The 23 NNAAP Skills Explained: What Each One Tests and Why the Steps Matter

The 23 NNAAP skills, grouped by what they protect

Credentia's handbooks list the 23 NNAAP skills alphabetically, except that Hand Hygiene comes first as a reminder of its importance. The table below keeps Credentia's numbers and titles but groups the skills by purpose. The grouping is Passy's. The skill titles are Credentia's, and the step lists behind them are not reproduced here: learn those from your state's current handbook.

The list reflects a federal requirement. The pool of skills a state draws from must include every personal care skill in the federal curriculum: bathing, grooming including mouth care, dressing, toileting, eating and hydration, feeding, skin care, and transfers, positioning and turning (42 CFR 483.154(b)(2) and 483.152(b)(3)).

Reasons that repeat across almost every NNAAP skill

Read any checklist closely and the same few purposes come back again and again. If you can name the purpose of a step, you are much less likely to skip it under pressure.

• Telling the resident who you are and what you will do. Residents have the right to be told in advance about the care they will receive (42 CFR 483.10(c)(4)). Explaining also lets the resident help, which makes the task safer and keeps the resident in charge of their own body.
• Privacy and dignity. Federal rules say personal privacy includes personal care (483.10(h)(1)). Steps that close a curtain or keep the resident covered exist for that right, not for the evaluator.
• Clean hands and gloves at the right moments. CDC's guidance for healthcare workers says gloves are not a substitute for hand hygiene, that you should always clean your hands after removing gloves, and that hand hygiene comes before moving from a soiled body site to a clean one on the same patient (CDC, February 27, 2024). Many steps place hand hygiene and glove changes at exactly those points.
• Leaving the resident safe. Credentia's tips ask you to place the call signal within reach whenever you leave the resident. Steps near the end of many skills return the room and the bed to a safe state for the same reason.
• Supporting the body, never forcing it. Mobility and range-of-motion steps exist so that the resident's weight and joints are supported and nothing is pushed past what the body allows. Your instructor teaches when to stop and tell the nurse.
• Recording what you actually measured. On the evaluation, full credit for a measurement needs an accurate measurement and an accurately recorded number, entered on a tablet.

What each NNAAP purpose group tests, and why its steps matter

Infection control skills: hand hygiene and PPE

Hand Hygiene is the only skill every candidate performs. Its steps exist to clean every surface of the hands and wrists and then keep them from being contaminated again before you touch the resident. Credentia's checklist asks for lathering of at least 20 seconds. CDC's page for healthcare workers says at least 15 seconds of rubbing with soap and water, notes that other organizations recommend 20, and accepts either. On test day, follow your state's checklist.

The PPE skill exists because the outside of a used gown and gloves is the dirty side. The removal steps keep that side away from your skin and clothes, and hand hygiene follows glove removal. Use the putting-on and taking-off order on your state's checklist and your facility's posted sequence. Use CDC’s clinical hand-hygiene guidance with the current skills checklist.

Measurement skills: pulse, respirations, blood pressure, weight, output

These skills test whether the nurse can trust your number. The steps that matter most are the ones that protect accuracy: counting for the full time, setting a scale to zero, reading at the right point, and writing the number down before anything else can push it out of your memory. Credentia says you must know both a standing scale and a non-digital bathroom scale and how to zero each one. The two blood pressure skills are state specific, and evaluators are told not to substitute one for the other.

Personal care skills: bathing to feeding

Personal care skills share three aims: keep the resident covered and warm, let the resident do what they can, and move from cleaner areas toward dirtier ones so germs are not carried back. Peri-care and catheter care add one more. The direction of each stroke, and when you switch to a clean part of the cloth, keep germs from being carried toward the urinary opening. Catheter care also connects to CDC's catheter guidance, which says to keep the drainage system closed, the tubing free of kinks, and the bag below the level of the bladder and off the floor (CDC/HICPAC CAUTI guideline, 2009, updated 2019).

Dressing a resident with a weak arm is about moving the weak limb as little and as gently as possible. Feeding is about safe swallowing and a meal that stays the resident's own, with positioning, pace and choices. Denture care is about keeping a fragile, hard-to-replace device clean and unbroken. Foot care and bathing give you a close look at the skin. AHRQ's pressure-injury toolkit notes that nursing assistants can be taught to check the skin any time they clean, bathe or turn a patient, and to report changes (AHRQ, content last reviewed October 2014). Practice those care principles with your instructor and the current state checklist.

Mobility and positioning skills: transfers, walking, turning, range of motion

Before a resident stands, several steps check the same things: that the resident's feet will not slip, that nothing the resident leans on can roll, that the resident knows when to stand, and that you are in position to support them. The transfer belt gives you a secure hold. You use the one at the test site, not your own. Positioning steps keep the resident from rolling toward an edge and support the body once they are on their side. Range-of-motion steps support the joint and move it gently, without forcing. Fall prevention and safe transfers and range of motion and restorative care explain the principles behind these steps.

Circulation: the knee-high elastic stocking

An elastic stocking only helps if it lies smooth and even. Wrinkles, folds and twists are what the steps guard against, because they press on the skin. When and how a resident wears one is set by the care plan and the nurse.

Tennessee's skill changes on November 1 and December 1, 2026

Tennessee only, as checked on October 18, 2026. Credentia's Tennessee skills page reads "Updated 10/6/2026" and says underlined changes will begin being tested 11/1/2026. It marks nine changed steps in seven skills. The changes concern how drying is described in Hand Hygiene, physically checking or locking the bed wheels in Assists to Ambulate, the wording on washing hands before recording in Radial Pulse, Respirations and Manual Blood Pressure, disposing of the gown in the dressing skill, and three changes in Positions on Side about the working side of the bed and physically placing the pillow. Separately, Skill 2 (Applies One Knee-High Elastic Stocking) and Skill 19 (Provides Foot Care on One Foot) begin being tested in Tennessee on 12/1/2026. If you test in Tennessee, practice from the updated page, and read the exact new wording there.

The Tennessee update is a good reason to distrust skills lists copied onto other websites. A list can be correct for one state and out of date for another, or out of date everywhere after a revision.

NNAAP skills your state may not test

As checked on October 18, 2026:

Other NNAAP states publish their own notes in their handbooks. States that use other vendors have their own skills lists: Florida's Board of Nursing describes five randomly selected nursing assistant skills on its Prometric exam, for example. Which CNA exam your state uses helps you find the right list.

How to use this guide with your state's skills checklist

1. Get the current checklist from your state's handbook or your instructor, and note its date.
2. Write the purpose next to each step in your own words: privacy, safety, infection control, communication or measurement. A step with no purpose you can name is the step to ask your instructor about.
3. Rehearse each skill hands-on with a classmate as the resident and someone holding the checklist.
4. Say the purpose as you perform the step, then drop the words once the step is automatic.

This guide teaches why the steps exist, not the steps themselves. How the skills evaluation works explains how those steps are scored on test day.