GNA 10 common mistakes
GNA 10 · Understand the traps and how to avoid them.
When a resident refuses a bath or morning care, the candidate stops documenting and moves on without telling the nurse or recording the refusal, treating 'respect the refusal' as the end of the task.
Candidates memorize 'honor resident rights' as a single rule and forget that refusal is also a clinical event the care team must know about, so they conflate respecting autonomy with dropping the task silently.
What to do instead
Practice the two-step script: accept the refusal without arguing, offer one alternative (different time, different approach, partial care), then report and document the refusal and what was offered. Rehearse phrasing such as 'That's your choice; I'll let the nurse know and check back later.'
The candidate performs hand hygiene incorrectly: turns off the faucet with bare hands, uses hand sanitizer after contact with visible soiling or after caring for a resident with C. difficile, or skips handwashing because gloves were worn.
Candidates learn 'wash hands' as a slogan rather than a sequence, and glove use creates a false sense of protection, so the drying, paper-towel faucet closure, and sanitizer-versus-soap distinction get lost under exam pressure.
What to do instead
Memorize the fixed sequence (wet, soap, scrub at least 20 seconds including between fingers and under nails, rinse, dry with paper towel, use that towel to turn off the faucet) and the two exceptions where soap and water are required: visible soiling and C. difficile. State aloud that gloves do not replace hand hygiene.
During a transfer, the candidate pulls the resident up by the arms or under the armpits, or lets the resident wrap arms around the candidate's neck, instead of using a gait belt and having the resident push up from the chair arms.
Candidates focus on getting the resident up quickly and mirror how untrained family members do it, and they underestimate how much shoulder and arm pulling risks injuring both resident and worker.
What to do instead
Drill the standard sequence until automatic: lock the chair or bed, apply and check the gait belt, place feet flat, instruct the resident to lean forward and push with the arms of the chair, keep the resident's hands off the candidate's neck, and pivot toward the stronger side. Rehearse a scripted cue such as 'Lean forward, push with your arms, and I'll guide you with the belt.'
The candidate answers a resident's repeated question about a deceased spouse by saying 'You know he died years ago, don't you remember?' or by inventing a story that the spouse is coming later.
Candidates feel uncomfortable with the resident's distress and reach for either correction or a comforting fiction, not realizing that correction triggers grief again and fabrication erodes trust when it unravels.
What to do instead
Use validation and redirection: acknowledge the feeling ('You miss him very much'), then redirect to a safe present activity or topic without confirming or denying the death. Practice three ready responses so the candidate is not improvising during the exam station.
The candidate speaks about the resident to a family member, another resident, or a coworker in a hallway, or shares details of a resident's diagnosis without checking who is authorized to receive it.
Candidates want to be helpful and friendly, and casual settings make confidentiality feel less formal; they also assume any family member may be given information.
What to do instead
Adopt a fixed rule: no resident information to anyone not directly involved in care, and family questions go to the nurse. Practice a polite deflection ('I'm not able to share that; let me get the nurse for you') and keep conversations about residents in private areas only.
The candidate charts before providing care, records a task as complete that was refused or partially done, or writes subjective judgments such as 'resident was difficult' in the record.
Charting is often treated as paperwork to clear off a list, and candidates copy the flow-sheet pattern without understanding that the record is a legal document reflecting what actually happened.
What to do instead
Follow the rule 'if it wasn't done, it wasn't documented; if it wasn't documented, it wasn't done.' Chart immediately after care, record refusals and partial care exactly as they occurred, and use objective descriptions of behavior rather than labels. Review sample entries and rewrite each subjective line into observable facts.
The candidate ignores a resident who is calling out, crying, or sitting alone, reasoning that the resident is 'just confused' or 'always like that,' and completes tasks in silence without explaining what is happening.
Task-oriented training emphasizes completing physical care on schedule, and repeated behaviors lead candidates to normalize distress instead of treating it as a signal of unmet need.
What to do instead
Treat every behavior as communication: check for pain, hunger, thirst, toileting, positioning, and fear before assuming it is the dementia. Narrate each step of care out loud, and practice reporting new or worsening behavior to the nurse rather than absorbing it silently.
The candidate leaves a resident unattended in the bathroom, in a shower chair, or on a bed with side rails down, or answers a call light by saying 'I'll be right back' and then continues another task.
Candidates try to be efficient and believe a short absence is harmless, and they underestimate how quickly an unattended resident with impaired mobility or cognition can fall.
What to do instead
Apply a non-negotiable rule: never leave a resident alone in a bathroom, shower, or on an elevated surface, and never promise a return you cannot keep. If you must leave, lower the bed, raise the rails per care plan, place the call light within reach, and get help first. Rehearse asking a coworker to assist rather than abandoning the resident.
The candidate encourages a resident to do a self-care task faster or takes over the task ('here, let me do that') when the resident is slow, or performs range-of-motion exercises past the point of pain to 'get the full range.'
Candidates are timed and task-focused, and watching a resident struggle feels unkind, so they rescue the resident instead of allowing the practice that preserves function; similarly, they equate full range with forcing.
What to do instead
Reframe the goal as function, not speed: allow extra time, set up supplies within reach, give one-step cues, and praise effort rather than outcome. For range of motion, move only to resistance or the point of discomfort, never pain, and stop and report if pain occurs. Practice a script such as 'Take your time; I'm right here if you need me.'
The candidate gives a resident a full glass of water with pills, crushes a medication into food without authorization, or leaves the medication at the bedside for a resident who is drowsy or confused.
Candidates want to help the resident swallow or avoid a conflict, and they do not consistently distinguish what an assistant may do from what requires nurse authorization, so they improvise.
What to do instead
Learn the firm boundaries: follow the care plan and nurse direction exactly, report any difficulty swallowing before giving anything, never alter a medication's form, and never leave medications unattended. When unsure, stop and ask the nurse; state that rule aloud during practice so it becomes the default response.