How to Hire CNAs: An Employer's Guide

A certified nursing assistant is the hands-on core of your care team. The work is direct personal care: helping people with bathing, dressing, toileting, eating and hydration, and with transfers, positioning and turning. The role's basic nursing skills include taking and recording vital signs and recognizing and reporting abnormal changes in body functioning — the task groups the federal nurse aide curriculum itself names. When the role is staffed well, licensed nurses supervise care instead of covering missed hands-on help, and your schedule holds.

Where CNAs fit depends on your setting. Nursing homes and skilled nursing facilities, assisted living and memory care communities, Medicare-certified home health agencies, hospices and staffing firms hire for aide roles. The rules that attach to the hire follow the setting and the payer, not the job title alone.

The occupation is large, which is why the hire shows up on your budget line. BLS's Occupational Employment and Wage Statistics for May 2025 counted 1,448,910 nursing assistants (SOC 31-1131) in payroll employment, 534,270 of them in skilled nursing facilities.

Match the credential to the work you actually need done. If the position is certified-aide work — a nurse aide role in a nursing facility, or aide visits under a home health plan of care — you are hiring credentialed aides. Each setting's rules name the training, competency evaluation and registry listing that credential requires. Companion and homemaker work is a different hire with different requirements, so decide which role your open shifts need before you write the posting.

The worker-side view of the job — what the day looks like, how candidates train for it and choose the field — lives in the CNA career guide. This page stays on the employer's side of the hire.

Federal rules require a state-approved nurse aide training and competency evaluation program — the federal floor is 75 clock hours of training, including at least 16 hours of supervised practical training — and states may require more (42 CFR 483.152).

The credential an employer verifies is the state's own. It is an active listing on the state nurse aide registry, and your state names the credential its own way — check the exact title and the current requirement with the state agency or registry that issues it before you write it into a posting.

For nursing facilities, federal Conditions of Participation put duties on the employer, not only on the candidate. A facility must receive registry verification before allowing an individual to serve as a nurse aide, unless the person is a full-time employee in an approved program or recently completed one and is not yet listed. It must also seek information from every state registry it believes will include information on that person (42 CFR 483.35).

Two federal time rules shape hiring decisions. A nursing facility may not use an individual as a nurse aide for more than 4 months on a full-time basis unless that individual has completed approved training and competency evaluation. During those first 4 months, the facility may use the individual only if they are a full-time employee in a state-approved training and competency evaluation program, have demonstrated competence through such a program, or are deemed competent. The window matters if you hire students or new graduates mid-program.

The second rule covers lapsed aides: a nurse aide who has gone 24 consecutive months without providing nursing or nursing-related services for pay must complete a new training and competency evaluation program or a new competency evaluation. A lapsed listing is not automatically a ready-to-work aide, so verify current status with the registry before scheduling.

Finally, match the credential to the role you are staffing. If the position is a home health aide or medication aide role, ask your state agency whether a CNA credential satisfies that role's requirement or whether the state requires its own training for it, rather than assuming the credentials are interchangeable.

Rules change and they are state-specific. Confirm the current training, testing and registry requirements for your state — and the credential title your posting should use — with your state nurse aide registry before you hire.

Two projections frame how much competition you face for candidates. BLS Employment Projections put nursing assistant growth at 2.6% from 2025 to 2035, with about 196,200 openings per year. PHI separately projects an estimated 9.7 million total job openings in direct care from 2024 to 2034, counting occupational transfers and labor-force exits.

The channels that produce CNA candidates are the ones you can actually operate: cohorts finishing state-approved nurse aide training programs, employee referrals, your own rehires and prior applicants, job postings on the boards where aides look, staffing agencies and community and workforce organizations.

Training programs deserve a note for facilities. If someone becomes employed by, or receives an offer from, a nursing facility within 12 months after completing a nurse aide training and competency evaluation program, the state must provide for pro-rata reimbursement of their training costs (42 CFR 483.152). Hiring close to a program's completion date puts the facility inside that reimbursement rule; confirm the mechanics with your state.

One guardrail sits on referral hiring, and the EEOC states it directly: relying on word-of-mouth recruiting by a workforce that is mostly one group can violate federal anti-discrimination law if almost all new hires end up sharing that group. Spread sourcing across channels so your applicant pool stays open.

Ad wording is regulated too. EEOC-enforced laws make it illegal to publish a job ad that shows a preference for, or discourages, applicants because of race, color, religion, sex, national origin, age (40 and older), disability or genetic information. The EEOC's own examples include ads seeking "females" or "recent college graduates." And a client's request for a caregiver of a particular sex or background does not make the preference lawful to act on: the EEOC treats job assignment decisions based on protected characteristics as illegal as well.

The channel detail — which boards deserve budget, how the ad itself is worded, how referral rewards are structured — belongs to the recruitment strategy guide, which walks the funnel from posting to hire. To sanity-check your posting against what candidates see, browse the CNA jobs board before you publish.

Start with the registry, and go past the certificate a candidate hands you. Federal rules bar nursing facilities from employing individuals with a finding in the state nurse aide registry concerning abuse, neglect, exploitation, mistreatment of residents or misappropriation of resident property (42 CFR 483.12). The same Conditions of Participation require registry verification before an individual serves as a nurse aide, apart from the trainee exceptions above, plus a check of every state registry the facility believes has information on them.

If your organization bills Medicare or Medicaid, exclusion screening belongs next to the registry check. Under 42 CFR 1001.1901, no federal health care program payment covers items or services furnished by an excluded individual. OIG's 2013 Special Advisory Bulletin describes civil money penalties, an assessment of up to three times the amount claimed, and exclusion itself for providers that employ a person they know or should know is excluded.

Federal law does not require providers to check the OIG's List of Excluded Individuals — OIG says so itself — although many state Medicaid programs and provider agreements do require exclusion checks. OIG recommends screening before hiring and periodically thereafter, and it updates the list monthly, which is why monthly screening best minimizes the liability.

If you order a consumer report on an applicant — a criminal background report, a motor vehicle record — the Fair Credit Reporting Act requires a clear written disclosure in a stand-alone document and the applicant's written authorization first.

Sequence the health steps lawfully. Under the ADA, a covered employer may require a medical examination only after a job offer and before duties begin, and only if every entering employee in the job category gets one. A test for the illegal use of drugs is not a medical examination under the ADA. The CDC recommends TB screening of health care personnel upon hire, not routine annual testing absent known exposure or ongoing transmission — and whether your aides need TB testing at all is set by the state licensing rules that apply to your setting.

Fingerprint checks are state law. CMS's National Background Check Program has awarded more than $65 million to 28 states to build fingerprint-based background check programs for direct patient access employees of long-term care providers. Whether your state requires fingerprints, and when you may hire pending results, is set by state law.

The step-by-step — what to order, in what order, with which disclosures — is the background checks guide's territory. Confirm your screening sequence with the EEOC, the state agencies that regulate your setting, or health-care counsel.

Anchor the offer to the BLS figures for the exact occupation. In the Occupational Employment and Wage Statistics for May 2025, nursing assistants (SOC 31-1131) earned a national median of $20.32 an hour — $42,260 a year — with a 10th-to-90th percentile hourly range of $16.32 to $24.99, in payroll employment of 1,448,910.

The setting moves the median. BLS's May 2025 industry rows put the median at $20.67 an hour in skilled nursing facilities (NAICS 623100), where 534,270 nursing assistants worked.

In continuing care retirement communities and assisted living (NAICS 623300), the median was $18.99 an hour. In home health care services (NAICS 621600), it was $18.29 an hour. These are medians by industry row in the May 2025 release — benchmarks to set your range against, not offers to copy.

Treat the figures as the floor of the conversation, not the ceiling of your budget. What you need to offer to compete is set by the postings CNAs in your market are actually comparing against yours, so check live listings alongside the BLS tables — the full state tables sit on the CNA salary data page.

One posting rule to check before you publish: Washington requires employers with 15 or more employees to disclose the wage scale or salary range and a general description of benefits in each job posting. Other states have their own pay-transparency laws, so confirm your state's requirements with your state labor agency.

Budget the wage-hour rules into the offer too. Since January 1, 2015, third-party employers such as home care agencies cannot claim the FLSA companionship exemption and owe minimum wage for all hours plus overtime at time-and-a-half over 40 hours in a workweek. And a hiring bonus is not free budget: a bonus promised at hiring or announced to keep people working is not discretionary and must be included in the regular rate used to compute overtime. The overtime rules behind agency scheduling are covered in the companionship exemption and overtime guide.

Interview for the job as it is actually performed. Build scenario questions around the core of aide work: how the candidate walks a resident through a transfer, what they do when a client refuses care, when they escalate a change in condition to a nurse, and how they document a visit. Whatever skills check you administer should mirror the tasks your setting assigns, not a generic quiz.

Keep the questions lawful. EEOC guidance says to limit pre-employment inquiries to what is essential for judging whether a person is qualified, and to avoid questions that would reveal race, sex, national origin, disability status, age, religion, color or ancestry. Any test you require must be necessary, related to the job, and applied so it does not exclude people on protected characteristics.

Accommodation is part of the process, not an afterthought: employers must provide reasonable accommodation to a qualified applicant or employee with a disability unless it causes significant difficulty or expense.

Sequence after the yes. The ADA allows a required medical examination only after an offer and before duties begin, which is the same point where background reports and exclusion screening should be wrapping up ahead of a start date.

The offer then turns into paperwork with fixed deadlines. Form I-9 Section 2 — the employer's review and verification of documents — must be completed within three business days of the hire. The form itself must be retained for three years after the date of hire or one year after employment ends, whichever is later.

E-Verify, where you use it, is a free online service that confirms an employee's information against government records. Whether it is mandatory for you depends on federal-contractor status and state law, so confirm with USCIS and your state labor agency.

Whatever else goes into the offer — shift pattern, setting, training promised, mileage and travel-time terms — name the credential requirement in your state's own registry terms. A precise requirement attracts candidates who already match it and screens out mismatches before an interview hour is spent.

Onboarding starts with the training floor your setting sits under. The floors below are federal minimums for certified providers; your state and your own policies add more on top.

In a nursing facility, nurse aide in-service training must be at least 12 hours per year, and it must include dementia management and resident abuse prevention training (42 CFR 483.95). The facility must also train staff on what constitutes abuse, neglect, exploitation and misappropriation of resident property, how to report it, and dementia management. Build both into the first-year calendar rather than improvising them after a survey.

In a Medicare-certified home health agency, the aides you hire furnish services under the home health aide conditions. The rule sets a training floor of at least 75 hours including at least 16 hours of supervised practical training, requires a successfully completed competency evaluation program before an individual furnishes services, and requires at least 12 hours of in-service training in each 12-month period. Aide supervision runs on the rule's cadence: a supervisory assessment by an RN or other appropriate skilled professional at least every 14 days when skilled services are provided, and an onsite RN visit every 60 days when only aide services are furnished. Hospice aides must receive at least 12 hours of in-service training per 12-month period.

Beyond the floors, the first weeks are yours to design: shadow shifts with the aide who will actually cover the route, a written run-through of your documentation and EVV routine, a named supervision contact, and a check-in scheduled before problems have time to become resignations. The plan in the caregiver onboarding guide adapts to aide hires.

Retention is where the hiring math pays out. Wages and hours are what PHI points to: it attributes direct care workers' median annual earnings of just under $26,000 to low wages and part-time hours. Judge your own retention from your own records — separations, exit reasons, weeks-to-first-quit — rather than from any industry figure, then fix what your records name. The playbook is the caregiver retention guide, and the scheduling, overtime and wage-hour topics around it sit in the employer hiring guide.

Employer information, not licensing, legal, medical, benefits or tax advice. Certification, registry, screening, training and pay rules come from the state agencies and federal bodies named above — confirm the current requirements with your state nurse aide registry, CMS, the DOL, the EEOC, or your own attorney or CPA before you hire.