English for Nursing Assistants

Hello colleagues, There is a huge need for Certified Nursing Assistants in many communities, including mine, and many adult English learners are interested in working in health care. While a CNA job is a entry-level, low-wage job, working as a CNA can be a gateway job to a better job in health care. Some nursing homes will even pay for a CNA's nurse training.

Does your program offer classes to support students to enter CNA training? If so, how is this working?

Some members may be aware of this self-paced online course designed to teach English for Nursing Assistants. Are you using this course in your program or recommending it to learners who are interested in health careers?

If this is the first time to visit this site, please share your thoughts.

Cheers, Susan Finn Miller

Moderator, AELL CoP



I have been team-teaching NA courses in what we call Career Pathways Bridge Program at NWTC for 13 years. This is an I-Best type program. Our students are very successful in the course and they would pass the certification exam with flying colors however there is a new certification agency that has taken over the testing. Our students are struggling with passing the certification exam now. It is more difficult and more rigorous. Headmaster will not allow accommodations for EL students. Has anyone experienced this? It is so frustrating as most of our students would become lifetime CNAs and as we all know there is a severe shortage. I welcome any comments or suggestions. As a state, WI is hoping to petition Headmaster and ask for accommodations for testing.

One of the strategies that the presenters suggested was testing often in order to inform your instruction.  A simple formative or alternative assessment is so helpful in determining where you should go in your next lesson. Even a question as simple as 'how did you feel today when learning X?' can give the instructor valuable feedback.  On the other hand, the concept which I will have to learn more about is 'having students generate content.' Perhaps I haven't considered this explicitly before and want to try it in my teaching.

One specific observation I made was that the teacher physically demonstrated directional vocabulary (left, right, up, down) with her arms while saying the words for students to repeat.  This demonstration not only taught directional vocabulary, but taught it in the way in which it would be contextualized in that moment. Soon afterwards, the students used this same directional knowledge and words to help their classmates locate sight words on the board.

The most challenging part of taking notes during this observation was determining where in the chart my evidence should go.  For example, although the Principles of Learning for Instructional Design were clearly defined within the chart, sometimes I second guessed myself as to the most applicable category.  I do think there is overlap and certainly connection among principles, though, so perhaps the value here is in my thought process and the raising of my awareness.  I really enjoyed this activity and video.

Q. Which of the strategies that they shared stand out to you?

Ans. The following principles and strategies stand out to me:

1. Choosing appropriate level of difficulty

2. Presenting material in a clear and organized format

3. Using multiple and variety of examples and format

4. Offering accurate and timely feedback in order to promote learning

5. Promoting learning by giving qualitative feedback rather than test scores and flagging errors.



Q. Which, in your experience, are the most difficult principles to implement?

Ans. In my opinion the most difficult principles to implement is to support learners in generating content and reasoning. We can encourage learners to generate content but it will be difficult for the English Language Learners (ELLs) who are new to the United States and have just started learning English, to generate explanations and resolve contradictions. It will be difficult in the beginning to encourage and convince the ELLs to construct ideas from multiple points of view and with different perspective.

Q. What is one ‘specific, concrete, and descriptive observation you would share with Andrea.

Ans. One specific and concrete observation I would like to share is that all the students were fully engaged no matter what activity they were doing, whether it was working with the whole story, recognizing the word order, recognizing sight word, sound spelling relationship, pronouncing any word etc. The students were thoroughly enjoying and participating in the activities whether they were doing them individually, in pairs, or as a whole class/group. The students were listening and then reading along the story. Repeating the sentences re-enforced the connection between the spoken words and written language. There are lots of visuals to support what they are learning in the class to the real-life scenario. Everyone participated willingly and was trying to learn and have fun at the same time. The fly smacker, flash cards, printed pictures, reading and writing activity, everything together made learning very impactful and will play an important role in helping learners acquire, retain, and transfer/apply the new knowledge and skills learned.

Q. What was challenging for you about doing the observation?

Ans. The most challenging part about doing the observation was observing both, the teacher, and the students and taking notes at the same time. I tried very hard to concentrate on the students and the teacher at the same time, but as an instructor I kept on switching to observe the teacher more than the students. I had to watch the video twice to absorb all the information presented - from watching the students as well as the teacher. It was also difficult to take notes at the same time as I had to keep pausing the video. It took me 60 minutes to finish the 30-minute-long video because of this.

What is one “specific, concrete, and descriptive” observation you would share with Andrea, the teacher in the videotaped class? 

I noticed there was more than one situation in which Andrea was speaking carefully and slowly when introducing new vocabulary but then would speak in a more normal rate when asking clarifying questions about their trip to the hardware store, knowing that the students knew the questions and how to answer them, probably something they had reviewed the previous day. Since she was getting the answers she was looking for, even when speaking more quickly, it shows that she knew her classroom well. 

What was challenging for you about doing the observation?

The second time I watched the first half of the video, I had to focus my attention on the students rather than the instructor and did notice more of their interactions. In some ways, the video emphasized the students versus Andrea, so it was presented in this way deliberately, but if I had been sitting in the back of a classroom as an observer, I know it would have been more tempting to focus all of my attention on the instructor and appreciate the reminder to observe the students as well, especially looking for cues of enthusiasm versus boredom or frustration.

Space presentations of new material across time is a great reminder to all teachers, especially new ones.  I've learned over many years of teaching that sticking to a spiraling curriculum has so many benefits.  Revisiting previously taught material allows students additional exposure and also allows me to reassess those students who did not master the content/skill that was originally taught.  I often do this informally, but provides a great opportunity for both instructor and students.

I loved watching Andrea teach! She took the real life needs of the adult students to develop the lesson with associated vocabulary and activities. Andrea showed compassion and personal interest in the concerns of the class. The story with partner/group applications provided practice in pronunciation in a "safe" and fun way. 


Andrea did a super job teaching! I think it would have been hard for all students to see the visuals on the pages. I suggest that the teacher has larger visuals, realia, or smart board photos to explain the vocabulary, especially the apartment problems and items to purchase. 

Specific, Concrete, and Descriptive

Andrea is/was a great ESL instructor.  I observed her energy, enthusiasm, and compassion.  She created a relevant story and went over and above visiting a low-income apartment complex, in turn, helped the learners connect and engage.


Overall Andrea did a fantastic job teaching ESL.  I did not have many challenges. A suggestion is to periodically change the pairing/partners for the shared activities.  This will hopefully ensure the learners get a balanced shared experience, just in case a paired partner is more dominate than the other.



Creating a relevant story/scenario based on shared experience is an excellent way to present a lesson and engage learners.  Considering, what is important to an adult learner and how they would use the information.  Focusing on what is important to them while enhancing their literacy proficiency. Developing the relevant story through the lesson, Repetition, Scaffolding, and physically acting assist with recognition, retention and fluency.


A challenging principle may be "Providing opportunities to practice and use skills for a purpose".  My goal is to create an environment conducive to info exchange and a safe environment for learning.  However, as an instructor I am not able to control what the learner does outside the class.  I will encourage the learner to set aside time to practice outside of the class and also to be confident in practicing.  Practicing outside of the class in real life situations is also key to success.