Michigan CNA common mistakes
Michigan CNA · Understand the traps and how to avoid them.
Starting a skill without performing hand hygiene before resident contact, or removing gloves and moving on without washing hands.
Candidates treat gloves as a substitute for hand hygiene and get absorbed in memorizing the task steps, so handwashing feels like an optional bookend rather than the first and last action.
What to do instead
Make hand hygiene the spoken first and last step of every skill: announce 'I am washing my hands before touching the resident,' perform it, and repeat after glove removal. Practice each skill with hand hygiene physically bracketing it until it becomes automatic.
Beginning a procedure without scanning and adjusting the environment: bed too high, wheels unlocked, call light out of reach, clutter on the floor.
Attention is fixed on the checklist steps of the task, so the candidate skips the environmental safety check that examiners look for before care begins.
What to do instead
Use a 10-second pre-skill pause and verbalize: 'Bed low and locked, call light within reach, clear path, side rails as ordered.' Build this pause into every practice run so it precedes the task automatically.
Performing perineal care by wiping back to front, reusing the same washcloth for multiple strokes, or keeping contaminated gloves on for the clean phase.
The candidate does not track contamination direction and rushes through an uncomfortable task, so clean and dirty steps blur together.
What to do instead
Practice the sequence out loud: front to back, one downward stroke per washcloth, change gloves before the clean phase, use a new cloth for each stroke. Rehearse with a mannequin until the order is fixed.
Estimating respirations instead of counting, counting for only a few seconds, or failing to note an irregular rhythm.
Candidates are anxious about time and assume breathing 'looks normal,' so they guess rather than count.
What to do instead
Count respirations for a full 30 seconds and double, or a full minute if irregular. Do not announce that you are counting breathing; keep a hand on the pulse and count silently. Practice with a timer until the count is habitual.
Feeding a resident who is lying flat or only slightly elevated, offering a full spoonful, and not stopping when the resident coughs or pockets food.
The candidate focuses on finishing the meal quickly and does not connect positioning and bite size to aspiration risk.
What to do instead
Before feeding, raise the head of the bed to at least 45–90 degrees, verify the diet card, offer small bites, allow time to swallow, and stop immediately if coughing or wet voice occurs. Report any swallowing change to the nurse.
Forcing a joint past the point of resistance during range-of-motion exercises or moving a limb without supporting the joint above and below.
The candidate believes full range must be achieved to 'pass' and lacks confidence to stop when the resident signals pain.
What to do instead
Support the joint above and below, move slowly only to the point of resistance, never past pain, and stop if the resident complains. State aloud: 'I move to resistance, not pain.'
Arguing with a confused resident about a false belief or ignoring a resident who is crying or agitated while continuing the physical task.
The candidate is task-focused and uncomfortable with emotion, so confrontation or silence feels faster than responding to the person.
What to do instead
Acknowledge the feeling first ('You seem frightened'), avoid arguing with delusions, orient gently and simply, and redirect to a calming activity. Pause the task long enough to respond to the person, then continue.
Entering a room without knocking or identifying yourself, or completing tasks for a resident who could do them independently, such as buttoning a shirt or holding a cup.
Time pressure and a desire to be helpful lead the candidate to take over, and privacy steps get skipped under exam stress.
What to do instead
Knock, announce yourself, and explain care before entering. Offer choices and allow extra time for the resident to do what they can; assist only with the parts they cannot manage. State the independence principle aloud during practice.
Observing a change in the resident but not reporting it to the nurse, or reporting a personal opinion or diagnosis instead of objective facts.
The candidate fears being wrong or does not recognize that reporting is part of the role, so observations stay unspoken or get mixed with guesses.
What to do instead
Report objective observations immediately to the charge nurse using SBAR: what you saw, when, and what you already did. Never diagnose or speculate; say 'I noticed' rather than 'I think it is.' Practice short reports aloud.
Accepting a task outside the nurse aide scope, such as administering medication or changing a sterile dressing, because a coworker asked or the unit was short-staffed.
The candidate wants to be helpful and is unsure where delegation lines are, so 'helping out' overrides scope-of-practice knowledge.
What to do instead
Know the Michigan nurse aide scope: medications and sterile procedures are not delegated to aides. Decline politely and refer the request to the nurse: 'That is outside my scope; I will get the nurse.' Rehearse this response until it is comfortable.