Nursing assistant skills checklist

A nursing assistant skills checklist is a structured assessment form that records whether a nursing assistant can safely perform core clinical skills. It applies to certified nursing assistants (CNAs) and to candidates training to become one.

It covers 8–12 skill domains, from hand hygiene and vital signs to transfers, feeding and elimination care. Candidates use it to practice for the state exam, instructors use it to grade training, and employers use it to sign off new hires.

Most US states follow the National Nurse Aide Assessment Program (NNAAP) framework, which standardizes the skills evaluated across testing vendors like Prometric and Credentia. Some states add skills or adjust the evaluation criteria, so treat the checklist below as the NNAAP baseline and confirm your own state’s list.

Key takeaways

A nursing assistant skills checklist documents competency in 8–12 core clinical domains aligned with NNAAP standards and state exam requirements.

Hand hygiene and infection control is the most critical skill on every CNA state exam, and it is always assessed before other clinical skills.

The checklist serves three purposes: CNA state exam preparation, clinical instructor evaluation during training, and employer onboarding and competency verification.

Pabau’s practice management software stores staff documents such as qualifications and certificates, so a signed checklist can be filed with each new hire’s records.

What a nursing assistant skills checklist is and who uses it

The checklist is a performance assessment document that records whether a CNA or nursing assistant candidate has shown competency in hands-on clinical skills. It typically includes checkboxes, scoring criteria and space for evaluator notes. Three groups use it:

• CNA candidates preparing for state exams: The checklist doubles as a study guide and practice tool. Students track which skills they have practiced and which need more work before the written and skills portions of the exam.
• Clinical instructors and educators: Instructors use the checklist during training to document student progress, flag skills that need more practice, and give feedback.
• Employers and healthcare facility managers: During onboarding, the checklist shows that new nursing assistants can safely perform required clinical tasks. It goes into the personnel file and serves as evidence of competency during regulatory audits or liability review.

The National Council of State Boards of Nursing (NCSBN) governs the NNAAP framework, which sets the standards most states follow. Those standards trace back to the Omnibus Budget Reconciliation Act of 1987 (OBRA ’87), which mandates minimum CNA training and competency assessment.

Core clinical competencies the checklist covers

The checklist covers eight core competency areas. Each domain includes several discrete skills evaluated during state exams and clinical practice.

Most states test five or six of these eight domains on the skills exam. Testing vendors may rotate which skills are evaluated or add state-specific changes. Candidates should confirm the exact skills list for their state through the Centers for Medicare and Medicaid Services (CMS) or their state board of nursing.

The communication domain is scored on how clearly the aide reports a change in the patient’s condition to the nurse. A structured format such as an SBAR nursing handoff keeps that report short and complete.

How to use it for CNA state exam prep

During exam preparation, the checklist works as a study and practice tool. Here is the step-by-step workflow:

1. Identify your state exam format. Confirm whether your state uses Prometric, Credentia, or another approved testing vendor. Each vendor administers a slightly different skill sequence, though the core competencies stay similar. Your training program or state board will provide the official skill list.
2. Practice each skill with the checklist. Run each skill several times. Have an instructor or peer evaluate you against the checklist’s scoring criteria. Record which skills you have practiced and which need more repetition.
3. Identify critical steps. For each skill, memorize the critical steps that exam evaluators score. A single missed critical step often fails the skill, even if the rest of the procedure is correct. The checklist highlights these.
4. Simulate the exam environment. Practice in a setting that mimics the testing room. Use the same equipment and room setup you will meet on exam day.
5. Track your progress. Check off skills as you demonstrate competency. Aim for 90%+ competency on all listed skills before sitting for the exam.

The hand hygiene and infection control skill is always evaluated first on state exams. Failing it ends the exam on the spot, so practice it until you can run it without thinking.

Using it in clinical education and student evaluation

Clinical instructors and nurse educators use the nursing assistant skills checklist to document student progress during CNA training programs. It gives every student the same objective standard and creates a record for program accreditation.

During clinical rotations, instructors observe students performing each skill and mark the result, usually “Pass,” “Fail,” or “Not Yet Attempted.” Many programs require students to pass every skill before sitting for the state exam. The completed checklist becomes part of the student’s transcript, and employers can review it during hiring.

Graduates applying for their first role often point to those completed skills in a nursing assistant application letter. It shows the hiring manager what has already been signed off.

How employers use it for staff onboarding

Hospitals, long-term care facilities and outpatient practices use the checklist during orientation. It confirms that each new nursing assistant can safely perform the required clinical tasks in that specific facility.

Orientation typically includes hands-on evaluation of each skill in the facility’s own patient rooms, with its own equipment and supplies. A charge nurse or preceptor uses the checklist to document competency. Once every critical skill is verified, the nursing assistant is cleared to work independently on the unit.

The completed checklist is filed in the employee’s personnel record. There it serves as evidence of due diligence during regulatory inspections or liability claims. Pabau, the practice management platform we build, includes team management software for staff scheduling and permissions.

It also stores staff documents such as qualifications and certificates. A scanned, signed checklist can sit in the same place as each nursing assistant’s CNA certificate.

Side by side, the three uses differ mainly in who marks the form and where the signed copy ends up.

Step-by-step procedures for core nursing assistant skills

Below are the standardized procedures for four of the most frequently tested nursing assistant skills. Each procedure is broken into discrete steps that align with NNAAP evaluation standards.

Hand hygiene and donning and doffing PPE

Hand hygiene is the foundational infection control skill. This procedure is always completed first on state exams.

1. Assess the need for hand hygiene (before and after patient contact, before clean procedures, after body fluid exposure).
2. Turn on water and adjust to warm temperature.
3. Wet hands and forearms, then apply soap.
4. Scrub for at least 20 seconds, including between fingers, back of hands, wrists, and forearms using circular motions.
5. Rinse thoroughly under running water.
6. Dry hands with a clean paper towel.
7. Don gloves by sliding hands into latex-free gloves and pulling up over wrist.
8. Perform the clinical task.
9. Remove gloves by grasping the outside of one glove near the wrist and rolling it off inside-out. Then slide fingers under the wrist of the remaining glove and roll it off, turning it inside-out with the first glove inside it.
10. Perform hand hygiene again post-procedure.

Measuring blood pressure

Accurate vital signs measurement is a critical clinical skill, and blood pressure is commonly tested on state exams. A high reading goes to the nurse, who may start or update a hypertension nursing care plan.

1. Gather equipment: sphygmomanometer (manual or digital) and stethoscope.
2. Ensure the patient has rested for five minutes before measurement.
3. Position the patient’s arm at heart level, supported on a flat surface.
4. Select an appropriately sized cuff (bladder encircles 80% of arm circumference).
5. Wrap the cuff snugly around the upper arm, one inch above the antecubital fossa (inside of elbow).
6. For the manual method, locate the radial pulse and inflate the cuff 20 mmHg above palpated systolic pressure. Deflate slowly while listening over the brachial artery with a stethoscope. Record the first Korotkoff sound (systolic) and the last sound heard (diastolic).
7. Record the reading in both arms on the first visit (compare for asymmetry).
8. Normal adult BP is less than 120/80 mmHg. Report any reading above 140/90 mmHg to the nurse immediately.

Making an occupied bed

Bed making is a high-frequency skill evaluated on most state exams. The occupied bed procedure keeps the patient in bed while changing linens.

1. Explain the procedure to the patient and gather clean linens.
2. Perform hand hygiene and don gloves.
3. Lower the side rail on the side you are working.
4. Loosen the bottom sheet on that side and roll it toward the patient (creating a bundle). Tuck it under the patient’s buttocks.
5. Place the clean bottom sheet on the exposed mattress and tuck it in. Then roll it under the soiled sheet bundle, creating a sandwich.
6. Ask the patient to roll to the opposite side (onto the clean sheet) or use a transfer device if the patient cannot move independently.
7. Pull out the soiled sheet bundle from under the patient and discard it.
8. Smooth the clean bottom sheet and tuck in hospital corners.
9. Repeat the process on the second side.
10. Apply the top sheet, blanket, and bedspread, leaving the foot of the bed unfolded so the patient can move freely.
11. Ensure side rails are secure and the patient call light is within reach.

Assisting a patient with feeding

Feeding assistance is evaluated for patient safety, including aspiration precautions and respect for patient preferences.

1. Check the patient’s dietary restrictions and any swallowing precautions documented in the care plan.
2. Assist the patient to an upright sitting position (at least 45 degrees) in a chair or bed.
3. Verify the patient is alert and able to swallow before beginning.
4. Protect the patient’s clothing with a napkin or bib.
5. Offer food in small spoonfuls (one-third to one-half teaspoon at a time).
6. Allow the patient time to chew and swallow before the next spoonful.
7. Offer sips of liquid between bites to aid swallowing.
8. Watch for signs of choking or difficulty swallowing. If coughing occurs, stop feeding and notify the nurse immediately.
9. Offer a napkin to wipe the patient’s face as needed.
10. Document the amount eaten and any concerns (difficulty swallowing, refusal, aspiration signs).

Aspiration, when food or liquid enters the airway, is a life-threatening complication. Always position patients upright and monitor closely during feeding. Patients with a known swallowing problem usually have an aspiration risk care plan that sets their positioning and diet texture.

How CNA skills requirements vary by state

Although most states follow the NNAAP framework, state boards of nursing may add, remove or modify skills based on local practice standards. For example, some states require a catheterization skill, while others do not. A few states test more than eight core skills. Before using this checklist, verify the exact skills your state’s testing vendor and board of nursing require. They may differ from the NNAAP baseline.

How Pabau keeps onboarding paperwork and patient records in one place

Many facilities still run competency sign-off on paper. The preceptor ticks the form at the bedside, and the original goes into a personnel folder. When an auditor asks for it, someone has to find it by hand.

With Pabau, the signed checklist is stored as a staff document alongside each nursing assistant’s qualifications and certificates. Managers set schedules and permissions in the same system, so a new hire’s paperwork and schedule live together.

The patient side moves off paper too. Pabau’s intake software for practices turns paper forms into digital form templates, and completed forms auto-populate the patient record. Nursing assistants start a shift with medical history already on file instead of chasing a paper copy.

Keep staff records and patient forms together

Pabau stores staff qualifications and certificates next to schedules and permissions, while digital intake forms auto-populate the patient record. New nursing assistants start with their paperwork filed and patient history on hand.

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Conclusion

The checklist earns its keep when someone other than the candidate marks it. Self-assessment tells a student what they have practiced, while an instructor’s or preceptor’s marks show what they can do under observation. Book the exam, or clear a new hire for independent work, only once every critical step has been observed and signed.

For employers, the trade-off is preceptor time during orientation. In return, you get a dated, signed record that answers an inspector’s question in one page.

Book a demo to see how Pabau keeps every signed competency record with the right nursing assistant’s staff documents.

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