FREE Washington NAC Exam Guide 2026: Pass the WA CNA Test First Try

Washington NAC Exam 2026: Your Complete Nursing Assistant-Certified Guide

In Washington State, the credential you need to work as a nursing assistant in hospitals, nursing homes, and long-term care facilities is called NAC — Nursing Assistant-Certified. Most other states call it CNA, but Washington's Department of Health (DOH) and the Washington State Board of Nursing (WABON) use the "NAC" designation. You will also hear about the NAR (Nursing Assistant-Registered) pathway, which lets you start working before you certify. This guide walks through every rule, fee, deadline, and test component you need to pass the Washington NAC exam on your first attempt in 2026.

The exam itself is the standard NNAAP (National Nurse Aide Assessment Program) two-part test, but Washington has its own training hours, fees, and eligibility routes. Miss these state-specific details and your application gets rejected or your scores never register with DOH.

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NAC vs NAR: Which Washington Credential Do You Have?

Washington is one of the few states that splits nursing assistants into two tiers. Understanding the difference prevents costly employment mistakes.

The workflow: enroll in an approved program → apply for NAR → start working (optional) → finish training → take the NAC exam → become NAC. Under federal OBRA rules, any nursing assistant in a Medicare/Medicaid-certified nursing home must convert from NAR to NAC within 120 days of their first paid day of work.

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Washington NAC Exam Format at a Glance

Washington is unusual in that the skills test is typically taken first, often at your training program's on-site lab on a scheduled evaluation day. You must pass the skills test before registering for the written exam. Both parts can sometimes be completed the same day at regional testing sites.

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Washington Training Hours: The 108 → 138 Transition

Washington requires more training than the federal OBRA minimum of 75 hours. This changed in late 2025.

The 2025 change nearly doubled the classroom component (35 → 66 hours) to meet updated state competency expectations. If you enrolled before the cutoff and graduated after it, confirm with your program whether you fall under the old or new rule — DOH will reject applications that do not match the correct curriculum.

All approved Washington training programs must also include:

• 7-hour HIV/AIDS education module (required by RCW 70.24.270)
• Dementia care content
• Mental health and developmental disabilities content
• CPR/First Aid certification (varies by program)

Find an approved program on the Washington State Board of Nursing training programs list.

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The 9 Eligibility Routes (E1–E9)

Credentia assigns every Washington NAC candidate to one of nine eligibility routes. Pick the wrong one on your application and it bounces back.

Note: a separate pathway exists for candidates whose WA training program has since closed — DOH handles these case-by-case. Submit all supporting documentation to DOH before Credentia can add you to the testing queue.

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Written Exam Content Breakdown (NNAAP)

The 70-question Washington written exam follows the national NNAAP content outline. Questions are scenario-based and emphasize patient safety, dignity, and scope of practice.

1. Physical Care Skills (~40%)

• Activities of Daily Living (14%): bathing, grooming, dressing, oral hygiene, toileting, nutrition, elimination
• Basic Nursing Skills (14%): vital signs, infection control, safety, emergency procedures, data collection
• Restorative Skills (8%): positioning, prevention of contractures, range of motion, ambulation

2. Psychosocial Care Skills (~10%)

• Emotional and mental health needs
• Spiritual and cultural needs
• Dementia and cognitive impairment
• Behavioral symptoms and de-escalation

3. Role of the Nurse Aide (~50%)

• Communication (8%): with residents, families, team members, non-verbal, reporting
• Client Rights (7%): OBRA residents' rights, HIPAA, privacy, dignity, confidentiality
• Legal/Ethical Behavior (3%): abuse/neglect reporting, mandated reporting, documentation
• Member of Healthcare Team (7%): scope of practice, delegation, chain of command, observation and reporting

You need roughly 70% correct to pass the written portion (49 of 70 questions).

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The 23 NNAAP Skills: Know Every One

Credentia randomly picks 5 skills from the 23-skill NNAAP pool. Hand hygiene is required on every candidate's list. The current Washington testing pool includes:

Hygiene & Comfort: hand hygiene (handwashing), mouth care, denture care, perineal care, partial bed bath, back rub

Mobility: transfer from bed to wheelchair using a transfer belt, ambulation with a transfer belt, positioning on side, passive range of motion (one shoulder or one knee and ankle)

Vitals & Measurements: radial pulse count, respiration count, electronic blood pressure (one arm), weight (upright scale)

Elimination & Nutrition: providing catheter care (female), measuring and recording urinary output from a urinary drainage bag, feeding a client who cannot feed himself/herself

Dressing & Skin: dressing a client with an affected (weak) right arm, applying one knee-high anti-embolism/elastic stocking, foot care (cleaning one foot and drying between toes), fingernail care (cleaning and filing nails on one hand)

Safety & Specialized: making an occupied bed, assisting with use of a bedpan

Remember: the WA state clinical skills checklist (used in training) lists many more tasks than the 23-skill Credentia testing pool. You are taught dozens of additional competencies in clinical rotations, but only the 23 Credentia skills appear on your exam.

The Non-Negotiable Critical Element Steps

Missing any of these fails the entire skill regardless of the rest:

1. Knock and identify yourself before entering
2. Identify the resident (verify by name/ID band)
3. Explain the procedure before starting
4. Perform hand hygiene before and after every skill
5. Provide privacy (close door, draw curtain)
6. Position bed safely (lowest position, locked wheels, call light in reach at the end)
7. Maintain dignity and communication throughout

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Practice the Exact Washington NAC Skills

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Each skill includes step-by-step procedures, critical step callouts, and AI-powered explanations of why each step matters for patient safety.

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6-Week Washington NAC Study Timeline

Total recommended prep after training: 60–80 hours of self-study layered on top of your 108/138 program hours.

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How to Register for the Washington NAC Exam (Step-by-Step)

Washington's registration flow trips up more candidates than the exam itself. Follow this sequence in order:

1. Complete an approved training program — find one on the WABON approved programs list. Your program submits completion records directly to Credentia.
2. Create a Credentia PCM account using the email your program has on file. Mismatched emails delay eligibility posting by weeks. Call Credentia at 888-204-6249 if your eligibility does not post within 7 business days.
3. Schedule the skills test first — often at your own training program's lab on a scheduled evaluation day. Regional WABON skills-test sites are available if your program cannot host one. Pay the program's skills fee directly.
4. Schedule the online knowledge test through PCM once eligibility is confirmed. Pay the $55 fee at booking; no test-site payment is accepted (credit card, prepaid card, or electronic voucher only).
5. Pass both parts — results post to your PCM account within 24 hours and flow to the Washington Nurse Aide Registry maintained by DSHS.
6. Submit the DOH NAC application with the $85 fee, fingerprint results, and required declarations via the DOH Online Services portal.
7. Check the WA Provider Credential Search a few business days after DOH processes your file — your credential number appears there once active.

Budget 4–8 weeks from exam pass date to active DOH credential; endorsement applications from out-of-state can take 8+ weeks.

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Washington-Specific Pitfalls (Avoid These)

1. NAR deadline: You have 7 days from your first day of paid work to submit the NAR application to DOH with the $85 fee. Missing the window = immediate ineligibility to work.
2. 120-day nursing home clock: Under federal OBRA, you must pass the NAC exam and convert to certified status within 120 days of your first paid nursing home day. Working beyond that as an uncertified aide is illegal.
3. 24-month no-work rule: If you go more than 24 consecutive months without any paid nursing-assistant work, your OBRA Registry status lapses — even if DOH still shows you as active. Reactivation requires retesting (E9).
4. Fingerprinting: Washington DOH requires a federal background check with fingerprints. Use DOH-approved electronic fingerprinting vendors; ink cards are usually rejected.
5. Skills first, written second: Most Washington sites require you to pass the skills test before booking the written. Do not pay the $55 knowledge-test fee until skills are done.
6. 200 hours of paid work for renewal: You must work at least 200 nursing-assistant hours per year (or 400 in the prior 2 years) to renew. Volunteer hours do not count.
7. Long-term care CE: If you work in long-term care, WAC 388-112A-0612 requires 12 hours of continuing education annually by your birthday — separate from DOH renewal.
8. Name match: The name on your government ID, training record, Credentia PCM profile, and DOH application must match exactly. A middle-initial mismatch is the #1 reason score files fail to post to the registry.

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Top Test-Taking Strategies for Each Component

Written Exam Strategies

• Read the stem twice — NNAAP questions often hide the real question in a qualifier like "first", "most important", or "best".
• Prioritize safety over efficiency — when two answers look right, the one that keeps the resident safer almost always wins.
• Protect dignity and privacy — any answer that exposes the resident, violates HIPAA, or skips consent is wrong even if clinically efficient.
• Stay within NAC scope — you do not give injections, assess wounds, insert catheters, or interpret lab values. If an answer has you doing RN-level work, eliminate it.
• Residents choose, then report — questions about resident preferences usually want you to honor the choice and report to the nurse, not override the resident.
• Pace yourself — 70 questions in 120 minutes is roughly 1 minute 40 seconds per question. Flag hard ones and move on.

Skills Evaluation Strategies

• Verbalize every step — evaluators score what they observe and hear. Saying "I am now washing my hands" helps the evaluator check the box.
• Never skip hand hygiene — perform it before and after the skill as a whole, and again after glove removal.
• Leave the unit safe — bed in lowest position, wheels locked, side rails per care plan, call light within reach, personal items in place. This is a checklist every evaluator scans at the end.
• If you make a mistake, correct it out loud — evaluators can give credit for recognized corrections on non-critical steps, but not for unfixed critical-element-step misses.
• Practice with a real timer — 30 minutes for 5 skills feels short the first time. Do at least 3 mock runs at home with a study partner.
• Watch for the 25-minute warning — when the evaluator announces "5 minutes left," finish the current skill safely before starting another.

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Test-Day Checklist

• Two forms of valid government-issued ID (one with photo, one with signature); name must match your Credentia PCM profile exactly
• Admission letter from Credentia (printed or mobile)
• Closed-toe, non-slip shoes for the skills test
• Scrubs or clean professional attire (no fake nails, no jewelry beyond a plain band, hair tied back)
• Wristwatch with a second hand (for pulse and respiration counting)
• No phones, no food, no notes at the testing station
• Arrive 30 minutes early — late arrivals forfeit the fee
• Credit card, prepaid card, or electronic voucher if paying any remaining balance (cash is never accepted, even for skills fees)

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Renewal, Reciprocity & Career Path

Annual Renewal

• Fee: $95
• Deadline: By your birthday each year
• Work verification: 200 hours as a nursing assistant in the past year (or 400 in the past 2 years)
• CE requirement for DOH: None for basic NAC (long-term care settings have separate WAC 388-112A rules)

Moving to Washington from Another State (Endorsement)

Washington offers reciprocity by endorsement. Requirements:

• Active, unencumbered certification on another state's OBRA Registry
• No findings of abuse, neglect, or misappropriation
• Submit the DOH Nursing Assistant Certification Endorsement Application + $85 fee + fingerprints (federal background check)
• Verification of placement on a state OBRA registry and work-history documentation
• Most applicants do not need to retest if their home-state training meets Washington's minimum hours
• Processing time: typically 8+ weeks (faster if fingerprints and registry verification arrive quickly)

Washington Nurse Aide Registry (DSHS)

Washington's registry is run by the Department of Social and Health Services (DSHS), not DOH. It holds records for 22,600+ caregivers, including abuse/neglect/misappropriation findings. Skilled nursing facilities must check the registry (using form DSHS 16-193) before hiring you — status updates return within 24–48 hours. Email: obraregistry@dshs.wa.gov.

Washington CNA Salary (2026)

• State average: $22–$25/hour ($46,000–$52,000 annually), among the highest in the U.S.
• Seattle metro: $20–$27/hour
• Hospital CNAs: typically earn 10–15% more than long-term care CNAs
• Source: BLS Occupational Employment Statistics and multiple 2026 wage surveys

Career Advancement from NAC

Why Washington Pays So Much More

Washington's nursing assistant wages run 20–35% above the national median for two structural reasons. First, the state's minimum wage (the highest statewide rate in the U.S.) sets an elevated floor for entry-level healthcare jobs. Second, acute aging demographics across western Washington (King, Pierce, and Snohomish counties especially) have created sustained CNA shortages that push shift differentials, overtime premiums, and sign-on bonuses higher than most states. Union density at large Puget Sound hospital systems (UW Medicine, Virginia Mason Franciscan, MultiCare, Providence, Kaiser) further lifts the ceiling. Expect the best combined packages at union acute-care hospitals, then skilled nursing facilities with Medicaid census pressures, then long-term care, then home health.

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Our platform covers every content area on the NNAAP written exam plus step-by-step walkthroughs for all 23 Credentia skills. Features include:

• Washington-specific content (NAR/NAC pathway, DOH rules, 108/138 training transition, E1–E9 routes)
• AI-powered explanations for every wrong answer
• Full-length practice tests mirroring the 70-question format
• Clinical skills checklists with critical-element-step highlighting
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Official Washington NAC Resources

• Washington DOH Nursing Assistant page — applications, fees, renewal
• DOH Endorsement Application (PDF 667-039) — for out-of-state CNAs
• Washington State Board of Nursing NAC info — exam overview and policy
• Credentia Washington test-taker portal — handbook, skills list, PCM login
• Credentia Washington FAQ
• WA approved NA training programs list
• DSHS Washington Nurse Aide Registry
• WA Provider Credential Search — public credential lookup
• CMS Nurse Aide Registry