Maryland CNA common mistakes
Maryland CNA · Understand the traps and how to avoid them.
Washing hands for only a few seconds, using alcohol-based sanitizer when soap and water is required (visible soil, C. difficile, after toileting), or pulling on gloves without washing first and then touching clean equipment with the gloved hand.
Under time pressure candidates treat hand hygiene as a formality between steps rather than a checkpoint, and they equate gloves with clean hands.
What to do instead
Anchor hand hygiene to four fixed trigger points in every skill (on entry, before gloving, after glove removal, on exit) and verbalize each one out loud. Practice the 20-second wash with a count or the Happy Birthday rhythm until it is automatic.
Touching the sterile field with a bare hand, reaching across it, letting tubing or supplies dangle below waist level, or turning away from the field to pick up an item during catheter or dressing care.
Candidates set up supplies while wearing sterile gloves instead of arranging everything on a clean surface first, so they must reach and turn to find what they need.
What to do instead
Lay out and open every supply before gloving. Then keep both hands above waist level and inside the field, and step around the field rather than reaching over it. Rehearse naming which hand is sterile and which is clean before starting.
Starting a skill without knocking, introducing self and role, verifying the resident's identity, explaining the procedure, or pulling the privacy curtain and draping the resident.
Attention narrows onto the graded technical steps, so the opening sequence is skipped as 'not part of the skill.'
What to do instead
Memorize one fixed opening script (knock, name and role, identity check, explain, privacy, hand hygiene) and run it verbatim before touching the resident or the equipment in every practice run.
Finishing a skill and walking away with the bed wheels unlocked, the bed left at working height, a side rail down that was up on arrival, or the resident left alone on a bedpan or in a chair without the call light in reach.
The candidate mentally 'ends' the skill at the last clinical step and treats cleanup and restoring the room as optional.
What to do instead
Treat the last 30 seconds as a graded step: brakes locked, bed low, rails as found, call light in hand, belongings in reach, resident comfortable. Say the checklist aloud at the end of every practice repetition.
Transferring or ambulating with a bent, twisted back, feet close together, lifting the resident under the arms, or walking a resident without a gait belt.
Candidates try to protect the resident's dignity or save time by hurrying, and they underestimate the resident's weight or weakness.
What to do instead
Set a wide base, bend the knees, keep the resident close to your body, and pivot the feet instead of twisting. Apply the gait belt before any move and stand on the resident's weaker side. Ask for a second aide any time the resident cannot bear weight.
Performing perineal care by wiping back to front, reusing the same washcloth or glove surface for multiple strokes, or cleaning the perineum before the surrounding area.
Candidates copy the order they clean themselves and worry about 'wasting' supplies, so they wipe in one long stroke and reuse the cloth.
What to do instead
Fix the rule in memory as cleanest to dirtiest, front to back, one stroke per cloth surface. Change gloves and cloth after each stroke when soiled, and always clean the perineum last.
Correcting, arguing with, or quizzing a disoriented resident ('You already ate,' 'Your mother is dead,' 'Do you know where you are?'), or talking about the resident to a coworker as if the resident were not present.
Candidates answer the literal content of the statement instead of the feeling behind it, and honesty feels like the right instinct.
What to do instead
Respond to the emotion first with a short validating phrase, then redirect to a real activity or topic. Never argue with a false belief and never reorient by confrontation; step out of earshot for any handoff conversation.
Doing everything for a resident who can still do part of the task, choosing the clothing or meal without asking, calling the resident 'honey' or 'dear,' or talking over the resident to the family member.
Finishing the task is faster and the candidate mistakes efficiency for good care, and pet names feel friendly.
What to do instead
Before each task ask, 'What can you do for yourself?' and let the resident do that part even if it takes longer. Offer two real choices (this shirt or that one) and address the resident by the name they prefer, speaking directly to them.
Performing tasks outside the aide's role, such as giving medication, adjusting oxygen flow, changing a sterile dressing, or taking a verbal order or report from a family member instead of the nurse.
Candidates want to be helpful and are afraid that refusing will look like they do not know their job.
What to do instead
Memorize the scope list as 'I do what is on the care plan; the nurse does assessment, medication, and anything invasive.' Use one fixed sentence: 'I'll report that to the nurse right away.'
Charting care before it is done, recording for another aide, writing vague or judgmental entries ('resident was good,' 'seemed lazy'), or noticing a change in condition and telling no one.
Batch charting at the end of a shift and casual language are habits carried over from informal work settings.
What to do instead
Chart after the care, only what you did or observed, in objective terms with times. Report any change to the nurse immediately and note to whom and when it was reported, never to a coworker only.