North Carolina CNA Exam 2026: Your Complete NA I and NA II Certification Guide
North Carolina is one of the only states in the country with a two-tier nurse aide system. Most healthcare workers start as a Nurse Aide I (NA I) — the standard 75-hour CNA role regulated by the NC Division of Health Service Regulation (DHSR) and listed on the NC Nurse Aide I Registry at NCDHHS. Many then advance to Nurse Aide II (NA II) — an expanded-scope role regulated by the North Carolina Board of Nursing (NCBON) with its own training program, skills checklist, and separate registry.
This distinction confuses almost everyone. A NA I is federally mandated under OBRA 1987 and can work in nursing homes, assisted living, hospice, and home health. A NA II is North Carolina's own invention — it lets experienced aides perform sterile procedures, tracheostomy care, wound care, urinary catheterization, and other tasks that NA I scope prohibits, which is why hospitals across the state prefer NA IIs.
This guide walks through both tiers: NA I (Credentia-administered NNAAP exam), NA II (NCBON-approved course + competency assessment), training hours, fees, skills lists, registry rules, renewal, reciprocity, salary in Charlotte and the Research Triangle, and study timelines for both. All of it is current for 2026.
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NA I vs NA II: The Core Differences at a Glance
| Feature | Nurse Aide I (NA I) | Nurse Aide II (NA II) |
|---|---|---|
| Regulator | NC DHSR (NC Dept of Health & Human Services) | NC Board of Nursing (NCBON) |
| Registry | NC Nurse Aide I Registry (ncnar.ncdhhs.gov) | NCBON Nurse Aide II Registry (ncbon.com) |
| Training hours minimum | 75 hours (16 clinical minimum) | 160 hours (80 theory + 80 clinical) |
| Exam vendor | Credentia (NNAAP) | NCBON-approved program competency assessment |
| Written questions | 70 multiple-choice | Program-specific competency assessment |
| Fee | $140 combined written + skills | Varies by program (usually $800–$2,500 total) |
| Prerequisite | 18 years old (16 with waiver); background check | Active NA I listing in good standing |
| Scope | ADLs, vitals, transfers, basic care | All NA I tasks PLUS sterile procedures, wound care, trach care, catheterization, ostomy |
| Typical employers | Nursing homes, assisted living, home health | Hospitals, rehab, ICU, high-acuity settings |
| Pay bump over NA I | — | Typically $2–$5/hour more |
| Renewal period | Every 24 months, 8 paid hours | Every 24 months, 8 paid hours under RN supervision |
The rule of thumb: if you want to work in a hospital, get the NA II. If you want to work in long-term care or home health, the NA I is enough.
Nurse Aide I (NA I) Exam Format
| Component | Details |
|---|---|
| Testing Vendor | Credentia (NNAAP) |
| Written Exam | 70 multiple-choice questions |
| Written Time Limit | 2 hours (120 minutes) |
| Oral Option | English or Spanish via headphones |
| Skills Test | 5 skills from a list of 22 |
| Skills Time Limit | ~30–40 minutes |
| Passing — Written | ~75% (score-report pass/fail) |
| Passing — Skills | 100% of critical steps on every skill |
| Fee (Written + Skills) | $140 initial registration |
| Written Only | $40 |
| Oral Only | $40 |
| Skills Only | $100 |
| Attempts Allowed | 3 total before full retraining |
| Registry Listing | NC Nurse Aide I Registry (NCDHHS) |
| Scheduling Platform | CNA365 (Credentia) |
North Carolina allows you to take the written or oral exam via online proctoring from home through Credentia's live-proctored platform — skills evaluations must still be in person at a Regional Testing Site (RTS). Oral exams are offered in both English and Spanish, a rare accommodation that makes NC one of the most bilingual-friendly CNA states.
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NA I Training Requirements: 75 Hours Minimum (Federal OBRA Floor)
North Carolina matches the federal OBRA minimum — 75 hours total, including at least 16 hours of hands-on clinical experience in a DHSR-licensed facility before sitting for the NNAAP exam.
Typical NA I program breakdown:
- 59+ hours classroom and lab instruction (theory and skill practice)
- 16+ hours hands-on clinical in a licensed nursing home or adult care home
- Hybrid programs allowed for the theory portion; the 16 clinical hours must be in person
- Cost: $500–$1,500 typical; many community colleges charge $150–$300 plus supplies
Where to Take NA I Training in NC
- NC Community College System (NCCCS) — 58 community colleges including Wake Tech, Central Piedmont, Durham Tech, Forsyth Tech, Guilford Tech, and Coastal Carolina
- Nursing facility in-house programs (many offer free training + paid employment)
- American Red Cross Nurse Aide Training (select NC sites)
- Private career schools approved by DHSR
- High school HOSA/health science programs in many districts
NA I Eligibility
- No regulatory minimum age — DHSR and the NC Board of Nursing recommend students be at least 16½ years old when enrolling (most licensed facilities will not hire aides under 18 under labor and insurance rules, so younger students often cannot log the 8 paid hours required for first renewal)
- Must pass a criminal background check — felonies involving abuse, neglect, fraud, or drug diversion are disqualifying
- Must show TB test, negative drug screen, and health clearance
- Must have valid photo ID and Social Security number
- Must read, speak, and comprehend English or Spanish sufficiently to perform patient care
- Must pass BOTH the written (or oral) exam AND the skills evaluation within 2 years of training completion OR within 3 total attempts — whichever comes first. Miss either window and you must retrain from scratch.
NA I Written Exam: NNAAP Content Breakdown
The NC NA I written exam is the standardized National Nurse Aide Assessment Program (NNAAP) — 70 questions (60 scored + 10 pretest), 2 hours, same blueprint used in 20+ states.
NNAAP Written Content Areas
| Content Area | % of Exam | Focus |
|---|---|---|
| Physical Care Skills | 64% | ADLs, basic nursing, restorative services |
| → Activities of Daily Living | 14% | Hygiene, dressing, nutrition, elimination |
| → Basic Nursing Skills | 39% | Vitals, infection control, safety, data collection |
| → Restorative Services | 11% | Mobility, prevention, self-care support |
| Psychosocial Care Skills | 10% | Emotional, mental health, cultural, spiritual |
| Role of the Nurse Aide | 26% | Communication, residents' rights, legal/ethical, care team |
High-Yield NA I Topics
- Infection control — standard precautions, PPE donning/doffing sequence, 20-second hand washing, transmission-based precautions
- Residents' rights under OBRA — privacy, refusal of care, grievance process, personal property
- Safety — fall prevention, RACE fire response, PASS extinguisher, restraint alternatives
- Vital signs normal ranges — BP 90/60–120/80, pulse 60–100, respirations 12–20, temp 97.6–99.6°F
- Dementia care — validation therapy, reality orientation, sundowning, redirection
- Abuse and neglect reporting — mandatory reporting to nurse-in-charge and DHSR
- Body mechanics — lift with legs, keep load close, avoid twisting, wide base of support
- Communication — active listening, therapeutic responses, cultural sensitivity
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NA I Skills Evaluation: All 22 Skills
You'll perform 5 skills randomly chosen by a Nurse Aide Evaluator. Hand Hygiene is always skill #1 and is tested as a standalone procedure using running water — hand sanitizer is an automatic critical-step fail. You have 30–40 minutes total.
The Complete NC NNAAP Skills List (2024 revision, current for 2026)
- Hand Hygiene (Hand Washing) — always first, running water required
- Applies One Knee-High Elastic Stocking
- Assists to Ambulate Using Transfer Belt
- Assists With Use of Bedpan
- Cleans Upper or Lower Denture
- Counts and Records Radial Pulse
- Counts and Records Respirations
- Donning and Removing PPE (Gown and Gloves)
- Dresses Client With Affected (Weak) Right Arm
- Feeds Client Who Cannot Feed Self
- Gives Modified Bed Bath (Face, One Arm, Hand, Underarm)
- Measures and Records Electronic Blood Pressure
- Measures and Records Urinary Output
- Measures and Records Weight of Ambulatory Client
- Performs Modified PROM for One Knee and One Ankle
- Performs Modified PROM for One Shoulder
- Positions on Side
- Provides Catheter Care for Female
- Provides Foot Care on One Foot
- Provides Mouth Care
- Provides Perineal Care (Peri-Care) for Female
- Transfers From Bed to Wheelchair Using Transfer Belt
Critical Steps Required on EVERY Skill
Automatic-fail triggers if missed. Memorize until reflex:
- Knock before entering and greet the client by name
- Identify yourself and state your role
- Explain the procedure before starting
- Provide privacy (close door, pull curtain)
- Wash hands before and after the skill
- Raise bed to working height; lower when finished
- Ask about comfort before leaving
- Place call light within reach
- Report completion to the evaluator
Skill Demo Strategy
- Talk your way through every step out loud — evaluators score what they see AND hear
- Count pulse and respirations for a full 60 seconds — 30-second doubling is a common fail
- Apply the BP cuff 1 inch above the antecubital space with the artery marker aligned
- Lock wheelchair brakes before every transfer; unlock only when moving
- Discard gloves before touching clean surfaces (door handles, pen, chart)
- Don't skip seemingly redundant steps — hand hygiene between contaminated-to-clean transitions is always scored
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Nurse Aide II (NA II): North Carolina's Expanded-Scope Tier
The Nurse Aide II is North Carolina's own credential layer — there is no federal equivalent. It's regulated by the NC Board of Nursing and exists because NC hospitals and higher-acuity settings need aides who can do more than basic care.
What NA II Can Do That NA I Cannot
The NCBON-approved NA II task list adds these skills to the NA I scope:
- Sterile dressing changes and wound care
- Tracheostomy care and suctioning
- Urinary catheter insertion and irrigation (both male and female)
- Ostomy care (colostomy, ileostomy, urostomy)
- Oxygen administration and respiratory procedures
- Nasogastric tube care (not insertion)
- Enteral feeding maintenance (gastrostomy tubes)
- IV site observation and discontinuation (NOT starting IVs)
- Administration of enemas and rectal tubes
- Fingerstick blood glucose (with optional module)
NA II Prerequisites
- Current, active NA I listing in good standing on the NC Nurse Aide I Registry
- No substantiated findings of abuse, neglect, misappropriation, or fraud
- High school diploma or GED (most programs)
- Passing grade on an NCBON-approved NA II program
NA II Training and Exam
- 160 total hours minimum — 80 hours theory/lab + 80 hours direct patient care under NCBON-approved instructor
- Optional fingerstick module adds additional hours
- Competency assessment administered by the NA II program itself (not Credentia)
- Each of the NCBON-required NA II skills must be assessed and passed
- Program cost: $800–$2,500 depending on institution
- Duration: 8–16 weeks typical
Where to Take NA II Training
- Wake Tech (Raleigh)
- Central Piedmont Community College (Charlotte)
- Durham Tech
- Forsyth Tech (Winston-Salem)
- Guilford Tech (Greensboro/High Point)
- Rowan-Cabarrus (Salisbury)
- Cape Fear Community College (Wilmington)
- Hospital-based programs — Atrium Health, Novant, Duke, UNC Health, WakeMed
NA II Registry and Renewal (NCBON)
- Listing maintained by NCBON at ncbon.com (separate from the DHSR NA I registry)
- Renewal every 24 months — must have performed nursing care activities for at least 8 compensated hours under direct Registered Nurse supervision in the prior 24-month period
- Must also hold an active NA I listing with NO substantiated findings of abuse, neglect, or misappropriation
- Lapsed-listing tiers (per NCBON): if your NA II listing expired within the past 24 months, you may relist by passing only the NA II Competency Assessment. If it expired more than 24 months ago, you must repeat the entire NA II program.
- NA II renewal does NOT automatically renew your NA I — both registries must be maintained separately on each one's cycle
NC-Specific Pitfalls That Fail Candidates
After reviewing years of candidate reports, these are the most common NC-specific failure patterns:
- Confusing the two registries — NA I is at ncnar.ncdhhs.gov (DHSR under NCDHHS), NA II is at ncbon.com (NC Board of Nursing). Employers verify on the correct registry; a listing on one does not prove the other.
- Missing the 2-years-OR-3-attempts deadline — you must pass BOTH written and skills within 2 years of finishing training OR within 3 total attempts, whichever comes first. Hit either limit and the only path forward is a fresh 75-hour program.
- Letting NA II lapse past 24 months — within 24 months of expiration you can relist by passing just the competency assessment; past 24 months you must repeat the full NA II program from the start.
- Using hand sanitizer during Hand Hygiene skill #1 — automatic critical-step fail; running water is required for the first skill every time.
- Not counting vitals for a full 60 seconds — Credentia evaluators require a full minute; 30-second doubling is a common fail.
- Forgetting the call light at the end of any skill — automatic critical-step fail.
- Wrong PPE order — gown → mask → goggles → gloves going on; gloves → goggles → gown → mask coming off.
- Transferring without locking wheelchair brakes — safety violation fails the skill.
- Dressing the strong arm first — always dress the weak/affected side first, undress the strong side first.
- Mailing a paper NA I renewal — DHSR stopped accepting paper renewal forms on August 31, 2021; you must use the Online Renewal + Online Employment Verification forms at ncnarforms.ncdhhs.gov.
- Assuming reciprocity covers NA II — NC reciprocity applies to NA I only. Out-of-state CNAs must complete a full NCBON-approved NA II program in NC to work at the NA II scope.
- Arriving late to Credentia — arrive 30 minutes early; late arrival forfeits the fee with no refund or transfer.
NC CNA Study Timeline (6-Week Plan for NA I)
| Week | Focus | Hours | Activities |
|---|---|---|---|
| 1 | Foundations | 8–10 | Role of the CNA, communication, residents' rights, legal/ethical |
| 2 | Infection & Safety | 8–10 | Standard precautions, PPE, hand hygiene, fire/fall safety |
| 3 | Physical Care Basics | 10–12 | Vital signs, ADLs, hygiene, elimination, nutrition |
| 4 | Advanced Nursing Skills | 10–12 | Transfers, ROM, catheter care, data collection, restorative |
| 5 | Psychosocial & Special Populations | 6–8 | Dementia, end-of-life, mental health, cultural sensitivity |
| 6 | Full Review + Skills Practice | 10–15 | Timed practice tests, demo all 22 skills, identify weak spots |
Total: 60–80 hours of focused study on top of your 75-hour training program.
Test-Day Checklist
Bring to the Test
- Two forms of ID (one government-issued photo ID with signature)
- Credentia admission letter / scheduling confirmation
- Watch with a second hand (for counting vitals) — digital/smart watches are NOT allowed
- Flat, closed-toe non-slip shoes (scrubs strongly recommended)
- Pen (black or blue ink)
Do NOT Bring
- Cell phone (must be off and stored)
- Smart watch / fitness tracker
- Food, drinks, or gum
- Study notes of any kind
- Long acrylic nails, dangling jewelry, or strong perfume
Morning-Of Tips
- Eat a protein-rich breakfast (you'll be on your feet for 30+ minutes of skills)
- Hair pulled back, nails trimmed short and clean
- Wear scrubs or professional attire — no open-toe shoes, shorts, or sleeveless tops
- Arrive 30 minutes early; check-in closes at the exam start time
NC Nurse Aide I Registry
Passing the NA I competency evaluation gets you listed on the NC Nurse Aide I Registry (ncnar.ncdhhs.gov) maintained by the NC Division of Health Service Regulation under NC DHHS.
Registry Verification
- Public verification: ncnar.ncdhhs.gov
- DHSR Nurse Aide contact: (919) 855-3969
- Email: DHSR.Nurseaide@dhhs.nc.gov
- Listing includes: name, certificate number, expiration date, and any substantiated findings of abuse, neglect, misappropriation, or exploitation
- Name and address changes must be reported within 30 days
NA I Renewal (Every 24 Months)
- Must have worked at least 8 hours of paid nursing or nursing-related duties in the past 24 months under a Registered Nurse's supervision
- No continuing education required and no state renewal fee
- Volunteer hours do NOT count — compensation is required
- Renewal must be filed through the Online Renewal Form plus the Online Employment Verification Form completed by an RN (DHSR stopped accepting paper renewal forms on August 31, 2021)
- Allow up to 5 business days after approval for the registry website to reflect the updated listing
- If you miss the 8-hour requirement, you must retake the 75-hour training + NNAAP exam to relist
NA I Reciprocity (Out-of-State to NC)
- Active, unrestricted listing on another state's nurse aide registry
- Training that met or exceeded federal OBRA standards (75 hours minimum)
- No findings of abuse, neglect, or misappropriation
- Recent employment as a CNA within the past 24 months
- Submit the NC Reciprocity Application with verification from the originating state
- Allow 10–15 business days for processing
- Reciprocity does NOT transfer NA II status — you must complete an NCBON-approved NA II program in NC
NC CNA Salary and Career Outlook
NC NA I Pay in 2026
| Location | Hourly (NA I) | Annual (NA I) |
|---|---|---|
| NC statewide average | $18.23 | $37,928 |
| Charlotte metro | $18.43 (full-time ~$19.60) | $38,344–$40,763 |
| Raleigh-Durham / Research Triangle | $17.39–$17.74 | $36,100–$36,896 |
| Greensboro / Winston-Salem | $16.50–$18.00 | $34,320–$37,440 |
| Asheville / Western NC | $16.00–$18.50 | $33,280–$38,480 |
| Wilmington / coastal NC | $16.50–$18.50 | $34,320–$38,480 |
| Rural eastern NC | $14.50–$16.50 | $30,160–$34,320 |
NA II Pay Premium
NA IIs typically earn $2–$5/hour more than NA Is in the same facility. Hospital NA IIs in Charlotte and the Research Triangle commonly earn $20–$25/hour, especially at Atrium, Novant, Duke, and UNC Health. Night, weekend, and float-pool shift differentials add another $2–$6/hour.
Where NC CNAs Work
- Skilled nursing facilities (nursing homes) — largest NA I employer
- Hospitals (Atrium Health, Novant Health, Duke Health, UNC Health, WakeMed, ECU Health, Mission Health) — strongly prefer NA IIs
- Assisted living and memory care
- Home health agencies
- Hospice providers
- Rehabilitation centers
- VA medical centers (Asheville, Fayetteville, Salisbury, Durham)
Career Advancement Pathways
| Path | Duration | Next Step |
|---|---|---|
| NA I → NA II | 8–16 weeks | NCBON-approved 160-hour program |
| NA II → LPN | 12–18 months | NC Community College LPN program |
| NA → ADN (RN) | 2 years | NCCCS associate nursing program |
| NA → BSN (RN) | 4 years | UNC, NC State, ECU, App State, UNCC, UNCG |
| NA → Medication Aide | +40–80 hours | NC Medication Aide certification (also Credentia) |
| NA → Patient Care Tech | On-the-job | Hospital PCT with phlebotomy/EKG |
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Official North Carolina CNA Resources
- NC Nurse Aide I Registry (NCDHHS / DHSR) — verification, renewal, forms
- Credentia NC Test-Taker Portal — schedule exams, access handbook
- NC Nurse Aide I Candidate Handbook — official exam details
- North Carolina Board of Nursing (NCBON) — Nurse Aide II registry and oversight
- NCBON Nurse Aide II Program — NA II scope and tasks
- NCBON NA II Teaching Modules — official clinical skills content
- DHSR Nurse Aide contact: (919) 855-3969 or DHSR.Nurseaide@dhhs.nc.gov
- NCBON contact: (919) 782-3211
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