A certified nursing assistant (CNA) is a healthcare worker who provides hands-on daily care to patients under the supervision of registered nurses. CNAs help with fundamental needs like bathing, dressing, eating, and moving around, making them the professionals who spend the most direct time with patients in hospitals, nursing homes, and home health settings. There are roughly 1.35 million CNAs working across the United States.
What CNAs Actually Do
The core of a CNA’s job is personal care. That means helping patients bathe, get dressed, use the bathroom, eat meals, and move safely between a bed and a wheelchair or walker. CNAs also take vital signs like blood pressure, pulse, and respiratory rate, and they report changes in a patient’s condition to the nurses overseeing their care.
Federal regulations outline nine categories of tasks CNAs are trained to perform: personal care, safety and emergency procedures, basic nursing skills, infection control, communication, care of cognitively impaired residents, basic restorative care, mental health and social service needs, and protecting residents’ rights. Beyond this baseline, about 22% of states allow CNAs to take on expanded duties such as medication reminders, wound care, or catheter management, though these always require delegation from a licensed nurse.
What CNAs generally cannot do is administer medications, start IV lines, perform wound care, or make clinical assessments on their own. Those tasks fall to licensed practical nurses (LPNs) or registered nurses (RNs). The line between CNA and LPN work is important: CNAs provide support and observation, while LPNs carry out medical interventions that require more advanced training.
Where CNAs Work
Nursing homes and skilled nursing facilities employ the largest share of CNAs, with about 458,600 positions. Hospitals are a close second at roughly 410,900. Home health care services account for another 81,400 jobs. The remaining positions are spread across assisted living communities, rehabilitation centers, and other care settings.
In long-term care facilities, federal staffing standards now require at least 2.45 hours of direct nurse aide care per resident per day. In practical terms, that means CNAs in nursing homes often care for multiple residents during a single shift, rotating through rounds of personal care, meals, repositioning, and documentation throughout the day.
How to Become a CNA
Becoming a CNA is one of the fastest entry points into healthcare. Every state requires completion of a state-approved training program, though the exact hours vary. The federal minimum is 75 hours of instruction, including at least 16 hours of classroom learning and 16 hours of supervised clinical practice with real patients. Some states require significantly more. Most programs can be completed in four to twelve weeks and are offered through community colleges, vocational schools, and some healthcare facilities.
After finishing training, you take a state certification exam that has two parts: a written (or oral) knowledge test and a hands-on skills evaluation. During the skills portion, you’re asked to demonstrate specific clinical tasks in front of an evaluator. These typically include hand washing, taking blood pressure manually, counting pulse and respirations, transferring a patient from bed to wheelchair using a transfer belt, providing a bed bath, assisting with a bedpan, dressing a patient with a weak arm, feeding a patient, performing passive range-of-motion exercises, and providing catheter care. Evaluators watch for proper technique, safety awareness, and respect for the patient’s dignity throughout.
Once you pass, your name goes on your state’s nurse aide registry, and you can begin working. To keep your certification active, most states require continuing education. Texas, for example, requires 24 hours of in-service education every two years, with mandatory training in geriatrics and dementia care including Alzheimer’s disease. Requirements in your state may differ, but the pattern of ongoing education every one to two years is standard.
Pay and Job Outlook
CNA work is physically demanding and emotionally intensive, and the pay reflects the entry-level nature of the role. Employment for nursing assistants is projected to grow 2% from 2024 to 2034, which is slower than the average for all occupations. That said, the sheer size of the workforce means tens of thousands of openings appear each year as people retire, advance into nursing roles, or leave the field.
Pay varies considerably by location and employer. Hospital-based CNAs tend to earn more than those in nursing homes, and wages in metropolitan areas generally exceed rural ones. Many CNAs also work evening, night, or weekend shifts, which sometimes come with differential pay.
Moving From CNA to Nursing
Many people use the CNA role as a stepping stone into nursing. The clinical experience you gain, especially comfort with patient care and familiarity with healthcare routines, gives you a real advantage in nursing school.
The most common path is an associate degree in nursing (ADN), which typically takes two years and qualifies you to sit for the RN licensing exam. Some accelerated programs compress this into as little as one year. If you already hold a bachelor’s degree in another field, accelerated BSN programs can get you to a nursing degree in just over a year. For CNAs without a prior degree, a traditional four-year BSN program is another option, though the ADN route is faster and more affordable for many people.
Working as a CNA while attending nursing school is common. The scheduling flexibility of shift work and the clinical relevance of daily patient care make the two roles complement each other well. Some employers even offer tuition assistance to CNAs pursuing nursing degrees, recognizing the benefit of retaining staff who already understand the organization’s workflow and patient population.