Oregon CNA common mistakes
Oregon CNA · Understand the traps and how to avoid them.
Performs hand hygiene at the start of a skill but skips it after removing gloves or before moving to a second resident/task, treating gloves as a substitute for washing hands.
Nervous candidates rush to the next checklist step and mentally file gloves as 'clean,' so they drop the second handwash the evaluator is watching for.
What to do instead
Say the moment out loud every time: 'I'm washing my hands before touching the resident and again after removing my gloves.' Build the habit of washing hands both at the start and at the end of every single skill, even after gloves.
Removes PPE in the wrong sequence, e.g., pulls off the mask before the gloves or snaps gloves off so the contaminated outer surface touches the wrist.
The order was memorized as a list of items rather than a logic (most contaminated to least, mask last because it is removed after leaving the room).
What to do instead
Practice the sequence until automatic: gloves first, then goggles/face shield, then gown, and mask last after exiting. When removing gloves, grasp the outside of one glove with the other gloved hand and peel it inside-out.
Announces 'I'm going to check your breathing now' and then counts respirations, or counts for only a few seconds instead of a full 30 or 60 seconds.
Candidates want to be transparent with the resident and don't realize that telling them changes the breathing rate; time pressure leads to short counts.
What to do instead
Keep fingers on the wrist as if still taking the pulse, watch the chest rise and fall, and count for 30 seconds then double it, or a full minute if the rate is abnormal. Report rate, rhythm, and depth.
Obtains an abnormal finding (low blood pressure, fever, new redness on a pressure point, drop in urine output) and writes it on the flow sheet without telling the nurse.
Candidates see charting as the end of the task and fear 'bothering' the nurse or being wrong.
What to do instead
Treat any result outside normal limits as a report-first event: tell the licensed nurse immediately, then document what you found and to whom you reported it, and when.
Provides perineal care wiping back to front, or reuses the same washcloth for multiple strokes without turning it to a clean area.
Rushed technique and not understanding that front-to-back and one-stroke-then-new-cloth are what prevent urinary tract infection.
What to do instead
Wipe front to back, use a clean portion of the cloth or a fresh cloth for each stroke, and wash the perineal area last in the bath. Say the direction aloud as you do it.
Corrects or argues with a resident who has dementia ('No, your husband died ten years ago') or tries to reason them out of a false belief.
The instinct is to be truthful and to fix the confusion, which escalates agitation.
What to do instead
Join the resident's reality instead of correcting it: acknowledge the feeling ('You sound like you miss him'), redirect to a safe topic or activity, and keep your tone calm and unhurried.
Walks into a resident's room without knocking, leaves the door or curtain open during care, or discusses a resident's condition in the hallway or elevator.
Task focus and familiarity with the room make candidates forget the resident still has a right to privacy and confidentiality.
What to do instead
Knock, announce yourself, wait for permission, close the door or pull the curtain for any care, and keep all resident information to the care team and a private space.
Begins a transfer or bed bath with the bed wheels unlocked and the bed at working height, or leaves the bed high with the call light out of reach at the end.
Attention is on the resident's body mechanics and the steps, not on the equipment setup and the end state of the room.
What to do instead
Use a fixed setup-and-closeout routine: lock brakes, lower the bed to a safe height, raise the far side rail, and leave the call light, water, and personal items within reach whenever you leave.
Places the gait belt over bare skin or too low on the hips, or stands on the resident's weak side and lets them walk without a hand on the belt.
Candidates copy what they saw without knowing the belt goes over clothing at the waist and the caregiver stays on the weak side.
What to do instead
Place the belt snug over clothing at the waist, check it with two fingers, stand on the weaker side with one hand on the belt and one ready to support, and have the resident push up from the chair arm.
In a choking emergency, leaves the resident alone to go find help or begins back blows and abdominal thrusts without first calling for help and activating emergency response.
Panic produces either freezing or solo action, and candidates forget that help must be summoned immediately.
What to do instead
Shout for help and tell someone to call 911 first, then start back blows and abdominal thrusts, staying with the resident until help arrives and never abandoning them.