Arizona CNA common mistakes
Arizona CNA · Understand the traps and how to avoid them.
Washes a female resident's perineal area by moving the washcloth from the rectal area toward the urethra, reusing the same cloth for each stroke.
The candidate focuses on 'getting the resident clean' and works from the area that looks dirtiest back toward the front, without thinking about where fecal bacteria will be dragged. Fatigue and haste at the end of a long care sequence make it worse.
What to do instead
Always stroke front to back (urethra toward rectum), use a fresh washcloth or fresh section of the cloth for each stroke, and change gloves and cloths as soon as any soiling occurs. Say the direction out loud in practice until it is automatic.
Announces 'I'm going to check your breathing now' and then watches the resident's chest to count respirations.
Candidates memorize 'count respirations for 60 seconds' but forget that breathing is under voluntary control, and residents who know they are being watched alter their rate. Nervousness also pushes candidates to narrate every step.
What to do instead
Keep the fingers on the wrist as if still taking the pulse and count respirations unobtrusively for a full 60 seconds (or 30 seconds times two), observing rate, rhythm and depth. Do not tell the resident you are counting breathing.
Pushes a wheelchair up to the bed and helps the resident to stand before checking that the bed wheels and the wheelchair wheels are locked.
The focus is on the resident's safety during the stand-up, and the candidate assumes equipment left by someone else is already secured. The lock check is a silent step with no immediate feedback, so it drops out of the routine.
What to do instead
Make locking part of the physical sequence: lock bed wheels, lock wheelchair wheels, raise/lower the bed to the correct height, then position the gait belt. Never release the gait belt until the resident is fully seated or standing securely.
When a resident starts to slide out of a chair or off the bed, the candidate grabs the resident under the arms and tries to hold or lift them back upright.
The instinct to 'catch' the person is strong, and candidates believe preventing the fall is always better than letting it happen. They also overestimate their own strength and underestimate the injury risk to both people.
What to do instead
Widen your stance, lower the resident in a controlled way toward the floor while protecting the head, and do not attempt to hold them up. Call for help, stay with the resident, do not move them until assessed, and report immediately.
Removes gloves after caring for one resident and goes straight to the next resident, or pulls on gloves instead of washing hands because 'the gloves are clean.'
Candidates equate gloves with hand hygiene and see handwashing as a time cost between rooms. Gloves that tear or are removed incorrectly leave contamination on the hands that is invisible.
What to do instead
Treat gloves as a supplement, never a substitute. Perform hand hygiene before gloving and immediately after glove removal, and again before moving to another resident or touching clean equipment. Use the 'before and after every resident contact' rule as the trigger.
Notices a new symptom (a reddened area, a change in breathing, refusal to eat, a complaint of pain) and decides to 'mention it to the nurse at the end of the shift.'
The candidate does not want to bother the nurse, is unsure whether the finding is important, or is worried about being wrong. Shift routines feel more urgent than a vague observation.
What to do instead
Report any change in condition to the charge nurse as soon as you observe it, stating what you saw, when, and what the resident said. Report in factual terms without diagnosing: 'Mrs. Ruiz has a red area on her left heel that was not there yesterday.'
Opens a resident's mail, answers the resident's phone and relays the message, or tells a caller/family member details of the resident's condition without checking whether that person is authorized.
The candidate is trying to be helpful and assumes family members and routine mail are harmless. Many candidates do not recognize these as rights violations rather than courtesies.
What to do instead
Deliver unopened mail to the resident, let the resident answer their own phone, and give no health information to anyone not confirmed as authorized. Say warmly, 'I'm not able to share that - let me get the nurse for you,' and know the resident's right to private communication.
Adjusts the oxygen flow rate on the regulator, applies a topical cream, or gives a medication from a cup the nurse left behind because 'the nurse was busy and it was quicker.'
Candidates want to help and may have seen the task done many times, so it feels routine. They may not have internalized which tasks fall outside the nursing assistant's scope in Arizona.
What to do instead
Follow the principle: if it is not in your allowed task list, do not do it. Report the need to the nurse and document that you reported it. When unsure about scope, ask before acting rather than after.
Corrects or argues with a resident who has dementia, for example insisting 'your husband died five years ago' or repeatedly re-orienting a resident who is searching for a parent.
The candidate is trying to be truthful and believes re-orientation helps. Being contradicted feels like lying, and candidates are uncomfortable with the resident's distress.
What to do instead
Do not argue with the reality of the moment. Acknowledge the feeling ('You miss him a lot'), redirect to a safe activity or topic, and use validation rather than correction. Keep the response calm, brief and reassuring.
Feeds a resident who is lying flat or propped only slightly in bed, spoons full bites quickly one after another, and offers a drink only at the end of the meal.
The candidate's goal is finishing the tray and getting enough food in, so pacing and positioning become secondary. Small signs of trouble swallowing are easy to miss when the focus is on the amount eaten.
What to do instead
Raise the head of the bed to a high Fowler's position (at least 45 degrees, ideally upright) before feeding, offer small bites, alternate food with fluids, allow time to chew and swallow, and feed a stroke survivor on the unaffected side. Stop and report coughing, choking, pocketing, or a wet/gurgly voice.