The Bedrock of American Patient Care
Certified Nursing Assistants (CNAs)—known as State Tested Nursing Assistants (STNAs) in Ohio and Licensed Nursing Assistants (LNAs) in New Hampshire and Vermont—provide more than 80% of direct hands-on daily patient care in American hospitals, rehabilitation facilities, assisted living communities, and nursing homes.
Because nursing homes receiving Medicare and Medicaid funding must comply with the federal Omnibus Budget Reconciliation Act (OBRA), CNAs cannot simply be hired on informal experience: they must complete a state-approved training program, pass a two-part written and clinical skills exam, and maintain an active listing on their State Nurse Aide Registry.
75–160 hrs clinical training. ADL care, vital signs, bed transfers. Entry wage: $18.50 – $23.00/hr ($38k–$48k/yr).
Vocational diploma, NCLEX-PN exam. Medication passes, wound care, IV starts. Pay: $28.00 – $36.00/hr ($58k–$75k/yr).
ADN or BSN degree, NCLEX-RN exam. Acute hospital care, triage, charge nurse duties. Pay: $42.00 – $60.00/hr ($87k–$125k/yr).
State-by-State CNA Licensing & Registry Comparison
| State | Mandatory Training Hours | Testing Examination Vendor | Registry Agency | Median Hourly Pay (2026) |
|---|---|---|---|---|
| California | 160 hours (60 theory / 100 clinical) | Credentia / Regional Colleges | California Dept. of Public Health (CDPH) | $22.80 – $27.40/hr |
| Texas | 100 hours (60 classroom / 40 clinical) | Prometric / Credentia | Texas Health & Human Services (HHSC) | $17.80 – $21.50/hr |
| Florida | 120 hours (or challenge exam pathway) | Prometric | Florida Board of Nursing | $18.20 – $22.40/hr |
| Ohio (STNA) | 75 hours (59 classroom / 16 clinical) | D&S Diversified Technologies (Headmaster) | Ohio Department of Health (ODH) | $18.50 – $23.10/hr |
| New York | 100 hours (30 clinical minimum) | Prometric | New York State Dept. of Health (NYSDOH) | $21.40 – $26.20/hr |
The Two-Part State Competency Evaluation
To earn active certification on the registry, candidates must pass both sections of the state examination, administered by third-party testing services:
- Written / Knowledge Exam: Typically 60 to 75 multiple-choice questions covering infection control (hand hygiene, PPE, standard precautions), resident rights, vital signs recording, communication techniques, and emergency procedures (choking, fire safety).
- Manual Clinical Skills Demonstration: Candidates are evaluated on 5 randomly selected clinical skills performed on a live testing volunteer or manikin. Handwashing is always scored, alongside tasks such as measuring blood pressure, transferring a patient with a gait belt, applying anti-embolic stockings, performing range of motion (ROM) exercises, or assisting with bedpan hygiene. A candidate must execute all designated critical checkpoints flawlessly to pass.
Career Progression: The CNA-to-LPN/RN Pipeline
For many healthcare professionals, working as a CNA is the most strategic entry point into medicine:
- Healthcare Employer Tuition Assistance: Major hospital systems (e.g. Cleveland Clinic, Texas Health, HCA Healthcare, Kaiser Permanente) routinely pay 80% to 100% of nursing school tuition for working CNAs pursuing an Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN).
- Accelerated Practical Nursing (LPN): CNAs gain clinical patient-handling instincts and vital signs proficiency, significantly lowering the attrition rate during intensive 12-month LPN programs.
- Travel CNA Agencies: Experienced CNAs willing to take 8- to 13-week regional travel contracts earn stipends of $1,000 to $1,400 per week with tax-free housing allowances.
Frequently Asked Questions
Can you challenge the CNA exam without taking a class in Florida?
Yes. Florida is one of the few states that allows candidates aged 18 or older with a high school diploma to "challenge" the state CNA exam administered by Prometric without completing a mandatory approved training program. However, passing the hands-on clinical skills evaluation without formal prep requires thorough self-study of Prometric's skill checklists.
How long does a CNA certification remain active?
Most state Nurse Aide Registries require renewal every 24 months. To remain active, the CNA must document at least 8 hours (or up to 48 hours depending on state rules) of paid nursing-related services under licensed nurse supervision during the preceding 24 months, with no substantiated findings of patient abuse or neglect.
Does a CNA license transfer to another state?
Yes, through "reciprocity" (endorsement). If you hold an active, unencumbered listing on your home state registry and your training meets the receiving state's minimum hours, you can transfer your credentials by submitting a state reciprocity application without having to re-take the written or skills exams.