What Are the 22 CNA Skills
The 22 CNA skills represent the standardized clinical and interpersonal competencies tested in state nursing assistant exams and required for certification programs. These skills cover direct patient care, safety, communication, and documentation tasks that nursing assistants perform daily in hospitals, nursing homes, and home health settings. The National Council of State Boards of Nursing (NCSBN) outlines these competencies as part of the Nurse Aide Assessment Program (NNAAP), which is used by many states to evaluate entry-level nursing assistant proficiency. According to labor market data, nursing assistants held about 1.4 million jobs in 2023, with the largest employers being nursing care facilities and hospitals. The U.S. Bureau of Labor Statistics projects employment of nursing assistants to grow faster than the average for all occupations through 2032, driven by an aging population and increased demand for long-term care. Many training programs, including those affiliated with the American Red Cross, structure their curricula around these 22 skills to ensure students meet state and federal requirements.
Employers such as large hospital systems and home health agencies use the 22 CNA skills as a baseline for hiring, orientation, and performance evaluations. Skills like hand hygiene, patient transfer techniques, and vital sign measurement are consistently ranked among the most critical competencies in job descriptions posted on major healthcare job boards. The skills also align with regulations from the Centers for Medicare & Medicaid Services (CMS), which sets federal requirements for nursing assistant training and competency evaluation in Medicare-certified facilities. In practice, nursing assistants apply these skills under the supervision of registered nurses (RNs) and licensed practical nurses (LPNs) to support activities of daily living (ADLs) and basic clinical tasks. Mastery of the 22 CNA skills is often a prerequisite for advancing to roles such as medication aide, patient care technician, or licensed practical nurse.
Core Clinical CNA Skills
Clinical skills within the 22 CNA skills include measuring and recording blood pressure, pulse, respiration rate, temperature, and oxygen saturation using approved devices and techniques. Nursing assistants are trained to perform hand hygiene according to the World Health Organization (WHO) "5 Moments for Hand Hygiene" and to use personal protective equipment (PPE) such as gloves, gowns, and masks to prevent infection transmission. Other clinical skills include assisting with oral care, grooming, bathing, toileting, and feeding patients who cannot perform these tasks independently. CNA training programs teach proper body mechanics for safe patient lifting, transferring, and repositioning to reduce the risk of injury to both the patient and the caregiver. Skills related to specimen collection, such as urine and stool samples, and basic wound care, such as dressing changes, are also included in many state competency checklists. These clinical tasks are performed in compliance with facility policies and under the direct or indirect supervision of licensed nursing staff.
Infection control and safety skills are central to the 22 CNA skills, especially in settings such as acute care hospitals and long-term care facilities where vulnerable populations are at higher risk for healthcare-associated infections. Nursing assistants are expected to follow standard precautions, isolate patients when required, and correctly dispose of sharps and biohazardous waste. Safety skills also include fall prevention measures, such as using call bells, keeping call lights within reach, and ensuring clear pathways, as well as fire safety and emergency response procedures. Many facilities incorporate training from organizations like the Occupational Safety and Health Administration (OSHA) to reinforce safe work practices. The ability to accurately document care, report changes in patient condition, and communicate effectively with the interdisciplinary team is also emphasized as part of these core clinical competencies.
Communication and Patient Care Skills
Communication skills are a key component of the 22 CNA skills, requiring nursing assistants to interact respectfully and clearly with patients, families, and healthcare team members. CNA training includes techniques for active listening, using appropriate language,