 years of nursing experience, at least 1 year of it in long-term care.
The state is also the gatekeeper for programs: approval of a nurse aide training program may not last longer than 2 years.
And a state may not approve a program offered by or in a nursing facility that, in the previous two years, was assessed a civil money penalty of at least $5,000 (as adjusted annually), had an extended survey, or drew certain other sanctions.
The exam has two parts — a written or oral test and a skills demonstration — and federal rules require you to pass both, with each state setting its own passing standard.
Cost protections exist on both steps: if a nursing facility employs you, or has offered you a job, when you begin the program, you cannot be charged for any part of it, including textbooks.
The same no-charge rule covers the competency evaluation itself.
The 12-month reimbursement applies to both steps.
Say you paid your own way for the training or the evaluation, and a nursing facility hires you — or offers you a job — within 12 months of completion.
The state must then provide pro-rata reimbursement while you are employed.
The state is the source of record
How do training hours differ by state?
The 75-hour figure is a federal floor, not your state's requirement: it is the minimum a state-approved program can run, and the total that applies to you is set by your state's own rules.
States approve nurse aide training programs under their own rules, so the hour total a program must run — and you must complete — comes from your state, and no state may approve a program shorter than that floor.
What does not vary — everywhere federal rules reach — is the shape of the floor: the supervised practical hours performed on a person, the first 16 hours of safety and rights topics, and the RN instructor standard.
The curriculum's core is fixed too: federal rules require programs to cover personal care skills including bathing, grooming and mouth care, dressing, toileting, eating and hydration, feeding techniques, skin care, and transfers, positioning and turning.
Programs must also cover care of cognitively impaired residents, including techniques for the needs and behaviors of individuals with dementia.
One more constant, wherever federal rules reach: the in-person parts are not optional, because the supervised practical hours must be performed on a person and the skills demonstration must happen in a facility or laboratory setting.
Because hour totals are state-set, totals quoted on general websites are sometimes out of date; get your state's current number from its nurse aide agency or registry before you enroll.
Which exam will you take and who runs it?
Federal rules fix the exam's shape but not its questions: you choose between a written and an oral examination, and you must pass a skills demonstration made up of tasks randomly selected from a pool that includes all the federal personal care skills.
The skills demonstration happens in a facility or laboratory setting comparable to where you will work, administered and evaluated by an RN with at least one year of experience caring for the elderly or chronically ill.
Pass both parts and you have met the federal requirement; the passing standard itself is each state's call.
If you fail, you must be told which areas were failed, and you are entitled to at least three opportunities to take the evaluation — states may cap attempts, but not below three.
Administration varies: the rule permits the state itself or a state-approved entity that is not a Medicare or Medicaid-participating nursing facility, and national testing companies run the exam in the states that contract with them.
Credentia runs the NNAAP, the nurse aide certification exam it acquired from Pearson VUE in April 2021 — so older pages still naming Pearson VUE are out of date.
Credentia lists NNAAP testing for Alabama, Alaska, California, Colorado, DC, DoDEA, Georgia, Guam, Iowa, Maryland, Nevada, North Carolina, Pennsylvania, Rhode Island, Tennessee, the US Virgin Islands, Virginia and Washington.
In 2026 it announced full-service written and skills NNAAP delivery for Tennessee and nurse aide testing for Iowa.
D&S Diversified Technologies, known as Headmaster, publishes CNA testing pages for its own long list of states, including Missouri, Ohio, Michigan, Massachusetts and New Mexico.
Prometric runs nurse aide testing as well — its candidate handbook governs the Texas exam — and offers registry status checks in its states.
The vendor lists overlap and drift: Headmaster's site still listed Tennessee and Iowa after Credentia announced in 2026 that it now delivers those states' exams.
So confirm your state's current vendor with the state's nurse aide agency, and read that vendor's candidate handbook for your state's exact format, skill count and fees.
Skill lists are not one national checklist: the count and the skills vary by state edition, and Credentia's 2024 Colorado NNAAP handbook, for example, lists 23 skills including state-specific blood pressure skills.
How do you get onto the nurse aide registry?
You do not apply to the registry the way you would apply for a license; you earn the listing by passing.
Every state must establish and maintain a nurse aide registry that is promptly accessible to the public and health care providers.
Once you pass, a record of passing must be added to the registry within 30 days of the date you were found competent.
Being listed costs nothing: federal rules bar states from charging nurse aides any registration fee for being listed on the registry.
At minimum, the registry holds your full name, identifying information and the date you became eligible for listing, along with any state finding of abuse, neglect or misappropriation of property.
That listing is what employers verify: before a nursing home lets anyone serve as a nurse aide, it must receive registry verification that the person met the competency evaluation requirements.
A state may contract the registry's day-to-day operation to a non-state entity, but the state remains accountable for it.
Two systems you might actually use: Prometric offers registry status checks in its states, and Headmaster's TestMaster Universe portal handles applications, scheduling and registry checks (Missouri's portal is the documented example).
Moving is the one step the listing does not automate: each state keeps its own registry.
The Texas candidate handbook from Prometric, the state's testing vendor, tells CNAs who move to contact the new state's registry, because whether certification transfers varies from state to state.
Federal rules assume your information may sit in more than one state's registry — nursing homes must check every registry they believe holds information on you — so plan on your new state's own application process, not an automatic carry-over.
How do you keep the certification active?
Staying certified comes down to two clocks: the federal work rule and your state's renewal cycle.
Federal rule first: if a nurse aide goes 24 consecutive months without providing nursing or nursing-related services for pay, the aide must complete a new training and competency evaluation program, or a new competency evaluation program.
The registry mirrors it: registries must remove aides who have performed no nursing or nursing-related services for 24 consecutive months, unless the entry includes a documented abuse, neglect or misappropriation finding.
On the job, federal rules require nursing homes to give nurse aides at least 12 hours of in-service training per year, including dementia management and resident abuse prevention training.
Nursing homes must also complete a performance review of every nurse aide at least once every 12 months and base in-service education on those reviews.
None of the federal rules above sets a renewal cycle: the cycle length, any continuing-education requirement and the paperwork are your state's rules.
Texas shows how specific it gets: its nurse aide registry certificates are valid for two years from issue.
And in Texas, a nurse aide who has not both performed nursing-related work and completed 24 hours of in-service education in the 24 months since registration or renewal is in expired status and must retake both exams.
Where Headmaster runs testing, its TestMaster Universe portal handles renewals as well as applications, scheduling and registry checks — the verified example is Missouri's portal.
In Texas, a lapsed listing means retaking both exams.
Whatever your state, check its registry's renewal page before the cycle ends rather than after.
Renewal rules are state rules
CNA requirements by state
The reliable way to read this page: the left-hand column below is the federal floor, and the right-hand column is where your state's own rules live.
| Step | The federal floor — the same everywhere federal rules reach | What your state decides |
|---|---|---|
| Training program | At least 75 clock hours, including at least 16 hours of supervised practical training performed on a person. | The total hours a program must run — the floor is a minimum, and your state's current rule sets its own number. |
| First 16 hours | Communication, infection control, safety and emergency procedures (including the Heimlich maneuver), resident independence and residents' rights, before any resident contact. | Anything the state adds to the curriculum beyond the federal list. |
| Instructors and program approval | An RN with at least 2 years of nursing experience, at least 1 of them in long-term care, performs or supervises the training — and no approval may run longer than 2 years. | Which programs get approved, under the state's own approval rules. |
| Competency evaluation | A written or oral exam plus randomly selected skills in a facility or lab; pass both parts; at least three attempts. | The vendor, the exact format and skill list, and the passing standard. |
| Registry listing | Every state maintains a registry; passing records are added within 30 days; listing carries no fee. | The registry's name and website, and whether a contractor operates it day to day. |
| Staying active | 24 consecutive months without paid nursing-related services means retraining or retesting. | The renewal cycle and any in-service or continuing-education rules beyond the federal floor. |
Read the table as a map of what differs: hour totals, exam vendors, registry names and renewal rules are all state-set, while the training floor, the two-part exam and the registry listing are the same everywhere federal rules reach.
Two habits keep you current: take hour totals and renewal rules from your state's nurse aide agency or registry rather than from general websites, and take exam details from your state's vendor handbook, because vendor lists and formats drift.
When you are ready to use the credential, browse CNA jobs in the settings that hire CNAs: nursing homes, home health and hospice providers, and assisted living communities.
Career information, not licensing, legal, medical or tax advice. Certification requirements come from federal rules and from each state, and they change — confirm the current requirements with your state's nurse aide registry or the agency that approves training programs before you enroll, test, apply or renew.