Your 2025 Guide to Becoming a Nurse Aide in Texas: Top Programs, Requirements, Exam & Salary Insights

Quick Summary: Ready to launch a meaningful career in healthcare in the Lone Star State? Becoming a Certified Nurse Aide (CNA), officially known as a "Nurse Aide" in Texas, is a direct and rewarding path. This comprehensive guide will walk you through every step: understanding Texas's specific certification requirements (including criminal history checks), finding HHSC-approved training programs, mastering the Prometric competency exam, and exploring salary expectations across Texas. We've included real-world scenarios, financial aid information, and tips for career growth and maintaining your active status on the Texas Nurse Aide Registry. Whether you're new to healthcare or seeking a new direction, this resource is your foundation for a successful Nurse Aide career in Texas.

Introduction: Your Path to Becoming a Nurse Aide in Texas

Howdy and welcome! If you're considering a career as a Nurse Aide (often referred to as a Certified Nursing Assistant or CNA) in Texas, you're in the right place. This guide is designed to help Texans like you navigate the process, from understanding the role and meeting the requirements set by the Texas Health and Human Services Commission (HHSC), to finding approved training programs, preparing for the state competency exam, and exploring career opportunities across the vast expanse of Texas. Let's get you started on this rewarding healthcare journey.

1. What is a Nurse Aide (CNA) in Texas?

In Texas, the official term is "Nurse Aide." A Nurse Aide is an essential member of the healthcare team who provides basic patient care under the direction of licensed nursing staff, such as Registered Nurses (RNs) and Licensed Vocational Nurses (LVNs). Nurse Aides are dedicated to ensuring patients' comfort, safety, and well-being. Key responsibilities typically include:

• Assisting patients with Activities of Daily Living (ADLs), such as bathing, dressing, grooming, toileting, and eating.
• Measuring and recording vital signs like temperature, pulse, respiration, and blood pressure.
• Helping patients with mobility, including transferring them, assisting with walking, and repositioning to prevent skin breakdown.
• Observing patients' physical and mental conditions and promptly reporting any changes to the supervising nurse.
• Providing emotional support, companionship, and respecting patient rights.
• Maintaining a clean, safe, and organized environment for patients.

The role of a Nurse Aide is both physically active and deeply fulfilling. It requires compassion, strong communication skills, keen observation, and the ability to follow care plans accurately. It's an excellent entry point into the healthcare field, offering valuable hands-on experience.

2. Job Outlook & Demand for Nurse Aides in Texas

The demand for Nurse Aides in Texas is very strong and is projected to grow significantly. This trend is fueled by Texas's rapidly growing and aging population, leading to increased needs in long-term care facilities, hospitals, and home health settings. The U.S. Bureau of Labor Statistics (BLS) projects robust national growth for nursing assistants, and Texas, with its large population and expanding healthcare sector, is a major contributor to this demand.

The Texas Workforce Commission (TWC) also forecasts substantial job growth for Nurse Aides in the state. Many new positions become available each year due to both industry growth and the need to replace workers who retire or move into other healthcare roles.

3. Understanding Local Nurse Aide Demand Across Texas

While Nurse Aide opportunities are plentiful across Texas, the concentration of jobs varies by region:

• Major Metropolitan Areas: The Dallas-Fort Worth Metroplex, Greater Houston, San Antonio, and Austin have the highest concentration of hospitals, nursing homes, and home health agencies, leading to a large volume of Nurse Aide positions.
• Border Regions & Other Cities: Areas like El Paso, the Rio Grande Valley (McAllen, Brownsville, Harlingen), Corpus Christi, Lubbock, and Amarillo also have significant healthcare needs and consistent demand for Nurse Aides.
• Rural Texas: While the number of large facilities may be fewer, there's a critical and ongoing need for Nurse Aides in community hospitals, local nursing homes, and particularly in home healthcare to serve geographically diverse populations across Texas.

Exploring the Texas Workforce Commission's job search resources (like WorkInTexas.com) and connecting with local healthcare providers can provide insights into current regional demand.

4. Nurse Aide Salary & Benefits in Texas

Average Compensation

Salaries for Nurse Aides in Texas are generally competitive, though they can vary based on the region's cost of living and demand. According to the U.S. Bureau of Labor Statistics (BLS) for May 2023, Nursing Assistants in Texas earned a mean hourly wage of $17.00, which translates to an average annual salary of approximately $35,360.

Wages can differ significantly based on location (e.g., higher in major metro areas like Houston or Dallas compared to some rural regions), years of experience, type of facility (hospitals may offer higher pay than some nursing homes), and any additional certifications. Entry-level positions may start in the $13-$16/hour range, while experienced Nurse Aides in high-demand settings or with specialized skills can earn more.

Pay by Setting (Typical Texas Estimates)

Setting	Average Hourly Wage Range (TX)
Hospitals	$16.00 – $22.00+
Nursing Homes / Long-Term Care Facilities	$14.00 – $19.00
Home Health Agencies	$13.00 – $18.00 (plus potential mileage)

Note: These are general estimates. Always research specific regions and employers.

Shift Differentials & Overtime

Many Texas healthcare facilities offer shift differentials (e.g., an extra $0.50-$2.50/hour) for working evening, night, weekend, or holiday shifts. Overtime pay (1.5 times the regular rate for hours over 40 in a week) can also increase earnings.

Common Benefits Packages

Full-time Nurse Aides in Texas, especially those working for larger employers, may receive benefits such as:

• Health, dental, and vision insurance
• Retirement savings plans (e.g., 401(k))
• Paid time off (vacation, sick leave)
• Tuition reimbursement or assistance for further education
• Life insurance options

5. Texas Nurse Aide Certification Requirements (HHSC)

To become a certified Nurse Aide in Texas and be listed as active on the Texas Nurse Aide Registry (NAR), you must meet requirements set by the Texas Health and Human Services Commission (HHSC) through its Nurse Aide Training and Competency Evaluation Program (NATCEP):

• Age: While there isn't a strict minimum age to take the training, you typically need to be able to meet employment requirements, often 18 years old (or 16-17 with certain conditions/parental consent for some programs, verify with specific programs).
• Complete an HHSC-Approved Training Program (NATCEP): You must successfully complete a Nurse Aide Training and Competency Evaluation Program approved by HHSC. This program must include at least 100 clock hours, consisting of:
  • A minimum of 60 clock hours of classroom instruction.
  • A minimum of 40 clock hours of hands-on resident care (clinical) training in a nursing facility.
• Pass the Competency Evaluation Program (CEP) Exam: After completing training, you must pass the state-approved Nurse Aide competency exam. In Texas, this exam is administered by Prometric. It includes two parts: a Clinical Skills Exam and a Written (or Oral) Exam.
• Criminal History Check: While HHSC does not conduct a criminal history check for initial certification, employers are required to check your background against the HHSC Employee Misconduct Registry (EMR) and the Nurse Aide Registry (NAR) for any findings of abuse, neglect, or misappropriation of resident property before hiring you. Some employers may conduct more extensive background checks. Certain criminal convictions may prevent employment as a Nurse Aide.
• Health Screening: Training programs usually require proof of immunizations and a TB test before clinical training begins.
• Application for Exam: Your training program will typically assist you with the application process to take the Prometric exam.

There are different eligibility routes to take the exam (e.g., new nurse aide candidate, out-of-state nurse aide, nursing student). The most common is Route 1: successfully completing an HHSC-approved NATCEP.

Always verify the most current and detailed requirements with the HHSC NATCEP website and your chosen HHSC-approved training program.

6. Finding HHSC-Approved Nurse Aide Training Programs in TX

Choosing a Nurse Aide Training and Competency Evaluation Program (NATCEP) that is approved by the Texas Health and Human Services Commission (HHSC) is crucial. Only graduates from these approved programs are eligible to take the state competency exam and become certified. HHSC provides resources for finding approved programs. Common providers in Texas include:

• Community Colleges & Junior Colleges: Many Texas community colleges offer affordable, HHSC-approved Nurse Aide training programs.
• Proprietary (Private) Career Schools & Vocational Institutes: Numerous private schools across Texas specialize in healthcare training, including Nurse Aide programs. Ensure they are HHSC-approved.
• High Schools with Health Science Programs: Some Texas high schools offer Nurse Aide training as part of their career and technical education pathways.
• Nursing Facilities (Nursing Homes): Some nursing homes offer their own HHSC-approved NATCEPs. Federal law prohibits approved nursing facilities from charging for training they provide to individuals who will be employed by that facility or have an offer of employment.
• Hospitals & Other Healthcare Entities: Occasionally, hospitals or other organizations may offer approved training.

When selecting a program in Texas, consider:

• HHSC Approval: This is mandatory. Verify the program's approval status with HHSC.
• Cost & Financial Aid: Inquire about tuition, fees (books, uniform, state exam), and any available financial aid (WIOA grants, scholarships, payment plans).
• Schedule & Duration: Programs vary from intensive full-time (a few weeks) to part-time evening/weekend options (several months).
• Location & Clinical Training Sites: Factor in commute times.
• State Exam Pass Rates: Ask the program about their graduates' success on the Prometric exam.
• Job Placement Assistance: Some programs may offer support in finding employment.

You can search for HHSC-approved NATCEPs through the Texas Long-term Care Provider Search (select "Nurse Aide Training Program" under Provider Type) or by contacting HHSC NATCEP staff.

7. What to Expect from Your Texas Nurse Aide Program Structure & Duration

All HHSC-approved Nurse Aide Training and Competency Evaluation Programs (NATCEPs) in Texas must provide a minimum of 100 clock hours of training. This is structured as:

• Classroom Instruction (minimum 60 clock hours): This portion covers theoretical knowledge and foundational skills. Topics typically include:
  • Introduction to long-term care, the role of the Nurse Aide, ethics, and resident rights.
  • Communication and interpersonal skills.
  • Infection prevention and control.
  • Safety and emergency procedures.
  • Basic nursing skills and personal care procedures.
  • Promoting residents' independence and dignity.
  • Mental health and social service needs.
  • Care of cognitively impaired residents (e.g., Alzheimer's disease and related dementias).
  • Basic restorative services.
  A portion of this (typically the first 16-24 hours) must be completed before students can engage in direct resident care.
• Clinical (Hands-On) Training (minimum 40 clock hours): This practical component must be conducted in an HHSC-approved nursing facility (nursing home). Students provide direct care to residents under the supervision of a qualified licensed nurse instructor, applying the skills and knowledge learned in the classroom.

Program Duration:

• Full-Time Programs: Can often be completed in 3 to 6 weeks.
• Part-Time Programs (Evenings/Weekends): May take 6 to 12 weeks or longer, depending on the schedule.

All approved programs are designed to equip students with the necessary competencies to pass the state exam and work effectively as a Nurse Aide in Texas.

8. The Texas Nurse Aide Competency Exam (Prometric): What You Need to Know

After successfully completing an HHSC-approved NATCEP, you must pass the Texas Nurse Aide Competency Evaluation Program (CEP) examination to become certified. This exam is administered by Prometric. It consists of two parts, and you must pass both:

1. Clinical Skills Exam

• You will be required to perform five randomly selected Nurse Aide skills.
• One of the skills will always be Hand Hygiene. The other four skills are chosen randomly from the official list of testable skills.
• A Nurse Aide Evaluator will observe and score your performance based on critical steps outlined for each skill. You must perform the critical steps correctly to pass a skill.
• You will have a specific time limit (usually around 30-40 minutes, check the Prometric Candidate Handbook) to complete all five skills.

2. Written (or Oral) Examination

• Consists of 60 multiple-choice questions.
• Tests your knowledge on topics covered in your NATCEP, such as safety, infection control, resident rights, basic nursing care, and communication.
• You will have 90 minutes to complete this examination.
• An oral version of the exam (questions read aloud via headphones) is available in English or Spanish if requested in advance during exam registration.

Attempts & Retakes: You are allowed up to three attempts to pass both parts of the examination within 24 months (two years) of completing your training program. If you fail one part, you only need to retake that part. If you do not pass both parts within the three attempts or the two-year timeframe, you must retake an HHSC-approved 100-hour NATCEP.

On Exam Day: Arrive on time. You MUST bring two forms of current, valid (not expired), signature-bearing identification. One ID must be a government-issued photo ID (e.g., driver's license, state ID, passport). Your name on your IDs must exactly match the name used for exam registration. Wear appropriate attire (flat, non-skid, closed-toe shoes; scrubs are often recommended/required) and a watch with a second hand.

Always refer to the latest Texas Nurse Aide Candidate Handbook (Bulletin) from Prometric for the most current exam policies, skill lists, fees, ID requirements, and testing site information.

9. Getting Certified & Listed on the Texas Nurse Aide Registry

Initial Certification & Registry Listing

Once you successfully pass both the Clinical Skills Exam and the Written (or Oral) Examination administered by Prometric, Prometric will transmit your results to the Texas Health and Human Services Commission (HHSC). HHSC will then process your certification. If all requirements are met (including being clear of any findings on the Employee Misconduct Registry or other relevant checks), you will be issued a Texas Nurse Aide certificate and your name will be added to the Texas Nurse Aide Registry (NAR) with an "active" status. Employers are required to verify your active status on the NAR before hiring you as a Nurse Aide. You can typically check your status online via the HHSC NAR search portal.

Maintaining Your Certification: Renewal

Your Texas Nurse Aide certification is valid for two years (24 months) from the date it was issued.

• Work Requirement: To renew your certification, you must have performed nursing or nursing-related services for pay, under the supervision of a licensed nurse, at some point during your two-year certification period. There isn't a minimum number of hours specified, but you must have worked.
• Continuing Education (In-Service): You must complete 24 hours of HHSC-approved in-service education every two years. At least 12 of these hours must be completed in each year of the two-year certification period if you are employed in a nursing facility. The nursing facility is responsible for providing this in-service education. If you are not employed in a nursing facility, you are responsible for obtaining these CEUs from an approved provider.
• Renewal Application: HHSC typically mails a renewal application to your address of record before your certificate expires. It is your responsibility to keep your address updated with the NAR. Complete and submit this form, including verification of employment and in-service education.

If you do not meet all renewal requirements, your certificate will expire. To reactivate an expired certificate, you will generally need to pass the competency exam (both parts) again. If your certificate has been expired for more than 24 months, you may need to retake an HHSC-approved NATCEP.

Out-of-State Nurse Aides: Reciprocity

If you are a Nurse Aide certified in another state and your certification is active and in good standing (no findings of abuse, neglect, or misappropriation), you can apply for Texas certification through reciprocity (also called "endorsement"). You'll need to complete the "Request for Entry on the Texas Nurse Aide Registry Through Reciprocity" form (Form 5506-NAR) and submit it to HHSC with required documentation, including verification from your original state of certification. If your credentials meet Texas standards, you may be granted Texas certification without retaking the exam.

10. Real Stories: Nurse Aide Journeys in Texas

Maria's Start in San Antonio

Maria, a recent high school graduate in San Antonio, enrolled in an HHSC-approved NATCEP at a local community college. She found the clinical experience at a nearby nursing home invaluable. After passing her Prometric exams, Maria was hired by a large hospital system. "The training was comprehensive, and the instructors really prepared us for the state exam," she shares. "I'm proud to be helping patients and learning so much."

John's Career Shift in the DFW Metroplex

John, after working in retail for several years in Dallas, sought a more stable and fulfilling career. He attended a part-time evening Nurse Aide program offered by a proprietary school in Fort Worth. "Balancing work and school was tough, but worth it," John says. He now works at a long-term care facility in a Dallas suburb and enjoys making a difference in the residents' lives. He's diligent about his annual in-service education.

Linda's Opportunity in Rural East Texas

Linda, from a small town in East Texas, found an HHSC-approved Nurse Aide program offered by a local nursing facility. The training was free with a commitment to work there post-certification. "It was a great opportunity for me," Linda notes. "The hands-on experience I got during training right there in the facility was fantastic." She values the close-knit community at her workplace.

11. A Day in the Life of a Texas Nurse Aide

A typical day for a Nurse Aide in Texas, whether in a busy Houston hospital or a community nursing home in West Texas, is centered around providing compassionate and competent direct care:

• Start of Shift:
  • Clock in, receive report from the previous shift on resident/patient assignments, conditions, and care needs.
  • Gather necessary supplies for your assigned residents.
  • Make initial rounds, greet residents, and assess immediate needs.
• Morning/Daytime Routine:
  • Assist with ADLs: bathing, dressing, oral hygiene, grooming, toileting according to care plans.
  • Serve meal trays, assist with feeding if needed, encourage hydration, and record intake/output.
  • Take and record vital signs (temperature, pulse, respirations, blood pressure) as directed.
  • Change bed linens, maintain room cleanliness and safety (e.g., call light within reach).
  • Assist with mobility: ambulation, transfers (e.g., bed to wheelchair), range-of-motion exercises, repositioning to prevent pressure injuries.
• Throughout the Shift:
  • Respond promptly and courteously to call lights and resident requests.
  • Observe residents for any changes in condition (physical, behavioral, emotional) and report immediately to the licensed nurse.
  • Provide emotional support, active listening, and engage in appropriate social interactions.
  • Accurately document all care provided and observations according to facility policy and state regulations.
  • Follow infection control procedures diligently (e.g., handwashing, use of personal protective equipment).
• End of Shift:
  • Ensure residents are comfortable, safe, and their needs are met before the next shift arrives.
  • Complete all charting accurately and thoroughly.
  • Provide a comprehensive report to the oncoming Nurse Aide/shift.

Nurse Aides in Texas are the backbone of direct care, requiring dedication, keen observation, and a commitment to resident-centered care.

12. Frequently Asked Questions (FAQs) for Aspiring Texas Nurse Aides

Do I need a criminal background check to become a Nurse Aide in Texas?

While the HHSC doesn't perform a direct criminal background check for initial registry certification, employers are required to verify your status against the HHSC Employee Misconduct Registry (EMR) and the Nurse Aide Registry (NAR) for any findings of abuse, neglect, or misappropriation. Many employers also conduct their own criminal background checks. Certain convictions can disqualify you from employment in healthcare facilities.

How many hours of in-service education are required to renew my Texas Nurse Aide certificate?

You need 24 hours of HHSC-approved in-service education every two years. Nursing facilities are responsible for providing at least 12 hours each year; if you’re not employed in a facility, you must obtain the hours from an approved provider.

Can I work as a Nurse Aide in Texas while waiting for my Prometric exam results?

After completing an HHSC-approved Nurse Aide Training and Competency Evaluation Program (NATCEP), you may work up to 120 days as a “nurse aide trainee” while pursuing certification. However, you cannot practice as a Certified Nurse Aide until you pass the Prometric exam and are listed as active on the Texas NAR. Verify specifics with HHSC and your employer.

What if my Texas Nurse Aide certificate expires?

If your certificate expires because you didn’t meet the renewal requirements, you cannot work as a Nurse Aide. To reactivate, you must reapply and pass both parts of the Prometric competency exam again. Certifications expired over 24 months may require completing a new HHSC-approved 100-hour NATCEP.

How do I transfer my out-of-state CNA certification to Texas (reciprocity)?

Apply for reciprocity by submitting Form 5506-NAR, “Request for Entry on the Texas Nurse Aide Registry Through Reciprocity,” to HHSC. Provide verification of your active, good-standing out-of-state certification and meet Texas’s requirements. If approved, you’ll be added to the Texas NAR without re-testing.

13. Tips for Success in Your Nurse Aide Training and Career in TX

• Know the Prometric Skills: Thoroughly practice every skill on the Prometric Texas skills checklist. Focus on performing all critical steps correctly.
• Attend All Training Hours: HHSC mandates 100 hours. Perfect attendance is key.
• Study Smart for the Written Exam: Use practice questions, understand key concepts from your training, and don't just memorize.
• Professionalism Counts: From day one of training through your career, maintain punctuality, appropriate attire, respectful communication, and a positive attitude.
• Understand Texas Regulations: Be aware of resident rights, abuse prevention, and reporting requirements specific to Texas.
• Keep Records of In-Service/CEUs: Maintain copies of all your in-service education certificates for renewal.
• Stay Current with HHSC: Ensure your contact information on the Texas Nurse Aide Registry is always up-to-date.
• Prioritize Resident Safety and Dignity: These are fundamental to quality care in Texas.

14. Advancing Your Career: Paths Beyond Nurse Aide in Texas

Your Texas Nurse Aide certification is a solid starting point. Many Nurse Aides in Texas advance their careers:

• Licensed Vocational Nurse (LVN): A very popular next step. LVN programs in Texas generally take 12-18 months. The Texas Board of Nursing (BON) regulates LVNs.
• Registered Nurse (RN): Pursue an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN) from a Texas BON-approved program.
• Medication Aide: With additional HHSC-approved training (typically 140 hours) and passing a state exam, certified Nurse Aides can become Permitted Medication Aides in certain long-term care settings in Texas.
• Specialized Roles: Consider roles like Restorative Aide (with specialized training) or working in specific units like dementia care or rehabilitation.
• Healthcare Administration or Education: With experience and further education (e.g., a degree in healthcare administration), Nurse Aides can move into supervisory roles or become instructors in NATCEPs.

Many Texas healthcare employers, particularly larger hospital systems, offer tuition assistance or reimbursement for employees pursuing further education.

15. Nurse Aide Training Costs & Financial Aid in Texas

The cost of Nurse Aide training (NATCEP) in Texas can vary:

Program Type	Typical Tuition Range (TX)	Additional Fees (Books, Uniform, Exam, etc. Estimate)	Common Financial Aid Options
Texas Community College	$700 – $1,500	$150 – $300	Pell Grants (if eligible), Texas Public Education Grant (TPEG), WIOA, scholarships.
Proprietary (Private) School	$900 – $2,000+	$200 – $400	School payment plans, WIOA, some scholarships.
Nursing Facility-Based Training	Often Free (if offered by an approved nursing facility to prospective employees, by federal law)	Minimal or covered	Employer-sponsored.
High School Programs	Varies, often low cost or part of regular school fees.	May vary	School-based.

Key Texas Financial Aid & Cost-Saving Tips:

• FAFSA: Complete for federal Pell Grants if attending an eligible college.
• Texas Workforce Commission (TWC): Contact your local Workforce Solutions office for information on WIOA (Workforce Innovation and Opportunity Act) training grants.
• Facility-Sponsored Training: Inquire with local nursing facilities about free NATCEPs for prospective employees.
• Scholarships: Search for scholarships from colleges, private foundations, and healthcare organizations.

Always get a detailed breakdown of ALL costs before enrolling: tuition, textbook, uniform, supplies, CPR certification (if required separately), TB test/physical, and the Prometric exam fee.

Conclusion: Start Your Nurse Aide Journey in Texas Today!

Becoming a certified Nurse Aide in Texas is a commendable step towards a rewarding career in healthcare. The Lone Star State offers abundant opportunities for those dedicated to providing compassionate care. By understanding Texas's specific requirements, choosing an HHSC-approved training program, preparing thoroughly for the Prometric competency exam, and committing to ongoing professional development, you'll be well-positioned for success.

Your journey starts with initiative. Use the resources provided in this guide to research programs in your community and begin the process of becoming a vital part of Texas's healthcare workforce.

Visit the Texas Health and Human Services Commission (HHSC) NATCEP website and the Prometric Texas Nurse Aide page for official program information, forms, exam details, and to embark on your path. A fulfilling career caring for fellow Texans awaits!

References & Further Reading (Texas)

1. U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, "Nursing Assistants and Orderlies" — www.bls.gov/ooh/healthcare/nursing-assistants.htm
2. U.S. Bureau of Labor Statistics, Occupational Employment Statistics, "May 2023 State Occupational Employment and Wage Estimates Texas - 31-1131 Nursing Assistants" — www.bls.gov/oes/current/oes_tx.htm#31-1131
3. Texas Health and Human Services Commission (HHSC) - Nurse Aide Training and Competency Evaluation Program (NATCEP) — www.hhs.texas.gov/providers/long-term-care-providers/nurse-aide-training-competency-evaluation-program-natcep
4. HHSC - Texas Nurse Aide Registry (NAR) Search & Information — HHSC - Texas Nurse Aide Registry (NAR) Search & Information , Renewals, Registration etc.
5. Prometric - Texas Nurse Aide Competency Examination Program — www.prometric.com/nurseaide/tx (Access Candidate Handbook/Bulletin here)
6. Texas Workforce Commission (TWC) - Job Seekers & Training Information — www.twc.texas.gov/jobseekers (and WorkInTexas.com)
7. Texas Board of Nursing (BON) - For LVN and RN information — www.bon.texas.gov/