How to Become a CNA in 2027: Training, the Competency Exam, and the Registry

Step 1: Finish a state-approved training program

Federal rules for nurse aides who work in nursing homes set the minimum every state must meet:

• At least 75 clock hours of training
• At least 16 hours of supervised practical training, in a lab or clinical setting under a registered nurse or licensed practical nurse
• At least 16 hours before any direct contact with a resident, covering communication and interpersonal skills, infection control, safety and emergency procedures including the Heimlich maneuver, promoting independence, and residents' rights
• training led by, or under the supervision of, a registered nurse with at least two years of nursing experience, at least one year of it in long-term care

The curriculum also covers basic nursing skills, personal care, mental health and social needs, care of residents with cognitive impairment, restorative care, and residents' rights.

States can, and many do, require more. Pennsylvania, for example, is an 80-hour state, with 37.5 of those hours in supervised clinical experience. Check your state's nurse aide registry or health department for the approved programs and the required hours.

Can you skip training? In some states, yes, through a "challenge" route. Florida's Board of Nursing allows candidates who are 18 or older, or who hold a high school diploma or equivalent, to take the exam without an approved program. Tennessee's E2 challenge route also requires no training up front, but sends candidates back to train after three failed attempts or two years. Whichever route you use, the skills test is a hands-on demonstration, so you need supervised practice with each skill before you sit it.

Step 2: Pass the competency exam

Every state's exam has two parts, and federal rules require you to pass both:

1. A written or oral knowledge test. You choose written or oral; the oral version must be read from a prepared text in a neutral way.
2. A skills demonstration, with tasks drawn at random from a pool of nurse aide skills and scored by a registered nurse with experience caring for older or chronically ill people.

The state sets the passing standard. In NNAAP states, the written exam follows the 2024 content outline, and Pennsylvania's handbook describes 70 questions in two hours and five skills in 30 minutes. Florida, which uses Prometric, lists 60 written questions in 90 minutes and five skills. The state-by-state guide shows how to find your exam.

Federal rules guarantee at least three chances to pass. States add time limits, such as two years from the end of training in Pennsylvania, so don't let months slip after your course ends. To prepare for the written part, practice CNA written-exam questions with explanations for every answer →, and use the CNA study guide to split your time between the two parts.

Step 3: Get on the nurse aide registry

When you pass both parts, federal rules require the state to add you to its nurse aide registry within 30 days. The registry is how employers confirm you're eligible to work, and you're told before testing that passing will put you there. States can't charge you to be listed.

Step 4: Start working, and know the rules that follow you

Once you're hired, a few federal rules shape your first years:

• Registry check before you start. The nursing home must verify your registry status, and check every other state registry it believes may have information on you.
• The four-month rule. A facility can't use someone as a nurse aide full time for more than four months unless they've completed training and passed the competency exam.
• Yearly training and review. Facilities must review your performance at least once every 12 months and provide at least 12 hours of in-service training a year.
• The 24-month rule. If you go 24 consecutive months without paid nursing or nursing-related work, you need a new training and competency program, and your registry entry can be removed. The registry guide explains how to stay active.

Who can train and test for free

Federal rules protect nurse aides who are already connected to a nursing home. If a facility employs you, or has offered you a job, on the date you begin training, you can't be charged for any part of the program, including textbooks and required materials. If you pay for training yourself and are hired by a facility within 12 months of finishing, the state must provide pro rata reimbursement for the time you work as a nurse aide.

That makes it worth asking local nursing homes about employer-sponsored training before you pay out of pocket. The cost guide lists current exam fees by state.

A realistic 2027 timeline

There's no national calendar, but the steps line up the same way everywhere: choose an approved program, complete the hours, schedule the exam soon after while skills are fresh, and allow time for the registry listing before your start date. If your program ends late in 2026, a test date in early 2027 keeps you well inside the two-year windows some states use, and inside the 12-month windows others, like Rhode Island and Virginia, apply.