Arkansas CNA common mistakes
Arkansas CNA · Understand the traps and how to avoid them.
Walks into a resident's room without knocking, or opens the bedside drawer/closet and moves personal items (mail, photos, clothing) without asking, while telling the resident 'I'm just tidying up.'
Candidates treat privacy as a paperwork concept and focus only on the task list, so the room feels like a work area rather than the resident's home. Nervousness during the skills check also makes them skip the announcement step to 'get started.'
What to do instead
Rehearse a fixed door routine every time: knock, state name and role, ask permission to enter, and close the door or pull the curtain. Before touching belongings, ask 'May I put these in the drawer?' and accept a refusal. Practice this on every single practice run until it is automatic, because evaluators score the greeting and privacy steps separately.
Fastens all the buttons, cuts up the food, or finishes the bath for a resident who can still do part of it, saying 'it's faster if I do it.'
Time pressure and a genuine wish to help push candidates toward completing tasks for the resident; they also fear the resident will fail or make a mess. Many were taught to 'get the job done' rather than to preserve function.
What to do instead
Before each task, ask the resident what they can do themselves and let them do it, even if it is slow. Use prompting ('You button the top two, I'll do the rest') and hand-over-hand cues rather than substitution. Build extra minutes into the schedule for self-care. On the skills check, verbalize what the resident is doing independently so the evaluator sees the reasoning.
Finishes care and leaves the bed at working height with the wheels unlocked, side rails in the wrong position, and the call light on the overbed table out of the resident's reach.
The bed height and call light are set up at the start of care and forgotten at the end, when attention shifts to charting or the next resident. Candidates mentally mark the task 'done' once the resident is clean and dressed.
What to do instead
Use a closing sequence said aloud every time: bed low, wheels locked, rails per care plan, call light in hand, personal items within reach, room uncluttered. Run the same five-item check on every practice resident and on the skills check before removing gloves, so it cannot be skipped under stress.
Tries to catch or hold up a resident who is sliding out of a chair or falling, or finds a resident on the floor and immediately lifts them back into bed without checking for injury or calling the nurse.
The instinct to protect someone from hitting the floor overrides training, and candidates believe moving the resident quickly is the helpful thing to do. Panic narrows attention to the resident's weight instead of the correct steps.
What to do instead
Practice the script: widen your stance, lower the resident gently to the floor by supporting the head and hips, do not attempt to carry them. Then leave them in place, stay with them, call for the nurse, check breathing and for pain or bleeding, and do not move them until told. State clearly that a fall must be reported and documented even if the resident seems fine.
Performs perineal care wiping from the rectal area toward the urinary meatus, or uses the same washcloth or glove for the entire area, then goes on to touch the bed controls and clean linen without changing gloves.
Candidates concentrate on getting the resident clean and dry and lose track of the direction and the glove changes. In a hurry, the front-to-back rule is easy to invert, especially when the resident is turned on their side.
What to do instead
Say the rule out loud while working: front to back, one stroke per cloth, new cloth and new glove before moving to the rectal area. Change gloves before touching anything else, and wash hands after. Practice the sequence in the same order on a manikin until the glove change happens without having to think about it.
Pulls a resident up in bed by the arms or under the shoulders, or pivots them during a transfer while holding them around the waist or by the clothing, without a gait belt or without locking the bed and wheelchair.
Candidates underestimate the resident's weight, feel they must move quickly to prevent a fall, and have not been shown how much of the pull their own body should be doing. Fear of dropping the resident makes the grip tighter and the movement rougher.
What to do instead
Always use a gait belt for transfers, lock the bed and wheelchair, and lower the bed to the correct height before starting. Pull with the legs, keep the resident close to your body, and support joints rather than limbs. Ask for a second staff member or a mechanical lift when the care plan calls for it. Rehearse the steps in order so the equipment check happens before hands are on the resident.
Takes a blood pressure with the bare arm hanging below heart level, the cuff over a sleeve or crooked, inflates to a random number, deflates in a few seconds, and records only the top number or rounds it to a 'nicer' figure.
Candidates rush through the procedure because they are unsure of the landmarks and do not want to pump and re-pump in front of an evaluator. Rechecking feels like admitting a mistake, so they write down the first number they see.
What to do instead
Learn a fixed sequence: resident seated and rested five minutes, arm supported at heart level, cuff one inch above the elbow crease, arrow over the brachial artery, inflate 30 mmHg above the point the pulse disappears, deflate 2-3 mmHg per second. Record both numbers exactly and recheck once if the reading seems off. Practice on classmates until the numbers look steady, because a jumping reading is a technique problem, not a machine problem.
Measures a temperature of 101.4 degrees F, a pulse of 112, or a respirations count of 8 and writes it on the flow sheet without telling the nurse, or counts respirations for five seconds and multiplies loosely.
Candidates see the numbers as data entry rather than as a message that needs to be delivered, and they fear the nurse will think they are overreacting. Respiration counting is often done while the candidate is still talking or while the resident is aware of being watched.
What to do instead
Memorize the reportable ranges (temperature at or above 100.4 degrees F, pulse under 60 or over 100, respirations under 12 or over 20, and a blood pressure change from the resident's baseline) and treat exceeding them as a report-first event. Tell the nurse immediately and record it, rather than the other way around. Count respirations for a full 30 to 60 seconds while pretending to take the pulse, so the resident breathes normally.
Washes hands for a few seconds without washing the wrists, thumbs, or under the nails, or removes gloves by peeling them from the fingertips so the contaminated outer surface snaps against the bare hand, and then touches clean equipment.
Candidates believe soap and water alone are enough and have never been shown the failure points of glove removal. Under observation, they hurry through hand hygiene to reach the 'real' skill being tested.
What to do instead
Practice 20 seconds of lather with interlocked fingers, thumbs, and wrists, then dry with a paper towel and use that towel to turn off the faucet. For gloves, pinch the outside of one glove at the wrist and peel it inside out, slide bare fingers under the second glove at the wrist, and peel it over the first so both are inside out. Perform this as a visible, unhurried sequence before and after every resident contact.
Charts care at the end of the shift from memory, signs off tasks a coworker performed, or writes opinions such as 'resident was uncooperative and seemed fine' instead of what was actually seen and done.
Batching documentation is efficient and candidates assume a task done at 2 p.m. can be recorded at 6 p.m.; signing for others feels like teamwork. Descriptive words feel more informative than bare facts, so opinions creep in.
What to do instead
Chart as soon as each task is finished, only what you personally did or directly observed, using the resident's own words in quotation marks. Replace judgments with facts: instead of 'uncooperative,' write 'resident said, "I don't want a bath," and refused; nurse notified.' Never sign for another aide, and never chart before the care is given. Check that late entries are marked as late.