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Iowa Certified Nursing Assistant — Requirements & Free Practice

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Certified Nursing Assistant (CNA)

Iowa nurse aide certification with Direct Care Worker Registry status for long-term care employment. DIAL approves training and maintains the registry; the training entity issues the course certificate. Certification does not expire, but active registry status depends on qualifying employment. Medication aide certification is a distinct profession and does not require CNA certification.

Licensing authority: Iowa Department of Inspections, Appeals, and Licensing · Application information

Deemed certification from pre July 1989 training of at least 100 hours
No examination is required for this applicant pathway.
Background and employability
For employment covered by Iowa Code 135C.33, comply with the criminal-history and child/dependent-adult abuse record checks and any required record-check employability evaluation, subject to the statute’s provisional-employment and prior-evaluation exceptions.
Continued eligibility
The separate inactivity reactivation requirements apply if there is a 24-month gap in qualifying paid work.
Historical qualification
Complete a nurse aide training and competency evaluation program before July 1, 1989 and be found competent after at least 100 clock hours of nurse aide training.
Prior assessment
The historical program or competency determination is evidence of qualification rather than a currently offered examination.

Official no-examination sources

Effective from 2026-09-22.

Deemed certification from pre July 1989 training with supplemental hours
No examination is required for this applicant pathway.
Background and employability
For employment covered by Iowa Code 135C.33, comply with the criminal-history and child/dependent-adult abuse record checks and any required record-check employability evaluation, subject to the statute’s provisional-employment and prior-evaluation exceptions.
Continued eligibility
The separate inactivity reactivation requirements apply if there is a 24-month gap in qualifying paid work.
Historical qualification
Complete a training and competency evaluation program before July 1, 1989 with at least 60 hours and make up the difference to 75 hours through supervised practical nurse aide training or regular in-service education.
Prior assessment
The historical program or competency determination is evidence of qualification rather than a currently offered examination.

Official no-examination sources

Effective from 2026-09-22.

Deemed certification using qualifying employment before December 1989
No examination is required for this applicant pathway.
Background and employability
For employment covered by Iowa Code 135C.33, comply with the criminal-history and child/dependent-adult abuse record checks and any required record-check employability evaluation, subject to the statute’s provisional-employment and prior-evaluation exceptions.
Continued eligibility
The separate inactivity reactivation requirements apply if there is a 24-month gap in qualifying paid work.
Historical qualification
Meet the pre-July 1, 1989 program-completion prerequisite in 441—81.13(1)(a), and demonstrate at least 24 consecutive months of nurse aide service at facilities of the same Iowa employer before December 19, 1989.
Prior assessment
The historical program or competency determination is evidence of qualification rather than a currently offered examination.

Official no-examination sources

Effective from 2026-09-22.

Deemed certification from a retrospectively approved pre July 1989 program
No examination is required for this applicant pathway.
Background and employability
For employment covered by Iowa Code 135C.33, comply with the criminal-history and child/dependent-adult abuse record checks and any required record-check employability evaluation, subject to the statute’s provisional-employment and prior-evaluation exceptions.
Continued eligibility
The separate inactivity reactivation requirements apply if there is a 24-month gap in qualifying paid work.
Historical qualification
Complete a nurse aide training and competency evaluation program before July 1, 1989 that DIAL determines would have met approval requirements when offered.
Prior assessment
The historical program or competency determination is evidence of qualification rather than a currently offered examination.

Official no-examination sources

Effective from 2026-09-22.

Initial certification by approved training and examination

All of the following:

  • At least one of the following alternatives:

  • Nurse Aide State Skills Exam (assessment without a question bank)
Approved training
Complete a DIAL-approved 75-hour CNA course, including 30 clinical hours. The applicant may enroll directly or be sponsored by an employer.
Attempt limit
Each part has three attempts. Only a failed part is retaken on a second or third attempt. If either part is failed three times, the 75-hour course must be taken or retaken before testing again (441—81.13(4)(b)(2)).
Background and employability
For employment covered by Iowa Code 135C.33, comply with the criminal-history and child/dependent-adult abuse record checks and any required record-check employability evaluation, subject to the statute’s provisional-employment and prior-evaluation exceptions.
Employment deadline
DIAL placement instructions require the written and skills tests to be passed within four months of hire.
Employment eligibility
A court conviction or founded finding of abuse, neglect, mistreatment, or misappropriation of resident property makes the CNA ineligible for registry employment.
Oral option
An oral/audio delivery option is available in place of the written knowledge test; it is the same knowledge examination requirement.
Passing standard
441—81.13(4)(a)(1) requires at least 70 percent on the written/oral and skills demonstration parts.
Registry submission
After successful examination completion the testing entity reports results; the registry records training and testing information and assigns a registry ID.
Setting
Active registry status is required for long-term care employment; CNA certification itself does not expire.
Training record checks
Before beginning or returning to the CNA training program, the program obtains the statutory criminal-history and abuse checks or accesses the single contact repository; a record may require an evaluation before clinical participation.
Maintenance of active registry status through employment reporting
No examination is required for this applicant pathway.
Background and employability
For employment covered by Iowa Code 135C.33, comply with the criminal-history and child/dependent-adult abuse record checks and any required record-check employability evaluation, subject to the statute’s provisional-employment and prior-evaluation exceptions.
Certification duration
Certification itself does not expire; this route maintains active registry status rather than renewing a separate professional license.
Employer reporting
The Iowa employer reports qualifying employment; the CNA cannot report their own hours.
In service training
CNAs employed by long-term care facilities complete at least 12 hours of in-service training per year.
Qualifying employment
Perform at least eight hours of qualifying paid nursing or nursing-related duties within each two-year period.

Official no-examination sources

Effective from 2026-09-22.

Certification using comparable military training and experience

All of the following:

  • At least one of the following alternatives:

  • Nurse Aide State Skills Exam (assessment without a question bank)
Attempt limit
Each part has three attempts. Only a failed part is retaken on a second or third attempt. If either part is failed three times, the 75-hour course must be taken or retaken before testing again (441—81.13(4)(b)(2)).
Background and employability
For employment covered by Iowa Code 135C.33, comply with the criminal-history and child/dependent-adult abuse record checks and any required record-check employability evaluation, subject to the statute’s provisional-employment and prior-evaluation exceptions.
Employment deadline
DIAL placement instructions require the written and skills tests to be passed within four months of hire.
Employment eligibility
A court conviction or founded finding of abuse, neglect, mistreatment, or misappropriation of resident property makes the CNA ineligible for registry employment.
Military status
Applicant is a veteran, active duty service member, or member of the reserve forces.
Military training
Document comparable U.S. military nurse aide training through a diploma, certification, or DD 214 showing hospital corpsman, medical service specialist, or equivalent training.
Oral option
An oral/audio delivery option is available in place of the written knowledge test; it is the same knowledge examination requirement.
Passing standard
441—81.13(4)(a)(1) requires at least 70 percent on the written/oral and skills demonstration parts.
Practical experience
Document 75 clock hours of practical nurse aide experience, which may combine classroom instruction and prior equivalent experience. Successfully complete the nurse aide training and competency examination.
Registry submission
After successful examination completion the testing entity reports results; the registry records training and testing information and assigns a registry ID.
Setting
Active registry status is required for long-term care employment; CNA certification itself does not expire.
Course certification for work outside long term care registry scope
No examination is required for this applicant pathway.
Background and employability
For employment covered by Iowa Code 135C.33, comply with the criminal-history and child/dependent-adult abuse record checks and any required record-check employability evaluation, subject to the statute’s provisional-employment and prior-evaluation exceptions.
Certified long term care exception
A skilled or swing-bed unit of a hospital is within DIAL’s long-term care registry requirements; this route does not cover work in those units.
Course certificate
DIAL approves CNA courses but does not issue course certificates; obtain the certificate from the training entity.
Employment setting
Applicant plans to work outside a nursing home, such as an assisted living facility or hospital, rather than seeking active long-term care registry status.

Official no-examination sources

Effective from 2026-09-22.

Certification by challenge after prior formal training

All of the following:

  • At least one of the following alternatives:

  • Nurse Aide State Skills Exam (assessment without a question bank)
Attempt limit
Each part has three attempts. Only a failed part is retaken on a second or third attempt. If either part is failed three times, the 75-hour course must be taken or retaken before testing again (441—81.13(4)(b)(2)).
Background and employability
For employment covered by Iowa Code 135C.33, comply with the criminal-history and child/dependent-adult abuse record checks and any required record-check employability evaluation, subject to the statute’s provisional-employment and prior-evaluation exceptions.
Employment deadline
DIAL placement instructions require the written and skills tests to be passed within four months of hire.
Employment eligibility
A court conviction or founded finding of abuse, neglect, mistreatment, or misappropriation of resident property makes the CNA ineligible for registry employment.
Oral option
An oral/audio delivery option is available in place of the written knowledge test; it is the same knowledge examination requirement.
Passing standard
441—81.13(4)(a)(1) requires at least 70 percent on the written/oral and skills demonstration parts.
Prior formal training
Present evidence of prior formal training before the challenge evaluation. The approved examining institution determines eligibility under DIAL guidelines; an Iowa-approved course is not required when the candidate is accepted for challenge.
Registry submission
After successful examination completion the testing entity reports results; the registry records training and testing information and assigns a registry ID.
Setting
Active registry status is required for long-term care employment; CNA certification itself does not expire.
Registry reactivation after 24 months without qualifying work

All of the following:

  • At least one of the following alternatives:

  • Nurse Aide State Skills Exam (assessment without a question bank)
Attempt limit
Each part has three attempts. Only a failed part is retaken on a second or third attempt. If either part is failed three times, the 75-hour course must be taken or retaken before testing again (441—81.13(4)(b)(2)).
Background and employability
For employment covered by Iowa Code 135C.33, comply with the criminal-history and child/dependent-adult abuse record checks and any required record-check employability evaluation, subject to the statute’s provisional-employment and prior-evaluation exceptions.
Employment deadline
DIAL placement instructions require the written and skills tests to be passed within four months of hire.
Employment eligibility
A court conviction or founded finding of abuse, neglect, mistreatment, or misappropriation of resident property makes the CNA ineligible for registry employment.
Oral option
An oral/audio delivery option is available in place of the written knowledge test; it is the same knowledge examination requirement.
Passing standard
441—81.13(4)(a)(1) requires at least 70 percent on the written/oral and skills demonstration parts.
Qualifying inactivity
There has been a continuous 24-month period with no paid nursing or nursing-related services. DIAL requires retaking both competency tests; federal requirements permit a new training-and-evaluation program or a new competency evaluation program.
Registry submission
After successful examination completion the testing entity reports results; the registry records training and testing information and assigns a registry ID.
Setting
Active registry status is required for long-term care employment; CNA certification itself does not expire.
Registry transfer by existing certification
No examination is required for this applicant pathway.
Background and employability
For employment covered by Iowa Code 135C.33, comply with the criminal-history and child/dependent-adult abuse record checks and any required record-check employability evaluation, subject to the statute’s provisional-employment and prior-evaluation exceptions.
Employment eligibility
Registry verification includes abuse, neglect, mistreatment, and misappropriation findings; ineligible individuals cannot obtain active employment status.
Existing registration
Applicant is currently listed on another jurisdiction’s nurse aide/CNA registry. Apply through the Iowa DCW Registry and obtain verification of the existing competency evaluation and registry status.
Prior examinations
Training and examinations completed for the other jurisdiction are prior qualification evidence; that jurisdiction’s examinations are not leaves of an Iowa transfer route.
Qualifying employment
If the applicant has had 24 consecutive months without paid nursing or nursing-related work, the separate inactivity reactivation requirements apply.

Official no-examination sources

Effective from 2026-09-22.

Restoration of expired registry status using previously unreported employment
No examination is required for this applicant pathway.
Actual inactivity
This is correction of an expired record where qualifying work occurred, not the separate route for 24 months without qualifying work.
Background and employability
For employment covered by Iowa Code 135C.33, comply with the criminal-history and child/dependent-adult abuse record checks and any required record-check employability evaluation, subject to the statute’s provisional-employment and prior-evaluation exceptions.
Employer letter
Employer sends a letter on facility letterhead with duties performed, full name, registry ID, hire date and separation date. An expired record cannot be corrected electronically; the CNA may not submit their own employment letter.
Prior qualifying work
Employer verifies at least eight hours of qualifying nursing or nursing-related duties performed after the last verification but before registry expiration.

Official no-examination sources

Effective from 2026-09-22.

Iowa Nurse Aide Knowledge/Audio Exam

Examination outline
  • Aging Process and Restorative Care
  • Basic Nursing Skills
  • Care Impaired
  • Client/Resident Rights
  • Communication
  • Data Collection
  • Disease Process
  • Infection Control
  • Mental Health
  • Nutrition
  • Personal Care
  • Role / Responsibility
  • Safety
Examination sources

Nurse Aide State Skills Exam

This assessment does not have a question bank.

Examination sources

NNAAP Written (or Oral) Examination

Provider
Credentia Nurse Aide LLC (develops and manages the NNAAP exam); administered by Credentia online or at test centers
Format
Multiple-choice examination taken online or at a test center, in English or Spanish, scored and retaken separately from the Skills Evaluation; candidates may choose the Oral Examination form, in which the multiple-choice questions are read aloud by recorded voice (MP3 player at test centers) and ten reading comprehension (word recognition) questions are added, and both Oral sections must be passed
Exam questions
70 multiple-choice items: 60 scored and 10 pretest (non-scored); the Oral form has 60 multiple-choice items and 10 reading comprehension (word recognition) items
Time limit
2 hours
Examination outline
  • I. Physical Care Skills — A. Activities of Daily Living (22% of the exam; 13 questions) (22%)
    • Activities of Daily Living — 1. Hygiene
    • Activities of Daily Living — 2. Dressing and Grooming
    • Activities of Daily Living — 3. Nutrition and Hydration
    • Activities of Daily Living — 4. Elimination
    • Activities of Daily Living — 5. Rest/Sleep/Comfort
  • I. Physical Care Skills — B. Basic Nursing Skills (35% of the exam; 21 questions) (35%)
    • Basic Nursing Skills — 1. Infection Control
    • Basic Nursing Skills — 2. Safety/Emergency
    • Basic Nursing Skills — 3. Therapeutic/Technical Procedures
    • Basic Nursing Skills — 4. Data Collection and Reporting
  • I. Physical Care Skills — C. Self-Care and Independence (7% of the exam; 4 questions) (7%)
    • Self-Care and Independence
  • II. Psychosocial Care Skills — A. Emotional and Mental Health Needs (8% of the exam; 5 questions) (8%)
    • Emotional and Mental Health Needs
  • II. Psychosocial Care Skills — B. Spiritual and Cultural Needs (2% of the exam; 1 question) (2%)
    • Spiritual and Cultural Needs
  • III. Role of the Nurse Aide — A. Communication (7% of the exam; 4 questions) (7%)
    • Communication
  • III. Role of the Nurse Aide — B. Client Rights (8% of the exam; 5 questions) (8%)
    • Client Rights
  • III. Role of the Nurse Aide — C. Legal and Ethical Behavior (5% of the exam; 3 questions) (5%)
    • Legal and Ethical Behavior
  • III. Role of the Nurse Aide — D. Member of the Health Care Team (6% of the exam; 4 questions) (6%)
    • Member of the Health Care Team
Examination sources