CNA Programs & Career Opportunities in Iowa

Before starting your training, it's important to understand exactly what Iowa requires to become a Certified Nursing Assistant (CNA), also referred to as a nurse aide. Meeting these requirements ensures you're eligible to complete the state competency testing process, be placed on the Iowa Direct Care Worker (DCW) Registry, and work as a CNA in Iowa nursing facilities.

Eligibility

• Program enrollment: The standard pathway involves completion of an Iowa Department of Inspections, Appeals, and Licensing (DIAL)-approved 75-hour nurse aide training course. Approved programs are offered through Iowa community colleges, healthcare facilities, private training providers, and other DIAL-approved entities.
• Challenge pathway: Iowa allows candidates to challenge the state competency examination without first completing the 75-hour training course. Candidates who use this pathway must still pass both the written knowledge and skills examinations. Candidates have three attempts to pass each portion; failing either portion three times requires completion of the full 75-hour nurse aide training course before beginning a new testing cycle.
• Background checks: Before a student begins or returns to a certified nurse aide training program, the program must obtain an Iowa criminal history check and checks of the child and dependent adult abuse registries. A criminal conviction or founded abuse record does not necessarily result in automatic exclusion, but an evaluation may be required before the student can participate in clinical training involving children or dependent adults.
• Good standing: Individuals with a court conviction for abuse, neglect, mistreatment, or misappropriation of resident property, or a substantiated finding involving these acts, may be listed as ineligible for employment on the Iowa Direct Care Worker Registry.

Training Hours & Clinicals

For candidates completing the standard training pathway, Iowa's state-approved nurse aide course consists of 75 total hours, including at least 30 hours of supervised clinical training. The classroom and laboratory portion covers required subjects such as communication and interpersonal skills, infection control, residents' rights, safety and emergency procedures, basic nursing skills, personal care, restorative care, and the mental health and social-service needs of residents.

Before providing direct care to residents, trainees must complete at least 16 hours of instruction in the federally required introductory subjects, including communication, infection control, safety and emergency procedures, promoting residents' independence, and residents' rights. Students must demonstrate competency in the skills they perform during clinical training and may provide only care for which they have received appropriate instruction and supervision.

Under federal rules, a Medicare- or Medicaid-certified nursing facility may employ an individual as a nurse aide for up to four months while the training and competency requirements are being completed. To continue working as a nurse aide in a certified nursing facility after that period, the individual must have completed the applicable requirements, passed both competency tests, and met Iowa registry requirements.

Competency Exam (Written & Skills)

To become certified, candidates must pass both the written knowledge examination and the skills examination. Iowa requires a passing score of at least 70% on each portion.

• Written knowledge examination: A 70-question multiple-choice test with a 60-minute time limit, requiring 70% to pass. As of 2026, candidates may take the written exam through D&SDT-Headmaster/TestMaster Universe (TMU) or Credentia. Headmaster offers remotely proctored testing as well as testing through participating Iowa community colleges, while Credentia offers a remotely proctored written or oral examination.
• Skills examination: The practical skills test must be completed in person. Candidates may take the skills examination through an Iowa community college or through another DIAL-approved skills-testing provider. Candidates demonstrate required nurse aide skills under the observation of an approved evaluator.

Candidates have up to three attempts to pass each portion of the competency evaluation. If one component is failed, only that component must be retaken. If either the written or skills test is failed three times, the candidate must complete or repeat the 75-hour nurse aide training course before beginning a new testing cycle.

A nurse aide working in a certified nursing facility must pass both the written and skills examinations within four months of the hire date. After successful completion of both tests, the testing entity reports the results to DIAL for placement on the Iowa Direct Care Worker Registry.

Placement on the Registry & Working as a CNA

After successfully passing both competency examinations and meeting the applicable requirements, your information is submitted to the Iowa Direct Care Worker (DCW) Registry, maintained by the Iowa Department of Inspections, Appeals, and Licensing. Once processed, you are placed on the registry and assigned a six-digit registry identification number. DIAL advises allowing at least two weeks for registry processing.

Active registry status is required for CNAs who want to work in an Iowa long-term care facility, including a nursing home. Iowa does not require active CNA registry status solely to work in settings outside long-term care facilities, although individual employers may impose their own training or credential requirements.

Iowa does not issue a separate state CNA license, and DIAL does not maintain copies of CNA course certificates. The certificate showing completion of the nurse aide course is issued by the college or training entity, while the DCW Registry serves as the official record of eligibility for nursing-facility employment.

Maintaining Active Registry Status

The Iowa CNA certification itself does not expire, but your active status on the Direct Care Worker Registry depends on employment. To remain active, you must perform at least 8 hours of paid nursing or nursing-related duties during every 24-month period. Qualifying employment must be reported to DIAL by an Iowa employer; CNAs cannot report their own hours directly to the registry.

Qualifying employment may be reported electronically by nursing facilities, hospitals, hospices, home health agencies, and ambulatory surgical centers. Other employers, including assisted living programs, intermediate care facilities, residential care facilities, and group homes, may submit employment verification to DIAL by letter showing that the CNA performed at least eight hours of qualifying paid nursing or nursing-related duties.

If you go 24 consecutive months without qualifying employment, your registry status expires. To regain active status, you generally must retake and pass both the written and skills competency examinations. If qualifying work was performed before the registry expiration but was not reported, the employer may be able to provide documentation to DIAL so the employment can be credited.

CNAs employed in Iowa long-term care facilities must also complete at least 12 hours of in-service education each year. The facility is responsible for providing and documenting this training. In-service hours do not, on their own, keep a CNA active on the registry; the paid-work requirement is separate.

Reciprocity

CNAs who are already listed on another state's nurse aide registry may apply to transfer their certification to Iowa through reciprocity. The application is submitted through the Iowa Direct Care Worker Registry's online system, where DIAL verifies the applicant's out-of-state registry information and eligibility.

Applicants must meet Iowa's requirements for placement on the registry and provide the information requested by DIAL during the transfer process. Once reciprocity is approved, the applicant is placed on the Iowa Direct Care Worker Registry and may work as a CNA in Iowa nursing facilities without completing Iowa's standard training and competency-testing pathway.

Costs & Reimbursement

The cost of Iowa's 75-hour CNA course varies by community college or approved training provider. Testing fees also depend on where and how the examination is taken. As of 2026, DIAL lists the Headmaster written exam at $50 when taken remotely or through a participating Iowa community college, while the Credentia remote written exam costs $70. The skills examination costs $115 at an Iowa community college or $135 through Health Tech Associates. Candidates should confirm current fees with the testing provider before registering.

Under federal and Iowa rules, an individual who is employed by—or has received an offer of employment from—a Medicare- or Medicaid-certified nursing facility when beginning an approved nurse aide training and competency evaluation program may not be charged for the required training or competency evaluation.

If an individual pays for training and testing before obtaining employment and becomes employed by or receives an offer from a certified nursing facility within 12 months of completing the program, the facility must reimburse eligible expenses on a prorated basis. Iowa's reimbursement formula includes the cost of the course, books, and competency examinations, divides those expenses over 12 months, and reimburses the resulting monthly amount for each month the individual works as a nurse aide until one year after completion of the course.

Sources: Iowa Department of Inspections, Appeals, and Licensing – Certified Nursing Assistants, DIAL – Placement on the Iowa Direct Care Worker Registry, DIAL – Iowa Direct Care Worker Registry, DIAL – Staying Active on the Iowa Direct Care Worker Registry, DIAL – Expanded CNA Online Testing Options, Iowa Administrative Code Chapter 441—81 – Nurse Aide Training, Testing, Registry, and Reimbursement, Credentia – Iowa Nurse Aide Testing, 42 CFR 483.152 – Federal Nurse Aide Training and Reimbursement Requirements, 42 CFR 483.154 – Nurse Aide Competency Evaluation