Healthcare knowledge progresses rapidly. Therefore, states now require minimum practice standards for persons entering the healthcare professions, including nursing assistants/nurse aides (NA). Those requirements include formal training and a recognized certification process. But certification is more than just a required process; it is also long overdue, formal recognition for a group of healthcare professionals who provide hands-on care for the ill and the elderly.
Prior to 1987, there were no standards in nursing homes and the quality of care was in question. As the public began to hear horrible stories in the media about the abuse and mistreatment of residents in nursing homes, the government decided to step in and take action. The result was the Omnibus Budget and Reform Act (OBRA), which required the implementation of standards for nursing homes that receive federal funds such as Medicare or Medicaid. The act also emphasized residents’ rights, registered nurse (RN) presence, and improved food and medical services for patients, along with better maintenance and housekeeping. Due to these new standards, states now individually regulate the training and testing of certified nursing assistants (CNAs). In August 2008, the National Council of State Boards of Nursing (NCSBN) became the exclusive owner of the National Nurse Aide Assessment Program (NNAAP) and the Medication Aide Certification Examination (MACE). NCSBN develops examination programs and administers them through a contract with a national testing service.
The information in this article is based on the national standards for CNAs, but each state specifies the amount of training, and what certification and practical skills exams CNAs must pass. Therefore, you will also need to contact state or local agencies to find out about the specific requirements in your state.
Characteristics of Nursing Assistants/Nurse Aides
Nursing assistants work in hospitals, long-term care facilities, and home care, often having more contact with patients than other members of the staff. Their duties depend upon their workplaces, but the job emphasis is always on the patient’s physical and emotional well-being, including reporting observations of changes in patient health status to the nurse. The work can be challenging, especially when dealing with difficult patients, but most CNAs get great satisfaction from their work. Common characteristics for this profession include dedication, patience, compassion, and reliability. Another key element is the ability to communicate and work well with others. CNAs must also be physically able to perform a job that may require standing for a good portion of their eighthour day, as well as lifting and moving heavy objects and equipment.
CNAs must participate in regular inservice education and performance reviews as mandated by OBRA. OBRA requires long-term care facilities to provide a minimum of 12 hours of inservice each year that may consist of new skills or a review of existing skills, depending upon the facilities’ need. OBRA also mandates retraining and the passing of a competency exam for CNAs who have not worked for two consecutive years.
Career Outlook and Earning Potential
According to the U.S. Bureau of Labor Statistics, nursing assistants held approximately 1.4 million jobs in 2006. About 53 percent of nursing assistants worked in nursing and residential care facilities, while another 29 percent worked in hospitals. Job opportunities are excellent since they will arise from a combination of employment growth and the need to replace many workers who leave the occupation each year. Overall employment is expected to grow about 28 percent between 2006 and 2016, faster than the average for all occupations. Home health aide jobs are expected to grow faster than other aides due to both consumers’ preference for home care and agencies’ cost cutting. Long-term care jobs for nursing assistants are expected to grow faster than average through 2016 in response to the health needs of an aging population. The median hourly wage for nursing assistants was $10.67 in 2006, with an hourly salary range of less than $7.78 to more than $14.99.
Finding Out about Certification Requirements
Your first step in becoming a CNA is obtaining your state’s education and certification requirements. You can do this a number of ways:
- Call your state’s nurse aide registry; each state’s contact information is listed at the end of this chapter.
- Contact your state or local health department; most phone books list these agencies in their blue (government) pages.
- Talk to the healthcare facility or employment agency where you wish to work, since they will often guide you through the education and certification process.
OBRA laws require that state registries be kept for CNAs. Thus, these agencies are valuable resources. They can provide you with information on certification dates, reports of abuse and neglect, and lapse periods. You may want to contact your state registry at some point before you seek certification.
Eligibility for Certification
Eligibility varies by state; however, most states have multiple eligibility options. The following list represents most types of eligibility, but you should check with your state for its requirements.
- New Nursing Assistant: Persons who have never been certified as a nursing assistant/nurse aide. These candidates must complete a state-approved nursing assistant education program prior to taking the exam.
- Nursing Student: Nursing students who have successfully completed a fundamentals of nursing course through a state-approved nursing program within one year of applying to take the examination, and those who have successfully completed the fundamentals course and are currently enrolled in a nursing program.
- Graduate Nurse: A person who has graduated from a state-approved nursing program and who is waiting to take the state nursing licensing examination.
- Foreign Graduate Nurse: A person who graduated a nursing program in a foreign country and who is currently a nurse in that country.
- Nursing Assistant in Another State: A person currently certified as a nurse aide in another state who is listed in that other state’s nurse aide registry (and usually who has not had their certificate revoked in any state and is not listed on any state’s nurse aide abuse registry). Military Nurse Aide: Persons who had equivalent nurse aide training and experience in a military service.
- Lapsed or Expired Certification: Persons who are applying back to the state in which they were originally certified and whose certification has lapsed or expired (and usually who have not had their certificate revoked in any state and are not listed on any state’s nurse aide abuse registry).
Some states allow reciprocity for a person who is already certified as a CNA. Reciprocity means that you are asking your new state to recognize the certification you received from your original certifying state. If you are already a CNA in good standing (no abuse or revocation incidents) in another state, check with your present state’s nurse aide registry.
Most healthcare facilities require that CNAs have a high school diploma or GED; however, some states allow persons to become CNAs at age 16. Many states require that you submit to a criminal background check and/or caregiver background check, and that you not have any exclusionary convictions on record or substantiated findings on another state registry or licensing board.
Some states allow hospitals and other agencies to employ nursing assistants prior to their being certified. Typically, the nursing assistant may be employed for up to four months (120 days) while studying to achieve certification. Check with your nurse aide registry to see if your state has this option.
Education and Training
Training programs consist of 75 to 150 hours of education that includes lectures and hands-on skills practice, as well as supervised experience in a healthcare setting. These programs are offered at vocational schools, community colleges, and some free-standing private training facilities. Many long-term care facilities also offer nursing assistant education. And many of these institutions also offer refresher courses for nursing assistants whose certification lapsed or expired.
You may be able to complete an online CNA preparation course, provided that you receive nurse aide experience and your state allows this type of program to sit for the certification exam. Online programs allow you to study at your own pace and complete the program at your convenience, although most can be finished in six to eight weeks.
CNA training programs include education on the signs and symptoms of common diseases, as well as:
- communication skills
- patient/resident rights
- legal and ethical issues
- the role of the nursing assistant/nurse aide
- infection control
- bathing and dressing patients
- helping patients in and out of bed
- range of motion exercises
- taking vital signs—temperature, pulse, respirations, and blood pressure
- feeding patients
- measuring fluid intake and urinary output
- setup and storage of medical equipment
Your CNA Prep Plan
Once you know what you must do in order to be certified in your state, begin your CNA prep plan. First, you need to find an appropriate training program. You can do this several ways:
- Do a web search for “nursing assistant programs in [your state].”
- Contact the hospital, home healthcare agency, or long-term care facility where you plan to work, and ask which programs they recommend.
- Go to a local career counseling center, state employment agency, or private healthcare job placement service to get information about training.
- Contact the local community college and ask if they have a program.
- Browse the Yellow Pages of your phone book.
If allowed by your state, you may be able to plan on your own. Whether you train on your own or take a course, obtain a textbook and other materials that can enhance your knowledge and assist you in learning your skills. You can purchase these at your local bookstore or from an online bookstore. You can also look for them in your local library.
Here are the steps to take to become a CNA:
- Contact your local or state health department or your state’s nurse aide registry. The list of registries follows.
- Contact local employment agencies for employment opportunities.
- Take your CNA course and/or use study guides and textbooks to prepare for certification.
- Take the first practice exam in this book and score it. Review your weakest areas.
- Continue to review and take practice exams. Score yourself on each exam to see how prepared you are for the actual certification exam.
- Once you feel confident to take the exam, go to www.pearsonvue.com and find the Candidate Handbook for your state. Read it and follow the instructions. You will be scheduled for testing once you submit your examination application, required documents and examination fee. If your state is not listed, contact your state’s nurse aide registry or health department.
- Take the certification exam and pass it!
- Present your certificate and resumes to your prospective employers. This shows you are ready to start a job and have the initiative to advance once you are hired.
If you faithfully follow these steps, you will be well on your way to a successful career as a certified nursing assistant.
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From Nursing Assistant/Nurse Aide Exam. Copyright © 2009 by LearningExpress, LLC. All Rights Reserved.
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