NH LNA Training, Testing, and Registry Regulations

The Legal Foundation: RSA 326-B and the Board of Nursing

In New Hampshire, the nursing assistant role is a licensed profession. That is why the credential is Licensed Nursing Assistant (LNA) rather than the "CNA" title used in many other states. Legal authority comes from RSA 326-B, the New Hampshire Nurse Practice Act, which defines licensure, scope, and discipline for LNAs, LPNs, RNs, and APRNs.

The New Hampshire Board of Nursing, under the Office of Professional Licensure and Certification (OPLC), approves nursing assistant education programs, oversees competency evaluation expectations, issues licenses, and maintains the Nurse Aide Registry. Findings of abuse, neglect, or misappropriation of property can permanently affect registry status and employability. Because the LNA is a licensee, you are expected to know the rules that govern your practice—claiming you "did not know" RSA 326-B or Board rules is not a defense in a disciplinary matter.

Training Requirements: 100 Hours Under Nur 704

Federal OBRA sets a floor of 75 training hours for nurse aides. New Hampshire is stricter. Under current Board education rules in the Nur 700 series (including curriculum requirements commonly cited as Nur 704), an approved nursing assistant program must provide a minimum of 100 hours of instruction, of which there shall be:

Programs may exceed these minimums (many community-college and private programs advertise more than 100 total hours), but they cannot fall below the Board floor. Before students provide direct care, programs also deliver foundational instruction covering role orientation, communication, safety and emergency procedures (including the Heimlich maneuver), and protection of care-recipient rights, dignity, and confidentiality.

During clinical, the student-to-instructor ratio must not exceed 8:1, and the instructor may not carry other work responsibilities while teaching. Unsafe practice can result in removal from the clinical site and program failure.

The Competency Exam: Excel Testing Logistics

After you complete an approved program (or qualify by an alternate Board-recognized path such as comparable nursing education or a Board-approved challenge route), you must pass the state Nursing Assistant Competency Examination. In New Hampshire, Excel Testing is a Board-selected testing provider (approved community-college sites may also administer the Excel exam). Register at exceltestingnh.com, upload proof of program completion or expired license as directed, and pay the exam fee when you reserve seats.

Current Excel Testing combined fee for Written + Skills is $200 (you register for both parts). Approved college competency sites may post a comparable site fee (for example, Lakes Region Community College has published about $190 for reinstatement testing in recent course materials). Always confirm the amount on the registration page the day you book—fees change.

Written / oral knowledge exam

• 60 multiple-choice questions
• 90 minutes
• Passing score: 70% or higher (at least 42 correct)
• Oral/audio administration is available if requested in advance; questions are read twice
• Blank answers are marked wrong—attempt every item
• Results to candidates are reported as pass/fail (not a detailed percentage on the score report)

Clinical skills exam

• Four randomly selected skills demonstrated (not simulated) for the observer
• 30 minutes
• Another candidate typically acts as the "resident"
• You receive a skills card listing the assignment
• You are also scored on indirect observations (knock, privacy, ID check, introduce self, explain care, leave call bell, infection control, safety, complete assigned tasks)

Excel Testing's published scoring rules (Nurse Aide Competency Test Guide, rev. 11/2023):

1. A step highlighted in bold is a critical/immediate-failure step if missed or performed incorrectly.
2. Other missed items are skill errors; four or more skill errors fail the skills exam.
3. Skills results are pass or fail—candidates do not receive a percentage score for skills.

Do not study to an invented "80% overall" skills cutoff; that is not how Excel Testing describes scoring. Memorize bold safety steps (for example, locking wheelchair brakes before transfer, keeping a catheter bag below the bladder, not contaminating the drain spout).

Retesting

If you fail written or skills, you may retake the failed portion. Excel Testing requires waiting at least 2 days after the previous attempt and charges a retest fee; no-shows forfeit fees. Confirm any Board attempt limits or training-recency windows with Excel Testing and OPLC when you schedule—do not rely on unofficial "three tries" summaries without checking current rules.

After both parts are passed, Excel Testing reports results to the Board/program. You still must apply for the LNA license through OPLC (background check/fingerprinting required). Passing the exam alone is not a license.

Renewal, Practice Hours, and Continuing Education

LNA licenses renew on a two-year cycle. To renew, New Hampshire expects evidence of continued competence, typically including:

• 200 hours of nursing-assistant-related work under licensed-nurse supervision within the prior two years (or successful competency retesting if practice hours are not met), and
• Continuing education contact hours that enhance LNA knowledge and skills (RSA 326-B frames LNA CE as 12 hours per year; Board renewal materials commonly describe 24 contact hours per two-year renewal).

If the license lapses, reinstatement pathways may require Board paperwork and retaking the competency exam. Do not work after expiration.

Medication Nursing Assistant (MNA) Pathway

New Hampshire offers an optional Medication Nursing Assistant (MNA) credential for LNAs who complete additional Board-approved medication education and testing. Public OPLC licensing summaries describe MNA education on the order of 30 hours theory and 30 hours clinical, plus an active unencumbered LNA license and exam requirements under Nur 300/Nur 800. MNAs administer limited, routine medications under nurse supervision—they do not gain RN/LPN assessment authority, injectable authority, or independent PRN decision-making. Treat MNA as a later career step after you master core LNA competencies for the Excel Testing exam.

Exam-Day Checklist (from Excel Testing)

Arrive 15 minutes early (late arrivals are not admitted). Bring two IDs (one photo), wear a uniform, bring a watch with a second hand, and a blue/black pen. Electronic devices must be off. No food/drink in the exam room. Allow up to about six hours on site when written and skills run the same day.