Tennessee CNA Exam 2026: Your Complete Nurse Aide Certification Guide
The Tennessee Certified Nurse Aide (CNA) exam — officially the Nurse Aide Competency Evaluation — is the two-part test required to work as a nurse aide in Tennessee nursing homes, hospitals, assisted living, home health, and hospice. Oversight sits with the Tennessee Health Facilities Commission (HFC) — the agency that took over nurse aide program approval and registry duties from the Department of Health.
2026 Vendor Transition (critical): Tennessee is switching nurse aide testing and registry vendors on June 1, 2026. Through May 31, 2026, exams run with D&S Diversified Technologies / Headmaster LLP via the TestMaster Universe (TMU) platform at
tn.tmutest.com. Starting June 1, 2026, Tennessee joins the Credentia NNAAP examination program at credentia.com. HFC confirms the switch on its official nurse aide page. If you test in 2026, read the "Credentia Transition" section below carefully — the exam format, testable skills list, and portal URL will change mid-year.
Tennessee lists over 40,000 active nurse aides on its registry and projects 38,800+ CNA positions statewide per TN.gov, making it one of the Southeast's fastest-growing healthcare entry points. This guide walks through training hours, both the current D&S format AND the incoming Credentia/NNAAP format, the full testable skill list, fees, registry rules, renewal, reciprocity (including states Tennessee won't accept), challenge exam pathways for LPNs and military medics, and 2026 Tennessee salary data — so you pass on the first attempt and start earning.
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Tennessee CNA Exam Format at a Glance (Through May 31, 2026 — D&S/Headmaster)
| Component | Details |
|---|---|
| Testing Vendor (current) | D&S Diversified Technologies / Headmaster |
| Testing Vendor (June 1, 2026 →) | Credentia NNAAP |
| Platform (current) | TestMaster Universe (TMU) — tn.tmutest.com |
| Regulatory Body | Tennessee Health Facilities Commission (HFC) |
| Knowledge Test | 75 multiple-choice questions (English or Spanish) |
| Knowledge Time Limit | 90 minutes |
| Skills Test | 5 skills randomly selected from ~25 |
| Skills Time Limit | 35 minutes total |
| Passing — Knowledge | 75% minimum |
| Passing — Skills | 80% on each skill AND no missed key steps (bold steps) |
| Knowledge Fee | $30 |
| Skills Fee | $60 |
| Typical Combined Fee | $90 (facility employers may cover) |
| Reschedule Fee | $35 (one free if >24 business hours notice) |
| Cancellation Fee | $25 |
| Reciprocity Fee | $20 |
| Background Check (IdentoGO) | $37.15 fingerprint fee (TBI/FBI) |
| Attempts Allowed | 3 total before retraining required |
| Results Posted | 5–7 business days via email or TMU portal |
| Candidate Handbook | v28, effective November 1, 2025 |
Tennessee offers oral administration for candidates with limited reading proficiency — you must request it when applying. The knowledge test can be taken in English or Spanish.
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Credentia Transition: What Changes on June 1, 2026
The Tennessee Health Facilities Commission has confirmed Credentia — the company that runs the NNAAP (National Nurse Aide Assessment Program) in roughly 20 states — will take over Tennessee nurse aide testing and registry services on June 1, 2026. This is the first vendor switch in over a decade.
What Stays the Same
- 75-hour minimum training requirement (federal OBRA floor)
- Two-part exam — written knowledge plus hands-on skills
- 24-month window to pass after training completion
- 3 attempts per portion before retraining required
- Tennessee HFC oversight and the existing nurse aide registry roster
- Reciprocity eligibility — Florida exclusion remains in effect
What Changes Under Credentia/NNAAP
| Area | D&S / TMU (thru May 31, 2026) | Credentia / NNAAP (June 1, 2026 →) |
|---|---|---|
| Platform | tn.tmutest.com | credentia.com candidate portal |
| Knowledge test | 75 multiple-choice, 90 min, 75% pass | Typically 60 scored + 10 pretest items on NNAAP |
| Skills count | 5 skills in 35 minutes | 5 skills in 25–31 minutes (NNAAP standard) |
| Skills list | ~25 TN-specific competencies | NNAAP 22-skill national list |
| Hand hygiene | Actual first skill, verbalize rest | Actual hand hygiene typically required more often |
| Fee structure | $30 knowledge + $60 skills | Announced by Credentia closer to go-live |
| Candidate handbook | D&S v28 (Nov 2025) | Credentia TN-specific handbook (pending) |
| Spanish administration | Yes, written + oral | Yes — NNAAP Spanish written available |
Practical Advice by Test Date
- Testing before June 1, 2026: Study to the D&S Tennessee Candidate Handbook v28. Your score and registry entry transfer automatically to Credentia — you do not retest.
- Testing on or after June 1, 2026: Watch credentia.com for the Tennessee candidate handbook, fee schedule, and test-site map. Core nursing skills and content do not change — practice fundamentals carry over.
- Already certified: Your existing TN registry listing moves to Credentia. Renewals and reciprocity go through Credentia after June 1, 2026.
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Our question bank teaches the nursing content and critical steps that carry across vendors — so you are ready whether you test in May 2026 or November 2026.
Tennessee Training Requirements: 75 Hours Minimum
Tennessee follows the federal OBRA floor of 75 hours — it does not add state hours on top like Georgia (85) or California (150). Breakdown:
- 16 hours pre-clinical instruction — interpersonal skills, communication, infection control, safety and emergency procedures, residents' rights — required BEFORE any hands-on patient contact
- ~59 hours combined classroom/lab plus supervised clinical rotation
- At least 16 hours must be hands-on clinical experience in a licensed long-term care facility
- Training must be conducted under a registered nurse with at least 2 years of experience, preferably in adult long-term care
Medicare/Medicaid-certified nursing facilities are federally required to reimburse your exam fees and training costs if they hire you within 12 months of certification. Many Tennessee nursing homes — Signature HealthCare, NHC, Life Care Centers, Diversicare, and others — sponsor free training programs with an employment commitment.
Who Approves Tennessee Training Programs?
The Tennessee Health Facilities Commission reviews, approves, and audits nurse aide training programs. Approved provider categories include:
- Tennessee Colleges of Applied Technology (TCAT) — 27 campuses statewide (Nashville, Memphis, Knoxville, Chattanooga, Jackson, etc.)
- Community colleges — Nashville State, Pellissippi State, Volunteer State, Chattanooga State, Motlow State, Roane State
- Nursing facilities with in-house HFC-approved programs
- Private career schools — Career Academy, American Red Cross chapters, Concorde, etc.
- High school health science programs in select districts
- Hospital-based programs at larger TN health systems
Programs run 4–12 weeks and cost $400–$1,500. Free facility-sponsored programs typically require a 6–12 month work commitment.
Other Tennessee Eligibility Rules
- Minimum age 16 (most programs require 18)
- Pass a Tennessee Bureau of Investigation (TBI) / FBI criminal background check — felonies involving abuse, neglect, or drug diversion are disqualifying
- Fingerprinting through IdentoGO or the program's approved vendor (current fee: $37.15)
- Proof of negative TB test (two-step), required immunizations, and physical exam
- Valid government-issued photo ID and Social Security card (both required to test)
- Must complete exam within 24 months of training completion
Tennessee Challenge Exam: Skip Training (If You Qualify)
Tennessee allows three groups to challenge the competency exam without completing a full 75-hour NATCEP program:
- Practical nursing (LPN) or registered nursing (RN) students who have completed a fundamentals-of-nursing course — submit official transcripts showing coursework completion.
- Military medics and corpsmen — submit a DD-214 documenting medical MOS/NEC training; army 68W, navy HM, and air force 4N0X1 typically qualify.
- Out-of-state CNAs whose registry listing has lapsed but whose training met OBRA — review with the HFC registry before applying.
You still pay the $30 knowledge and $60 skills fees and must pass both portions on the same terms as first-time candidates. Challenge candidates do not receive fee reimbursement from Medicare/Medicaid facilities because they bypassed the approved training program.
Tennessee CNA Knowledge Exam: 75 Questions, 9 Content Areas
The D&S/Headmaster knowledge exam has 75 multiple-choice questions and a 90-minute time limit. You need 75% correct to pass. Tennessee's blueprint covers these content areas:
Knowledge Exam Content Breakdown
| Content Area | Approx % | Focus |
|---|---|---|
| Basic Nursing Skills | 20–25% | Vital signs, bed making, I&O, data collection, comfort |
| Personal Care / ADLs | 15–20% | Bathing, grooming, dressing, elimination, feeding |
| Safety & Emergency | 10–15% | Fall prevention, fire (RACE/PASS), restraint alternatives, body mechanics |
| Infection Control | 10–15% | Hand hygiene, PPE order, standard and transmission-based precautions |
| Role & Responsibilities | 8–12% | Scope of practice, chain of command, delegation, documentation |
| Communication & Interpersonal | 8–10% | Therapeutic communication, cultural sensitivity, reporting |
| Residents' Rights / Legal-Ethical | 6–10% | OBRA rights, HIPAA, abuse/neglect reporting, advance directives |
| Mental Health & Cognitive Care | 5–8% | Dementia, depression, anxiety, behavior interventions |
| Care of Impaired/Aging Residents | 5–8% | Disease process, end-of-life, rehab, restorative care |
High-Yield Topics for Tennessee Candidates
- Hand hygiene timing — 20-second scrub before AND after every skill; between contaminated and clean tasks; after glove removal
- PPE order — going on: gown → mask → goggles → gloves; coming off: gloves → goggles → gown → mask
- Vital sign normal ranges — BP 90/60–120/80, pulse 60–100, resps 12–20, temp 97.6–99.6°F oral
- Residents' rights under OBRA — privacy, refusal of care, confidentiality, grievance, personal belongings
- Dementia care — validation, redirection, reality orientation, sundowning, avoiding argument
- Safe transfers and body mechanics — lift with legs, keep load close, avoid twisting, gait/transfer belt use
- Abuse and neglect reporting — mandatory reporting to charge nurse AND to HFC/state registry
- Scope of practice — CNAs do NOT administer medications, change sterile dressings, or give IV care in TN
Free Tennessee CNA Practice Questions
Our question bank mirrors the D&S/Headmaster blueprint, with detailed explanations for every answer. Filter by content area, track weak spots, and use the AI tutor to explain anything you miss.
Tennessee CNA Skills Test: The 25 Testable Skills
You'll perform 5 skills randomly pulled from roughly 25 competencies within 35 minutes. You must score at least 80% on each skill AND perform every bold/key step correctly — missing a key step is an automatic fail on that skill, even if your overall percentage is above 80%.
Tennessee-Specific Skills Rule
The first assigned skill in Tennessee is typically one that requires actual running-water hand washing — bedpan use, measuring urinary output, or perineal care. For the remaining four skills, you may verbalize hand hygiene (say aloud: "I would wash my hands now for 20 seconds with soap and warm water") without physically performing it. This is a Tennessee-specific efficiency rule most other states do not allow.
The Tennessee Testable Skills List
- Hand Washing — required in person when paired with the first skill
- Applying One Knee-High Elastic Stocking (TED hose)
- Assisting to Ambulate Using a Transfer/Gait Belt
- Assisting With Use of a Bedpan
- Cleaning Upper or Lower Denture
- Counting and Recording Radial Pulse (60-second count)
- Counting and Recording Respirations (60-second count)
- Donning and Removing PPE (Gown and Gloves)
- Dressing Client With an Affected (Weak) Arm
- Feeding a Client Who Cannot Feed Self
- Giving a Modified Bed Bath (face, arm, hand, underarm)
- Measuring and Recording Electronic Blood Pressure
- Measuring and Recording Manual Blood Pressure
- Measuring and Recording Urinary Output
- Measuring and Recording Weight of an Ambulatory Client
- Performing Modified PROM for One Knee and One Ankle
- Performing Modified PROM for One Shoulder
- Positioning on Side
- Providing Catheter Care for a Female
- Providing Foot Care on One Foot
- Providing Mouth Care
- Providing Perineal Care (Peri-Care) for a Female
- Transferring From Bed to Wheelchair Using a Transfer/Gait Belt
- Making an Occupied Bed
- Assisting With Oral Hygiene for an Unconscious Client
Critical Steps Required on EVERY Skill
These are automatic-fail triggers if omitted. Drill them until they are muscle memory:
- Knock before entering, greet client by name, identify yourself
- Explain the procedure before starting
- Provide privacy (close door, pull curtain)
- Wash hands (actual or verbalized per TN rule)
- Raise bed to working height for your back; lower when finished
- Lock wheelchair brakes before any transfer
- Check client comfort and needs before leaving
- Place call light within reach before leaving the room
- Return bed to lowest position and side rails as appropriate
- Report completion and observations to the evaluator
Skills Demo Strategy
- Narrate every step out loud — Tennessee evaluators score both what they observe and what they hear
- Count pulse and respirations for a full 60 seconds — 30-second doubling is one of the top TN fails
- Apply the BP cuff 1 inch above the antecubital space, artery marker aligned over the brachial artery
- Always lock wheelchair brakes AND raise footrests before transfer
- Remove gloves before touching clean surfaces like door handles, pens, or the client's chart
- Never use hand sanitizer when hand washing is required — TN requires running water for the first skill
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Our skills module breaks each competency into numbered steps with critical (bold) elements flagged in red and the most common Tennessee failure points called out explicitly.
Tennessee CNA Exam Fees (2026)
| Exam Type | Fee |
|---|---|
| Knowledge Test Only | $30 |
| Skills Test Only | $60 |
| Typical Combined Fee | $90 |
| Reschedule (within 24 business hours) | $35 |
| Cancellation | $25 |
| Reciprocity / Endorsement Application | $20 |
| Registry Renewal | FREE |
Fees are paid directly to D&S Diversified / Headmaster through the TMU candidate portal. Accepted payment: credit/debit card, money order, or employer voucher. Applications and payments can also be mailed to D&S DT, PO Box 418, Findlay, OH 45839-0418. Long-term care facility employers frequently cover both fees — federal rules require Medicare/Medicaid-certified facilities to reimburse new hires within 12 months of certification.
Retake Fees and Attempts
- Failed knowledge only: retake for $30
- Failed skills only: retake for $60
- Failed both: retake both for $90
- You have 3 total attempts at each portion; after 3 failures, you must repeat the 75-hour training program before retesting
- You must complete testing within 24 months of training completion, or the training expires
Tennessee-Specific Pitfalls That Fail Candidates
After reviewing D&S/Headmaster directives and Tennessee candidate reports, these are the most common reasons TN candidates fail:
- Using hand sanitizer instead of running water on the first skill — automatic critical-step fail
- Not counting pulse and respirations for a full 60 seconds — 30-second doubling does NOT meet TN requirements
- Forgetting the call light at the end of a skill — an automatic critical-step miss
- Transferring without locking wheelchair brakes — safety violation fails the skill
- Wrong PPE donning/doffing order — memorize "gown, mask, goggles, gloves" on, reverse on removal
- Weighing with shoes on — always remove shoes before recording an ambulatory weight
- Dressing the strong arm first — always dress the weak/affected side first; undress the strong side first
- Contaminating clean linen — don't let clean linen touch your uniform, the floor, or the overbed table
- Arriving late — Tennessee requires arrival at least 15–30 minutes before scheduled start; late arrival forfeits the fee
- Missing the 24-month testing window after training — you must retrain fully if you exceed it
Tennessee CNA Test-Day Checklist
Bring to the Test
- Non-expired government-issued photo ID with signature (driver's license, passport, state ID)
- Social Security card — Tennessee specifically requires the physical card
- TMU admission notice / scheduling confirmation
- Watch with a second hand for counting vitals — smartwatches are NOT allowed
- Flat, closed-toe, non-slip shoes (scrubs preferred)
- Pen (black or blue ink only)
Do NOT Bring
- Cell phone (must be powered off and stored away)
- Smart watch / fitness tracker of any kind
- Food, drinks, or gum
- Study notes, textbooks, or cheat sheets
- Long acrylic nails, rings, dangling jewelry, or strong fragrance
- Hats, hoodies, or sunglasses
Morning-Of Tips
- Eat a protein-rich breakfast — skills can take 30+ minutes on your feet
- Hair pulled back off the shoulders; fingernails trimmed short
- Wear clean scrubs or professional attire — no shorts, sleeveless tops, or open-toe shoes
- Arrive 15–30 minutes early; check-in closes at scheduled start time
The Tennessee Nurse Aide Registry
Passing both portions adds you to the Tennessee Nurse Aide Registry, administered by the Tennessee Health Facilities Commission. Employers are federally required to verify registry status before hiring any CNA.
Verifying Your Registry Status
- Primary registry lookup: TN Health Facilities Commission Nurse Aide page at tn.gov/hfc
- D&S candidate portal: hdmaster.com
- Tennessee Board of Nursing (separate — handles RN/LPN): tn.gov/health/licensure/nurs.html
- D&S / Headmaster support: (877) 201-0758 or tennessee@hdmaster.com
- Listings include name, certificate number, expiration date, and any findings of abuse, neglect, or misappropriation of property
- Name and address changes must be reported via the TMU portal with supporting documentation (signed SSA card for name changes)
Renewal (Every 24 Months, FREE)
Tennessee uses employment-based renewal — no classroom hours or continuing education required.
- You must complete at least 8 consecutive hours of paid nursing-related work in a licensed or certified Tennessee healthcare facility within the past 24 months
- The 8 hours must be performed under the supervision of a licensed nurse (RN or LPN)
- Volunteer hours and private-duty hours do NOT count unless documented under a licensed nurse
- Accepted proof: pay stub, payroll printout from the employer, OR a notarized attestation form signed by a licensed nurse supervisor
- Renewal is processed through the TMU portal (moving to Credentia after June 1, 2026) — no fee; routine renewals process within 72 hours of submission
- You'll receive renewal reminders approximately 60 days before expiration
If you don't meet the 8-hour requirement, your certification lapses and you must retake the full 75-hour training program plus both exam portions to be relisted.
Reciprocity / Endorsement (Out-of-State CNAs Moving to Tennessee)
Tennessee accepts reciprocity applications from most states for CNAs in good standing.
Requirements:
- Active, unexpired status on another state's Nurse Aide Registry
- No findings of abuse, neglect, or misappropriation
- Training that met or exceeded federal OBRA standards (75 hours)
- Tennessee background check clearance
Additional documentation required if transferring from Alabama, Illinois, Iowa, Missouri, or Nebraska — you must submit recent paystubs proving active CNA employment.
Tennessee does NOT accept reciprocity from Florida. Florida-certified CNAs must complete the full Tennessee 75-hour training program and pass both D&S exam portions.
Process:
- Complete the online reciprocity application through the TMU portal or mail a paper application to D&S DT
- Upload copies of photo ID and Social Security card
- Include paystubs if transferring from AL, IL, IA, MO, or NE
- Pay the $20 processing fee
- Allow 2–4 weeks for processing
Tennessee CNA Study Timeline (6-Week Plan)
| 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 order, hand hygiene, fire/fall safety |
| 3 | Physical Care Basics | 10–12 | Vital signs (60-second counts!), ADLs, hygiene, elimination |
| 4 | Advanced Nursing Skills | 10–12 | Transfers, PROM, catheter care, feeding, data collection |
| 5 | Psychosocial & Special Populations | 6–8 | Dementia, end-of-life, mental health, cultural care |
| 6 | Full Review + Skills Practice | 10–15 | Timed 75-question practice tests, demo all 25 skills, identify weak spots |
Total: 50–70 hours of focused study on top of your 75-hour state-approved training program.
Tennessee CNA Salary and Career Outlook
Tennessee CNA Pay in 2026
| Location | Hourly | Annual |
|---|---|---|
| Tennessee statewide average | $18.21 | $37,879 |
| Nashville metro | $18.50–$21.00 | $38,480–$43,680 |
| Memphis metro | $16.24–$19.00 | $33,780–$39,520 |
| Knoxville metro | $16.75–$19.50 | $34,840–$40,560 |
| Chattanooga | $16.00–$18.75 | $33,280–$39,000 |
| Tri-Cities (Johnson City / Kingsport) | $15.50–$18.00 | $32,240–$37,440 |
| Rural West / East TN | $14.00–$16.50 | $29,120–$34,320 |
| 75th percentile statewide | ~$20.53 | $42,700 |
| 90th percentile statewide | ~$24.22 | $50,372 |
Nashville pays approximately 6.5% above the Tennessee state average, driven by Vanderbilt, HCA, Ascension Saint Thomas, and Tristar. Memphis is anchored by Methodist Le Bonheur, Baptist Memorial, and Regional One. Knoxville is led by Covenant Health and UT Medical Center.
Setting-based pay: hospitals typically pay 10–15% more than long-term care, while hospice and home health often lead with shift differentials and mileage reimbursement. Night and weekend differentials add $2–$5/hour.
Where Tennessee CNAs Work
- Skilled nursing facilities (nursing homes) — largest single employer
- Hospitals — Vanderbilt, HCA Tristar, Methodist, Baptist, Erlanger, UT Medical, Covenant Health, Ascension Saint Thomas
- Assisted living and memory care communities
- Home health agencies (Amedisys, Encompass Health, LHC Group)
- Hospice agencies
- Rehabilitation centers
- TN Department of Veterans Services homes and VA medical centers (Nashville, Memphis, Mountain Home)
Career Advancement Pathways
| Path | Duration | Next Step |
|---|---|---|
| CNA → LPN | 12–18 months | TCAT LPN program (27 campuses statewide) |
| CNA → ADN (RN) | 2 years | Community college nursing (Nashville State, Pellissippi, Volunteer) |
| CNA → BSN (RN) | 4 years | UT Knoxville, Vanderbilt, Belmont, East TN State, Memphis, MTSU |
| CNA → Medication Aide (CMA) | +40–100 hours | Tennessee Medication Aide certification through HFC |
| CNA → Patient Care Tech (PCT) | On-the-job | Hospital PCT role with phlebotomy / EKG add-on training |
Pass the Tennessee CNA Exam with Confidence
Join Tennessee candidates who passed their D&S/Headmaster competency evaluation with our comprehensive, 100% FREE study tools:
- Tennessee-aligned practice questions mirroring the 75-question D&S blueprint
- All 25 testable skills with step-by-step critical element checklists
- AI tutor that explains wrong answers and quizzes you on weak areas
- Timed mock exams with the exact 75-question, 90-minute format
- Updated for 2026 — reflects Candidate Handbook v28 effective November 1, 2025
No credit card. No trial period. No hidden fees. Just free prep that works.
Official Tennessee CNA Resources
- Tennessee Health Facilities Commission — Nurse Aide — state regulatory body, registry, and vendor transition notices
- D&S/Headmaster Tennessee Test-Taker Portal — schedule exams through May 31, 2026; download Candidate Handbook v28
- D&S TMU Candidate Portal — applications, renewals, demographic changes (moved here March 28, 2025)
- Tennessee CNA FAQ (Headmaster) — fees, reschedules, reciprocity rules
- Credentia — new Tennessee NNAAP vendor effective June 1, 2026
- Tennessee Department of Health — Board of Nursing — RN/LPN licensing (separate)
- HFC nurse aide team: (615) 532-5171 | nurseaid.health@tn.gov
- D&S/Headmaster Tennessee support: (877) 201-0758 | tennessee@hdmaster.com
- D&S reciprocity desk: (888) 401-0465 | reciprocity@hdmaster.com
- Mailing address for paper applications: D&S DT, PO Box 418, Findlay, OH 45839-0418
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