South Dakota CNA common mistakes
South Dakota CNA · Understand the traps and how to avoid them.
Documents vital signs, weights, intake/output, or bowel/bladder records from memory at the end of the shift, rounding or estimating amounts instead of measuring them, and sometimes pre-charting care that has not yet been given.
Under time pressure candidates treat charting as paperwork to catch up on later, and they assume 'about 200 mL' is close enough; pre-charting feels efficient because the task is certain to happen eventually.
What to do instead
Measure with the actual device (graduated cylinder, scale, watch with a second hand) at the moment of care, and document immediately after finishing each task. Never document a task before performing it, and never document for a coworker. If you forgot a value, re-measure rather than reconstruct it, and tell the nurse the record is incomplete.
Notices a change (new redness, refusal to eat, complaint of pain, urine that looks concentrated, a resident who seems more confused) and says nothing because the resident 'seems okay' or because the nurse looks busy.
Candidates fear being wrong or being a bother, and they do not realize that observing and reporting is their single most important legal duty as an aide.
What to do instead
Report any change to the licensed nurse the same shift, in specific observable terms ('she ate two bites and turned her head away from the spoon at lunch' rather than 'she's not eating'). Report before you leave the unit, and chart what you reported and to whom. If it is an emergency, call for the nurse immediately rather than finishing your rounds.
Rushes personal care: performs perineal care back-to-front, reuses the same washcloth for the perineum as for the face or for repeated strokes, and starts care without closing the door, pulling the curtain, or draping the resident so only the area being washed is exposed.
Candidates focus on getting the task done in the allotted skills-test time and underestimate how many points are lost on sequence, clean-to-dirty order, and privacy rather than on speed.
What to do instead
Set the sequence before you touch the resident: knock, close door and curtain, explain and drape. Wash from cleanest to dirtiest, front to back, using a fresh part of the washcloth or a fresh cloth for each stroke, and change gloves before and after perineal care. Expose only what you are washing and re-cover immediately.
Provides care silently and mechanically: does not greet the resident, does not explain what is about to happen, offers no choices on things the resident can control (which shirt, wash face or hands first, when to use the toilet) even when the resident is capable of choosing.
Candidates concentrate so hard on the skill checklist that conversation feels like a distraction, and in a test setting they default to 'efficient' behaviour that strips the resident of control.
What to do instead
Build talk into the task rather than adding it on: greet by name, state what you are doing and why before each step, and offer two real choices at natural decision points. Pause for the resident's answer instead of answering for them. Remember that choice and explained care are scored as part of the skill, not as extras.
Arguing with or correcting a resident who has dementia and states something untrue (insists it is time to go to work, that her dead husband is picking her up, or that staff stole her purse), or quizzing the resident with 'Do you remember me?' and 'What did you have for breakfast?'
Candidates apply ordinary logic and honesty to a brain that cannot use them, and they believe correcting the resident shows respect; memory quizzes are copied from everyday small talk.
What to do instead
Respond to the feeling, not the fact: acknowledge ('You're worried about getting to work') and then redirect to a safe, real activity or topic. Do not lie elaborately and do not argue. Introduce yourself every time without testing the resident's recall, and never ask questions the resident cannot reliably answer.
Communicates without adapting to the resident's deficit: speaks from behind or from the next room to a hard-of-hearing resident, uses vague, rapid, or jargon-filled speech, finishes sentences for a resident with aphasia or answers for them, uses baby talk, or directs all information to the family member while the resident is sitting right there.
Candidates default to their own normal conversational speed and volume, and families often step in and are easier to speak to, so the resident quietly drops out of the conversation.
What to do instead
Get in front of the resident at eye level, reduce background noise, and speak clearly at a slightly lower pitch rather than shouting. Allow full time for a resident with aphasia to respond and let them attempt words rather than supplying them. Address the resident first every time; include the family only with the resident's permission.
Discusses a resident's diagnosis, behaviours, or personal history in public areas, in the elevator, at the front desk, in the dining room, with a neighbour or caller who is not involved in care, or leaves a chart, care plan, or screen visible to visitors; also enters a resident's room without knocking.
The unit hallway feels like a private staff space, and casual conversation is the social norm; candidates do not recognize that any identifiable detail, including a room number and a diagnosis, is protected information.
What to do instead
Move any resident-specific conversation to a private area and share only with staff who need the information to provide care. Knock and wait for an answer before entering, even when you are delivering a tray. Do not confirm to a caller or visitor whether a person is a resident; refer them to the nurse or social worker.
Restricts a resident without authorization: tucks a sheet in tightly, uses a lap tray, seatbelt, or 'posture cushion' to keep someone in a chair, wedges a wheelchair with a table, tells a resident they cannot go to an activity or cannot refuse a bath, or limits when family may visit.
Candidates describe these as 'just safety' or 'keeping them from falling' and do not know that any device or practice that limits freedom of movement is a restraint requiring a nurse's order, assessment, and release.
What to do instead
Honor a refusal the first time and report it; do not repeat the offer as a battle. Use no device to hold a resident in place without a licensed order, and never tie anything to a bed or chair. If a resident is unsafe without supervision, stay with them or lower them to the floor safely and get the nurse; report any restraint you see.
Glove and hand hygiene lapses: wears the same gloves from one resident to the next, or from perineal care to touching the bed rail, door handle, and call light; removes gloves and moves straight to the next resident without washing hands; wears gloves as a substitute for handwashing; forgets to clean shared equipment like a blood pressure cuff or gait belt between residents.
Gloves create a false sense of protection and candidates forget that gloves themselves become contaminated; hand hygiene also disappears when a task 'didn't get messy.'
What to do instead
Perform hand hygiene before resident contact, before and after glove use, and after contact with body fluids or shared equipment. Change gloves between dirty and clean steps of the same task and between residents. Follow the order: gloves off, then wash hands; clean shared equipment between residents; place used linen and trash in the correct container without touching the outside of either.
Moves and leaves residents unsafely: pulls a resident up in bed by the arms or under the shoulders instead of using a draw sheet, transfers without a gait belt, lifts or catches a falling resident alone, leaves the bed at the wrong height with wheels unlocked, side rails in the wrong position, or the call light out of reach at the end of care.
Candidates are strong enough to manage the move and think calling for help makes them look incompetent; the end of the task feels like the finish line, so the environment check gets skipped.
What to do instead
Before any move, set the bed to working height, lock the wheels, and lower the rail on your side; use a gait belt, a draw sheet, or a mechanical lift as ordered, and get a second staff member rather than catching someone alone. Lower a falling resident to the floor instead of trying to hold them up. End every contact with the same sweep: bed low, wheels locked, rails as ordered, call light and personal items within reach, resident positioned and covered.