A Certified Nursing Assistant (CNA) is a health care professional who provides direct patient care under the supervision of a licensed nurse. The role involves assisting patients with activities of daily living in settings like nursing homes, hospitals, and assisted living facilities. Challenging the CNA exam in North Carolina allows qualified individuals to bypass the required state-approved training course. This option is available for those whose prior education or experience is deemed equivalent to the standard training curriculum, allowing them to apply directly for the competency examination.
Eligibility for Challenging the CNA Exam in North Carolina
North Carolina provides several specific pathways that allow an applicant to test for CNA I certification without completing the standard training course. The North Carolina Nurse Aide Registry (NCNR) or its designated testing vendor, Credentia, must verify and approve this eligibility before an examination can be scheduled. Applicants who do not qualify for one of these routes must complete a state-approved training program.
Nursing Students
Current or recently withdrawn students enrolled in a state-approved Registered Nurse (RN) or Licensed Practical Nurse (LPN) program may qualify to challenge the exam (Route E5). Eligibility requires successful completion of coursework considered equivalent to the state-approved nurse aide training. The coursework completion date must fall within the previous two years of the application date. Testing must be completed within two years of that date or within three attempts, whichever comes first.
Out-of-State CNAs or Lapsed Registrants
Individuals actively listed and in good standing on another state’s nurse aide registry can typically apply for reciprocity to be listed on the North Carolina registry without testing. If an out-of-state individual completed a state-approved program within the last 24 months but is not currently listed on any registry, they may challenge the exam (Route E9). Similarly, a North Carolina CNA whose listing has lapsed due to failed renewal requirements must retest and may be eligible to challenge the exam (Route E10).
Military Personnel with Medical Training
Military veterans who received medical or nursing training credentials while serving in the U.S. Armed Forces may be eligible to challenge the exam (Route E8). This pathway recognizes the equivalent knowledge and skills gained through military service. Other healthcare professionals, such as an active Emergency Medical Technician (EMT), are also included in this eligibility route.
Those Who Completed Unapproved Training
Route E8 also covers unlicensed nursing graduates or students who completed nurse aide equivalent training within the last 24 months but were not enrolled in a North Carolina-approved program. For categories E8, E9, and E10, the applicant must apply for a training waiver through the Credentia online platform to verify eligibility. The testing window for these “challenge” candidates is two years from the application approval date or a maximum of three attempts, whichever occurs sooner.
Documentation and Application Process
Once an applicant determines their eligibility route, they must submit an application for the competency examination through the designated testing vendor, Credentia. This process is managed through an online platform where the applicant first creates an account. The application requires submitting personal details and documentation specific to the chosen eligibility route to verify the claim.
For challenge routes, such as military or out-of-state training pathways, a training waiver application must be completed within the online platform. This waiver allows the NCNR to review and approve the equivalency of the applicant’s prior experience or education. While the application process may not have a fee, the competency examination requires a non-refundable payment.
The application is reviewed, and once approved, the candidate can schedule the examination through the online system. Applicants should save all receipts; those employed by a Medicare/Medicaid skilled nursing facility within 12 months of passing the exam may be eligible for reimbursement for training and testing costs. The administrative process must be completed to secure permission to test before the eligibility window expires.
Preparing for and Taking the CNA Examination
The North Carolina CNA I examination, formally known as the National Nurse Aide Assessment Program (NNAAP), is a two-part evaluation. Both the knowledge test and the clinical skills evaluation must be successfully passed to be placed on the registry. Candidates must be physically capable of performing all required skills; those on restricted activity or light duty due to medical reasons are not permitted to take the skills evaluation.
The knowledge portion is a written examination consisting of 70 multiple-choice questions (60 scored, 10 pre-test items). Candidates have two hours to complete it. An oral examination is available as an optional substitute for the written test, split into two parts: 60 multiple-choice questions read aloud and 10 questions testing understanding of common long-term care words. The questions cover a broad range of knowledge required for an entry-level nurse aide, including resident rights, basic restorative care, and infection prevention.
The second part is the clinical skills evaluation, where the candidate must successfully perform five randomly selected nurse aide skills, including Hand Hygiene. A Nurse Aide Evaluator assesses the performance, which reflects real-life scenarios encountered in a long-term care setting. Candidates are allowed a maximum of three attempts to pass both the written and skills portions within a two-year period from the eligibility approval date. Failure to pass both parts within the three attempts or the two-year window requires the candidate to complete a state-approved nurse aide training program before retesting.
Initial Registration and Listing on the Nurse Aide Registry
Successful completion of both the knowledge and clinical skills portions of the NNAAP examination is the final step before official certification. Passing both parts triggers the process for the candidate to be placed on the North Carolina Nurse Aide I Registry (NCNR). The NCNR is maintained by the Division of Health Service Regulation (DHSR) and serves as the official record of all certified nurse aides in the state.
The listing process typically takes a short period, with candidates often being placed on the registry within 10 business days after passing the competency exam. Once listed, the status is active and in good standing, which is a prerequisite for employment as a CNA I in North Carolina. Candidates can verify their active listing directly through the online registry portal.
Maintaining Your North Carolina CNA Status
To keep the Nurse Aide I certification active, the CNA must meet specific ongoing requirements every two years, as the certification is subject to a 24-month renewal cycle. The primary requirement for renewal is that the CNA must have worked for compensation, performing nursing care activities under the supervision of a Registered Nurse (RN), for a minimum of eight hours within the preceding 24 months.
This compensated work must involve performing nurse aide duties; private duty employment typically does not qualify for renewal. The process requires the CNA to complete an online Employment Verification Form, which must be verified by the supervising RN. Allowing the registration to lapse by failing to meet the work requirement necessitates retaking and passing the state-approved competency examination to be reinstated.