New Hampshire LNA common mistakes
New Hampshire LNA · Understand the traps and how to avoid them.
Starts a task (feeding, oral care, transferring) using only the room number or the resident's appearance, without checking the ID band and asking the resident to state their name.
Routines feel familiar and time pressure makes identity checks seem like a formality; residents in shared rooms can be confused for one another, especially when one is drowsy or has dementia.
What to do instead
Make a two-identifier check a fixed first step for every task: read the ID band and ask the resident to say their name, then say it aloud before beginning. If the band is missing or the name doesn't match, stop and get the nurse.
Counts respirations for 5–10 seconds and multiplies, or announces 'I'm counting your breaths' while doing it.
Breathing looks regular so the count feels predictable, and the pulse was just taken so the extra time seems unnecessary; telling the resident is meant to be reassuring.
What to do instead
Keep fingers on the wrist as if still counting pulse, count for a full 30 seconds and double it (60 seconds if irregular), and never tell the resident you are counting breaths.
Notices a new reddened area, a refusal to eat, or a change in behavior and writes it in the chart or saves it for end-of-shift report instead of telling the nurse at the time.
The LNA believes documentation is the report, worries about 'bothering' the nurse, or assumes someone else has already seen it.
What to do instead
Report any change verbally to the licensed nurse immediately, then document what was observed in objective terms (what, where, when, size, color). Treat charting as a record, not a notification.
Puts on gloves and moves from one resident to the next, or from a dirty task to a clean task, without removing gloves and performing hand hygiene.
Gloves feel protective and look clean, so the step of hand hygiene before and after gloving gets skipped, especially when call lights are lining up.
What to do instead
Treat gloves as task-specific: hand hygiene before gloving, change gloves between residents and between dirty and clean steps, remove gloves and wash hands immediately after. Gloves never substitute for handwashing.
Transfers a resident out of bed or a wheelchair without first locking the wheels and lowering the bed to a safe height.
Attention is on the resident's body and balance; the equipment checklist is invisible and gets compressed under time pressure.
What to do instead
Use a spoken, fixed sequence before every transfer: lock wheels, lower the bed, position the chair at the correct angle, then move. Build the check into the start of the transfer rather than the middle.
Finds a resident on the floor and immediately tries to lift them back into bed or into a chair alone.
Panic and the wish to restore the resident's dignity and comfort drive a fast physical response; moving them seems kinder than leaving them on the floor.
What to do instead
Do not move the resident. Check responsiveness and breathing, call for help using the call bell or emergency cord, stay with them, and keep them warm and still until the nurse arrives.
Discusses a resident's diagnosis, behavior, or family situation in the hallway, elevator, break room, or on a personal social media account.
Coworkers are the natural people to vent to, and a casual comment in a semiprivate space doesn't feel like a disclosure; posting feels like a private outlet.
What to do instead
Discuss residents only in private, only with the care team, and only on a need-to-know basis. Never post or text anything about a resident on personal devices; redirect family and visitor questions to the nurse.
Enters a resident's room without knocking, or provides care with the door open and the curtain pulled back while others can see.
The task feels routine and the resident's modesty can get lost in the flow of a busy shift; the LNA may not register who is in the hallway.
What to do instead
Knock, wait for an answer, introduce yourself, and state what you are there to do. Close the door and draw the curtain before undressing or providing personal care, and re-cover the resident as soon as each step is done.
Corrects or argues with a resident who has dementia, for example saying 'Your husband died ten years ago' or insisting it is time for a shower.
Being truthful and accurate is the instinct, and the resident's statement is plainly wrong, so correcting feels like the helpful response.
What to do instead
Respond to the feeling, not the fact: acknowledge the emotion ('You must miss him'), then redirect to a safe activity or a different approach to the task. Do not argue, quiz, or attempt reality orientation.
Ties a sheet, uses a lap belt, or raises bed rails to keep a restless resident in a chair or bed without an order.
Fear of a fall and the wish to protect the resident make an improvised restraint feel like the safest option in the moment.
What to do instead
Never apply any restraint without a physician's order and required monitoring. Report the fall risk to the nurse, stay with the resident, and use alternatives such as diversion, positioning, toileting, and increased checks.