Missouri CNA common mistakes
Missouri CNA · Understand the traps and how to avoid them.
Washes hands for only a few seconds, or skips hand hygiene entirely after removing gloves and before moving to the next task, treating gloves as a substitute for handwashing.
In practice tests, candidates rush to get to the 'real' skill (bed bath, catheter care, perineal care), so they treat hand hygiene as a formality that is not actually being scored.
What to do instead
Drill the rule 'gloves protect the nursing assistant, not the resident' and rehearse an explicit sequence: hand hygiene, don gloves, task, remove gloves, hand hygiene again. Practice lathering with friction for at least 20 seconds, cleaning under nails and between fingers, and turning off the faucet with a dry paper towel. Say each step out loud during practice until it is automatic.
Begins a task on a resident without knocking, introducing themselves, verifying identity with the identification band, and explaining what they are about to do.
Candidates focus so hard on the mechanics of the skill that the opening sequence gets dropped, especially when a grader is watching and the clock is running.
What to do instead
Memorize one fixed opening script that applies to every skill: knock, state name and role, check the ID band against the assignment, explain the procedure, ask permission, provide privacy. Rehearse the script at the start of every practice skill until it feels strange to skip it.
Exposes the resident's whole body during bathing or perineal care, leaves the door open or the curtain pulled back, or fails to drape with a bath blanket.
Laboratory practice on a mannequin removes the real-world cues (an open door, a roommate, a hallway) that should trigger privacy habits.
What to do instead
Create a physical check ritual done in the same order every time: close the door, pull the curtain, drape the resident, expose only the area being washed, and re-cover before moving on. Have a partner watch and call out any moment skin is exposed unnecessarily.
When a resident refuses a bath, meal, or transfer, the candidate argues, coaxed, or physically proceeds anyway instead of honoring the refusal, documenting it, and reporting it.
Candidates equate a refusal with personal failure or with 'not finishing the skill,' and they fear the grader will mark the skill incomplete.
What to do instead
Learn refusal as a legitimate endpoint: stop, do not force, offer alternatives once, tell the nurse, document the refusal and what was offered in the resident's own words. Practice saying 'That's your choice. I'll let the nurse know and check back with you later' without negotiating further.
Counts respirations for 15 seconds and multiplies by four while telling the resident 'I'm going to check your breathing now,' or takes a blood pressure with the cuff over a sleeve, an arm unsupported, or deflates far too quickly.
These shortcuts feel accurate enough in practice, and announcing the respiration count prompts the resident to change their breathing pattern, so the candidate never notices the reading is wrong.
What to do instead
Standardize technique: count respirations for a full 30 seconds and double it (or a full minute if irregular), keep fingers on the wrist as if still taking a pulse, and never announce it. For blood pressure, place the cuff on bare skin, support the arm at heart level, and deflate at 2 to 3 mm Hg per second.
Finishes care and walks away leaving the bed at working height with the wheels unlocked and the call light out of reach, or leaves the resident without needed items in reach.
The 'closing' steps come after the graded skill appears finished, so attention has already shifted to the next task.
What to do instead
Build a fixed end-of-care checklist: bed lowered, wheels locked, side rails per the care plan, call light in the resident's hand, personal items, water, and phone within reach, and the resident asked whether anything else is needed before leaving. Run the checklist aloud after every practice skill, not just transfers.
Feeds a resident who is lying flat or only slightly elevated, takes large bites, delivers the next spoonful before the previous one is swallowed, and never checks the diet card for thickened liquids or swallowing precautions.
Candidates concentrate on pace and finishing the tray quickly, and thickened liquids or dysphagia diets look unfamiliar, so they are easy to overlook.
What to do instead
Before feeding, verify the diet card and any swallowing precautions, raise the head of the bed to a high Fowler's position, sit at eye level, and offer small bites at a slow pace, checking that each is swallowed before the next. Observe for coughing, pocketing, or a wet voice and stop and report if any appear. Document the percentage eaten.
Transfers a resident by holding them under the arms or around the waist, forgets to lock the wheelchair, or performs the entire transfer for the resident instead of encouraging them to help.
Candidates want the transfer to look smooth and fast, and helping more feels safer and kinder than allowing the resident to do the work.
What to do instead
Use a gait belt for every transfer, lock the wheelchair and move the footrests, stand on the resident's weaker side, and cue the resident to push up and pivot rather than lifting them. Build in a pause to ask what the resident can do themselves, and let them do it, even if it is slower, unless the care plan says otherwise.
Corrects or argues with a resident who has dementia ('We already told you, your daughter isn't coming today'), quizzing them with 'Do you remember me?', or rushing them through a task.
Candidates instinctively try to restore reality and orient the resident, not realizing that correction escalates distress and that a rushed approach increases resistance.
What to do instead
Use validation and redirection instead: acknowledge the feeling ('You miss your daughter'), give one instruction at a time in short sentences, and redirect to a concrete activity. Approach from the front at eye level, allow extra time, and keep routines consistent; never argue about facts the resident believes are true.
When a resident discloses sadness, fear, or mistreatment, the candidate promises to keep it a secret or dismisses it as attention-seeking; when a resident becomes withdrawn or stops eating, the candidate reports nothing.
Candidates want to be supportive and trustworthy, and do not realize that a promise of secrecy about abuse or harm is one they are not permitted to keep, and that changes in mood are reportable observations.
What to do instead
Say 'I'm glad you told me. I can't keep that to myself, but I'll make sure the right person helps you,' and report to the nurse immediately, documenting the resident's own words without interpretation. Treat any change in mood, appetite, sleep, or participation as something to report, not to judge.