CNA Skills Test 2026: All 23 NNAAP Skills + Automatic Fails

CNA Skills Test 2026: The Short Answer

The CNA skills test is the hands-on half of nurse aide certification: a nurse evaluator watches you perform assigned skills on a classmate, an actor, or a mannequin and scores you against a checklist. How many skills you get, how long you have, and which mistakes fail you automatically depend on your state's testing vendor:

• Credentia (NNAAP): 5 skills in 30 minutes. Hand hygiene is always one of them, and one is always a measurement skill.
• Prometric: 5 scored skills. Your instruction card lists 3 assigned skills; Handwashing and Indirect Care are scored on every test without any prompt. Time limits run 31 to 40 minutes.
• D&SDT-Headmaster (California and Wisconsin handbooks): 3 or 4 tasks in 30 minutes, starting with a mandatory task that ends in soap-and-water handwashing.
• Regional Testing Center (California only): 5 skills in 30 minutes, always including handwashing and one measurement skill.

Every vendor requires you to pass every assigned skill. On NNAAP, Headmaster, and the Regional Testing Center, missing one bold critical step (the Regional Testing Center and Headmaster's Wisconsin handbook say "key" step) fails that skill. Prometric does not publish critical steps; it scores checkpoints instead. You do not need a perfect score on the other steps, though: NNAAP sets a cut score for each skill, Headmaster requires 80% of the non-key steps, and the Regional Testing Center requires at least 70% on each skill.

This guide is built from the current candidate handbooks (linked at the end, checked October 2, 2026). It shows the real critical steps for each skill, which is where most online checklists go wrong. Placing the call light, explaining the procedure, and providing privacy are scored steps, but on NNAAP none of them is an automatic fail.

Preparing for the written test too? Take a FREE CNA practice test, work through the FREE CNA study guide, and review the CNA flashcards. Testing in California? Use the California CNA practice questions and California CNA study guide.

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Compare the Four Skills Test Formats

Sources: Credentia California and Colorado NNAAP handbooks, Prometric Clinical Skills Checklist and timing summary, D&SDT-Headmaster California Candidate Handbook (effective March 1, 2026), and the Regional Testing Center CNA handbook (January 2026).

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Which Vendor Will Test You?

Your training program and your state's nurse aide registry tell you which vendor applies. Vendor websites listed these nurse aide programs on October 2, 2026:

• Credentia (NNAAP): Alabama, Alaska, California, Colorado, District of Columbia, Georgia, Iowa, Maryland, North Carolina, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, and Washington, plus Guam, the Northern Mariana Islands, the U.S. Virgin Islands, and DoDEA schools.
• Prometric: Alabama, Connecticut, Delaware, Florida, Hawaii, Louisiana, New York, Oklahoma, and Texas. In Idaho, Prometric gives only the written exam.
• D&SDT-Headmaster: active nurse aide pages include Arizona, California, Michigan, Minnesota, Ohio, Oregon, and Wisconsin, among other states listed on hdmaster.com.
• Illinois: Southern Illinois University Carbondale gives the written competency exam, and training program instructors and evaluators check the 21 mandated manual skills.

Some states appear on more than one vendor's site (Alabama lists both Credentia and Prometric, and California approves three vendors), so confirm your vendor before you study a skills checklist. Headmaster writes a separate handbook for each state, so task counts and steps can differ outside California and Wisconsin.

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California Has Three Skills Test Formats

The California Department of Public Health (CDPH) approves three CNA testing vendors: D&SDT-Headmaster, Credentia Nurse Aide LLC, and the Regional Testing Center at Golden West College in Huntington Beach. Prometric is not a California vendor. Each one runs a different skills test:

Headmaster's four mandatory first tasks are: assist with a bedpan and measure urine output; female catheter care; put on a gown and gloves, empty a urinary drainage bag, and remove the gown and gloves; and female perineal care. Catheter care and perineal care are performed on a manikin, and each mandatory task ends with soap-and-water handwashing. California's Headmaster and Regional Testing Center handbooks allow three attempts to pass each part within two years of finishing your training program.

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How Hand Hygiene Is Scored, Vendor by Vendor

Hand hygiene is on every test, but each vendor scores it differently.

Credentia (NNAAP). Hand Hygiene is Skill 1, performed at a real sink with running water. Only two steps are Critical Element Steps:

1. Lather all surfaces of the wrists, hands, and fingers with friction for at least 20 seconds, keeping hands lower than the elbows and fingertips down.
2. Rinse all surfaces of the wrists, hands, and fingers, keeping hands lower than the elbows and fingertips down.

The other eight steps still count toward the cut score: greet and introduce yourself, turn on the water, wet hands and wrists, apply soap, clean fingernails against the opposite palm, dry from the fingertips with a clean paper towel, turn off the faucet with a clean, dry paper towel (or a knee or foot control), and never touch the inside of the sink. After your first wash, the evaluator tells you to simply say when you would wash your hands during the remaining skills.

Prometric. Handwashing is unprompted: nobody tells you to do it. The evaluator rates your technique at the beginning of the first skill (in Florida, two nurses observe), and the test time includes 3 minutes for it. The six checkpoints include friction for at least 20 seconds and ending with clean hands without recontaminating them, for example by touching faucet handles or the sink. After the first skill, hand hygiene is scored as part of Indirect Care.

D&SDT-Headmaster (California). Soap-and-water handwashing happens at the end of your mandatory first task. Two of its steps are critical: scrub with soap for at least 20 seconds, and do not recontaminate your hands (for example, by touching the sides of the sink or crumpling the faucet paper towel with both hands). Every other task starts and ends with hand sanitizer steps that you must actually perform; Headmaster does not count verbalized steps.

Regional Testing Center. The key steps are lathering with friction for at least 20 seconds through a set rub sequence repeated at least twice, keeping fingertips pointed down, and rinsing with fingertips down without shaking water off your hands. After the first wash, you tell the evaluator when you would wash.

Bottom line: touching the faucet with clean hands is an automatic fail on Headmaster, a scored checkpoint on Prometric, and a missed non-critical step on NNAAP. Do not risk it on any vendor.

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All 23 NNAAP Skills and Their Critical Element Steps

Credentia's skills listing puts Critical Element Steps in bold. Miss one and you fail that skill. Four skills have no critical step, but you still have to reach the cut score.

State exclusions: Credentia's California listing marks electronic blood pressure "not tested," and Pennsylvania's listing excludes both the bedpan skill and electronic blood pressure. Check your own state's listing before you practice.

Prometric's pool is different. Prometric has no blood pressure or weight skill. Instead, its 20 assignable skills include changing an occupied bed, hand and nail care, a partial bed bath with back rub, range of motion for an elbow and wrist, mouth care for a resident with teeth or dentures, and foot care for a resident sitting in a chair.

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Steps That Are Not Automatic Fails but Still Cost You

Many checklists claim that forgetting the call light, privacy, or an introduction is an automatic failure. On NNAAP, none of those steps is in bold. They are still scored, and missing several of them can drop a skill below its cut score:

• Explain the procedure, speaking clearly and face to face.
• Provide privacy with a curtain, screen, or door.
• Leave the signaling device within reach, with the bed in low position. Credentia's handbook tells candidates to place the call signal within reach whenever they leave the client.
• Wash your hands (or say you would) before recording a measurement and after finishing.

On Prometric, these habits form the Indirect Care skill, which is one of your five scored skills. Its seven checkpoints are: greet the resident by name and introduce yourself, explain care before and during it, ask about preferences, use standard precautions and infection control, ask about comfort or needs, promote resident rights, and promote resident safety. Sloppy habits spread across three skills can fail Indirect Care even if each skill looks fine.

On Headmaster, these steps count toward the 80% non-key requirement for each task.

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Measurement Accuracy by Vendor

Your recorded number is compared with the evaluator's. Outside the tolerance, the skill fails.

Count pulse and respirations for one full minute. Every handbook above asks for a full-minute count.

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How to Perform the Highest-Risk Skills

Manual blood pressure (NNAAP version)

1. Explain the procedure and wipe the stethoscope earpieces and bell or diaphragm with alcohol.
2. Position the arm palm up with the upper arm exposed, and feel for the brachial artery at the inner elbow.
3. Place the cuff snugly on the upper arm with the arrow over the brachial artery, then place the diaphragm over the artery.
4. Inflate to 160 to 180 mmHg. If you hear a beat as soon as you start deflating, deflate completely and re-inflate to no more than 200 mmHg.
5. Deflate slowly. The first sound is systolic and the last sound is diastolic; round up to the nearest 2 mmHg if needed.
6. Remove the cuff, leave the signaling device within reach, wash your hands, then record both numbers.

On Headmaster's California test, you get up to three attempts (switching arms is recommended), and your reading must be within 6 mmHg.

Feeding a client who cannot feed self

• Check the name card on the tray and ask the client to state their name.
• Before feeding, sit the client upright at 75 to 90 degrees (critical on NNAAP and Headmaster; the Regional Testing Center's key step is at least 45 degrees).
• Clean the client's hands, sit facing them, say what is on the tray, and ask what they want first.
• Using a spoon, offer one bite of each type of food, offer the beverage at least once, and ask whether they are ready for the next bite.
• At the end, clean the client's mouth and hands and leave them upright with the signaling device in reach.

Headmaster's California task adds two critical calculations: food intake within 25 percentage points and fluid intake within 30 mL of the observer's.

Transfers and ambulation with a gait belt

Lock the wheelchair wheels, check or lock the bed wheels, put non-skid footwear on the client, and seat them with feet flat on the floor before they stand. Give a prearranged signal, grasp the belt on both sides with an upward grasp, and keep the client's legs stable knee to knee or toe to toe. Headmaster's California tasks make locking both the bed and wheelchair brakes critical.

Perineal and catheter care

Wash and rinse from front to back with a clean area of the washcloth for each stroke. For catheter care, hold the catheter where it exits without tugging and clean at least 4 inches, moving only away from the meatus. Check the water temperature and ask the client to confirm it is comfortable before washing.

Positioning on the side

NNAAP's steps: lower the head of the bed, raise the side rail on the side the client will face, roll the client slowly toward it, adjust the pillow under the head, move the arm so the client is not lying on it, and support the top arm, back, and legs (top knee flexed) with supportive devices. Headmaster's California version makes raising the side rail critical (or directing the observer to stand on the opposite side).

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Rules That Trip Up Prepared Candidates

1. Saying a step instead of doing it. Except for handwashing after the first wash on NNAAP and the Regional Testing Center, you must physically perform every step. Headmaster states that verbalized or simulated steps will not count.
2. Correcting a step the wrong way. On NNAAP and at the Regional Testing Center, you can fix a step only within the current skill. If you correct an order-dependent step without saying when it should happen, or the evaluator had to remind you about gloves, you get no credit.
3. Forgetting unprompted handwashing on Prometric. Nobody will tell you to wash at the start.
4. Running out of time. Rehearse full timed runs: 5 skills in 30 minutes (NNAAP and the Regional Testing Center) or 3 to 4 tasks in 30 minutes (Headmaster).
5. Bringing your own equipment. Credentia does not allow your own gait belt or other equipment. Know how to zero both a standing scale and a non-digital bathroom scale.

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What to Wear and Bring

If your vendor turns you away for attire or ID, you are usually treated as a no-show and lose the fee, so read your handbook's ID section twice.

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If You Fail a Skill

• NNAAP: your score report lists all 5 skills as Satisfactory or Unsatisfactory and shows why a skill failed. You retake the part you failed; fail either part three times and you must retrain and retake both parts.
• Prometric (Texas): you can take each test up to three times within 24 months before retraining is required; results arrive by email the next day.
• California (Headmaster and Regional Testing Center): three attempts per part within two years of finishing training. With Headmaster, you pay again only for the part you failed.

A retake is a full skills test, not a redo of only the skill you missed. Headmaster's Wisconsin handbook adds that one retest task will be a task you previously failed.

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2-Week Skills Practice Plan

Use the CNA cheat sheet for a one-page review, and ask the OpenExamPrep AI tutor (10 free AI questions per day) to quiz you on any skill's steps.

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Official Sources (checked October 2, 2026)

• Credentia NNAAP skills listing, California and California skills evaluation rules
• Credentia Colorado NNAAP candidate handbook (2024) and Credentia state program list
• Credentia Pennsylvania skills listing
• D&SDT-Headmaster California Candidate Handbook, effective March 1, 2026 and Wisconsin Candidate Handbook V75
• Prometric Nurse Aide Clinical Skills Checklist, Clinical Skills Timing summary, Texas Candidate Information Bulletin, and Prometric nurse aide states
• CDPH Certified Nurse Assistant Testing Vendors and the Regional Testing Center CNA Examination Handbook
• Illinois Nurse Aide Testing (SIU Carbondale)
• NCSBN NNAAP and MACE