CNA skills test: how it works, the skills list and why people fail

What the skills test is

Federal rules (42 CFR 483.154) require every state's nurse aide competency evaluation to include a skills demonstration: randomly selected tasks from a pool of the tasks nurse aides generally perform, given in a facility or lab setting and evaluated by a registered nurse. You must pass it as well as the written (or oral) test to be placed on the registry.

How the demonstration is organized depends on your state's test vendor. This guide follows the NNAAP version run by Credentia, using the South Carolina candidate handbook, then shows how Prometric (Florida) and D&S Diversified Technologies (Ohio) differ. The written test is covered on our free CNA practice test page.

How the NNAAP skills evaluation works

From the South Carolina handbook:

• Five skills, 30 minutes. You must complete all five satisfactorily to pass (Introduction).
• Hand hygiene is always one of the five, and there is always one measurement skill: blood pressure, pulse, respirations, urinary output or weight. The other three are drawn at random from the skills list.
• Another candidate plays the client, acting as a weakened elderly person. You will also play the client for someone else. You must speak to each other in English so the evaluator can score you, and you may not receive help.
• You actually perform every step. Only hand washing can be stated rather than repeated: after you have washed your hands once, the evaluator tells you to just say when you would wash them during the other skills.
• The evaluator does not answer questions once the test starts and does not tell you how you are doing. Ask about the equipment before you begin; the evaluator shows you where everything is.
• Plan for the whole day. The handbook asks you to arrive 30 minutes early and warns that test times are approximate.

Dress for it: the handbook requires flat, slip-on, non-skid shoes and loose clothes that roll up. Tell the evaluator about latex or food allergies before you start.

The official skills list

South Carolina's handbook lists 23 skills, with hand hygiene placed first "as a reminder of the importance of performing this skill before all other skills" (Skills):

Blood pressure is state-specific: South Carolina tests the electronic version and marks manual blood pressure as not tested there. Your own state's handbook tells you which version applies. Each skill in the handbook is broken into numbered steps, and that step list is what the evaluator scores, so study from it rather than from a summary.

Critical element steps: the main reason people fail

Some steps are printed in bold. These are critical element steps: if you leave one out or do it wrong, you fail the skill (The Skills Evaluation). Getting the critical steps right is not enough on its own, either: you must also perform enough of the other steps to meet the skill's passing standard.

Examples of bold steps in the current skills listing:

• Hand hygiene: lather all surfaces of wrists, hands and fingers with friction for at least 20 seconds, hands lower than the elbows and fingertips down; rinse the same way.
• Transfers and walking: before the client stands, non-skid footwear is on and feet are flat on the floor; for a wheelchair transfer, the wheelchair wheels are locked.
• PPE: remove the gloves before the gown, the second glove turned inside out as it comes off.
• Dressing: the weak (affected) arm goes into the sleeve first.
• Feeding: the client sits upright at 75 to 90 degrees before you start.
• Bed bath: eyes first, with water and no soap, inner to outer corner, a different area of the cloth for each stroke.
• Perineal and catheter care: wash and rinse front to back (perineal care), or away from the meatus along at least 4 inches of catheter, with a clean area of the cloth for each stroke.
• Range of motion: support the joint and move it at least 3 times unless the client says it hurts.

Measurement tolerances

The measurement skill is scored on the number you write on the recording sheet. It must fall within the evaluator's reading (Skills):

You must also be able to zero both a standing scale and a non-digital bathroom scale.

Other ways to lose a skill

• Correction rules. If you make a mistake, say so and redo the step; you do not repeat the whole skill. But if the evaluator has to remind you to put on or remove gloves, the correction earns no credit, and an order-dependent step ("before" or "after") only counts if you say when it should have happened. Once you start a new skill, you cannot go back.
• Forgetting the routine steps. Most skills also check that you explain the procedure, provide privacy, and leave the call signal within reach and the bed in low position. The handbook stresses placing the call signal within reach whenever you leave the client.
• Helping or being helped, or speaking another language with your partner: the test is stopped.

If you fail, the score report marks each skill Satisfactory or Unsatisfactory and prints the numbers of the steps you missed under each failed skill, so you know exactly what to practice.

How other states run it

Tennessee (Credentia): also 5 skills in 30 minutes, rated by an RN evaluator; you must perform all bolded steps correctly and pass all five skills (Tennessee handbook).

Florida (Prometric): you are scored on five skills, three assigned ones plus hand washing and "indirect care", which covers residents' rights, communication, safety, comfort and infection control. The time allowed ranges from 31 to 40 minutes depending on the skills, two nurses watch you, and you must pass all five (Florida bulletin). Prometric's bulletin says you are not required to perform a skill perfectly but must show competency against its checkpoints; you cannot correct a step after a safety issue.

Ohio (D&S Diversified Technologies, Headmaster): 3 or 4 tasks in 35 minutes, each with a scenario read by the RN test observer. To pass, you must perform all key steps (in bold) and 80% of the non-key steps on each task, and steps are not order-dependent unless they say "before" or "after" (Ohio handbook). Steps that are only spoken or simulated do not count.

How to practice

1. Print your own state's skills list and practice each skill out loud from the numbered steps, highlighting the bold ones.
2. Drill the measurements until you are reliably inside the tolerances: count a full minute, read the graduate at eye level on a flat surface.
3. Run timed sets of five, starting with hand hygiene, so 30 minutes feels comfortable.
4. Practice with a partner playing the client, in English, as on the day.

Many written-test questions cover the same infection-control and safety steps, so this work also helps with the knowledge exam; see how many questions are on the CNA exam and our CNA study guide. Our practice materials cover the written test only; they cannot grade a hands-on demonstration.

Sources

• South Carolina Nurse Aide Candidate Handbook, The Skills Evaluation — Credentia (checked October 3, 2026)
• South Carolina Nurse Aide Candidate Handbook, Skills (NNAAP skills listing) — Credentia (checked October 3, 2026)
• South Carolina Nurse Aide Candidate Handbook, Introduction — Credentia (checked October 3, 2026)
• South Carolina Nurse Aide Candidate Handbook, Exam Results — Credentia (checked October 3, 2026)
• Tennessee Nurse Aide Candidate Handbook, Exam Overview — Credentia (checked October 3, 2026)
• Florida Certified Nursing Assistant Candidate Information Bulletin (Rev. 11012025) — Prometric (checked October 3, 2026)
• Ohio Nurse Aide Candidate Handbook, Version 27 (December 2025) — D&S Diversified Technologies (Headmaster) (checked October 3, 2026)
• 42 CFR 483.154, Nurse aide competency evaluation — eCFR (checked October 3, 2026)

NNAAP is a registered trademark of its owner. passmock is not affiliated with or endorsed by Credentia, the National Council of State Boards of Nursing (NCSBN), Prometric, D&S Diversified Technologies (Headmaster) or any state nurse aide registry.