Nursing assistants generally perform direct patient care duties such as making beds, feeding patients and helping them with personal hygiene. Not all nursing assistants must be certified, and federal law only requires those nursing assistants who work in nursing homes to complete training and competency testing. CENA stands for Competency-Evaluated Nursing Assistant, and is a term often used in some states, such as Michigan and Washington, to distinguish nursing assistants who have successfully passed a state competency exam from those who have not.


Competency-evaluated nursing assistants must complete a minimum of a 75-hour training course in basic nursing skills. Some programs last longer. CENA training programs usually include both classroom and clinical sections, where students work in a real nursing environment. To qualify to take the state CNA exam, the nursing program must be state-approved. Submitting official transcripts or certificates from an approved program is part of registering for a state's exam and state licensing.

State Competency Exam

CENAs must take a state nursing assistant competency exam before being certified. Most nursing assistant exams are made up of two parts, a written section and a skills section. The written section is usually multiple-choice, but the skills portion consists of five or more nursing skills that must be properly demonstrated in front of an examiner. These skills often include answering call lights, using a gaiter belt, taking vital signs and correctly measuring patient input and output.

Criminal Background Check

Many states require that all certified nursing assistants submit to a criminal records search before being issued a license or being placed on the nursing assistant registry. Though routine traffic infractions are usually not considered a problem, violent crimes such as murder, assault or abuse, fraud, or theft may automatically disqualify a person from becoming a CENA. A state may allow waivers for some offenses, and a hearing in cases of denial of license.

Continuing Education Units

After obtaining certification, a CENA may have to complete a certain number of continuing education hours before being allowed to renew. Continuing education hours can be taken at the place of employment or from an approved provider. Some states allow continuing education credits for a subject relevant to nursing, such as patient and resident rights, communication, and infection control. Other states, such as Florida, require that CENAs take classes in specific subjects, such as HIV/AIDS, cardiopulmonary resuscitation and domestic violence.