Tennessee CNA common mistakes
Tennessee CNA · Understand the traps and how to avoid them.
Strips off soiled gloves at the bedside, tosses them in the trash, and walks straight to the next resident to begin care without washing hands.
Gloves feel like a barrier that 'counts as' hand hygiene, and the CNA is focused on finishing the task quickly before the next call light.
What to do instead
Use a fixed sequence every time: wash hands, don gloves, provide care, remove gloves, wash hands again before touching anything else. Say the sequence out loud during skills practice until it is automatic, and treat the doorway as the trigger point for the second wash.
Takes a blood pressure, temperature, or pulse, writes the number on the flow sheet, and says nothing to the nurse even when the reading is far outside the resident's usual range or the ordered alert parameters.
The CNA sees the task as 'get the number and chart it' and worries that speaking up is overstepping or complaining.
What to do instead
Learn the specific report-now parameters in the facility policy (for example systolic below 90 or above 160, temperature 100.4 F or higher, pulse under 60 or over 100, respirations outside 12-20) and memorize the rule that any abnormal value is reported to the nurse verbally at the time it is found, then documented with the time and to whom it was reported.
Provides perineal care by wiping from the rectal area toward the urinary meatus, or makes several strokes with the same soiled area of the washcloth before folding it.
The CNA works from the area that is easiest to reach (the back) toward the front, and reuses a cloth corner to save time and supplies.
What to do instead
Practice the rule 'front to back, one stroke, then fold or change the cloth' with a fresh washcloth for each stroke direction, and verbalize the direction out loud during the skill. Rinse and dry front to back as well, and use a clean, dry cloth to dry after rinsing.
Leaves the resident's chest, buttocks, or legs uncovered during a bed bath, dressing change, or catheter care, or leaves the door open and the curtain pulled back.
The CNA focuses on the mechanical steps of the task and treats draping as an optional extra rather than part of the procedure.
What to do instead
Build draping into the setup: close the door, pull the curtain, and place a bath blanket over the resident before removing the gown; wash and dry under the blanket, exposing only the part being washed and re-covering it immediately.
Begins a bed-to-chair transfer, or a repositioning move, before locking the bed wheels and the wheelchair wheels and before lowering the bed to the lowest working height.
The resident is already sitting up and reaching for the CNA, so the CNA skips the safety steps to keep pace with the resident's movement.
What to do instead
Use a spoken, unskippable pre-transfer checklist: brakes on both the bed and the chair, bed at the lowest position, side rails in the facility-approved position, non-skid footwear on, gait belt in place. Say each item out loud before the resident moves.
Runs the bath or shower water and helps the resident in without testing the temperature on the inner wrist, or steps out of the room leaving the resident alone in the tub or shower.
The CNA assumes the water heater is set safely and that a brief absence is harmless, and older skin and reduced sensation mean the resident may not feel or report scalding water.
What to do instead
Test water on the inner forearm or wrist before the resident gets in and keep one hand on the resident or stay within arm's reach at all times; if a supply must be retrieved, complete the bath first or call for help instead of leaving.
Finishes care, turns off the light, and leaves the room without placing the call light within reach and without setting needed items (water, glasses, phone, urinal, tissues) within the resident's reach.
The CNA considers the task done once the physical care is complete, and the resident may be unable to reach or may be too embarrassed to ask for help getting to the bathroom.
What to do instead
Add 'call light and personal items within reach' as the final step of every care routine and state it out loud before leaving the room; if the resident cannot use the call light, explain how to call for help and check back at the interval the nurse has specified.
Enters the room without knocking, does not state name and role, calls the resident 'honey' or 'sweetie,' and answers questions that the nurse or family member has directed to the resident.
The CNA is nervous or rushed, and baby talk feels warmer and less awkward than using a formal name.
What to do instead
Use a fixed opening script every time: knock, pause, 'Mr./Ms. [last name], it's [name], your nursing assistant, I'm here to help you with [task]. Is that okay?' Address all answers to the resident, and if the resident is slow to respond, wait at least ten seconds before offering help.
Takes over a dressing, bathing, or feeding task the resident can still do, or accepts a refusal and simply marks the task 'not done' without reporting it to the nurse.
Doing it is faster and looks more helpful, and a refusal can feel like a personal rejection or a conflict the CNA wants to avoid.
What to do instead
Assess what the resident can do and provide only the amount of help needed, encouraging them to do the rest. When a resident refuses, honor the refusal, explain what is being offered, offer again later, and report the refusal and any reason given to the nurse so it is documented and followed up.
Argues with a resident who has dementia about a false belief (insisting 'your mother died years ago'), or repeatedly quizzes the resident on the date and their location until the resident becomes agitated.
The CNA believes the correct approach is to bring the resident back to reality and thinks quizzing proves orientation.
What to do instead
Respond to the feeling rather than the fact ('You miss your mother'), then redirect to a calming activity or a different subject. Do not quiz on orientation beyond what the care plan asks, and do not correct or argue; document what happened and what worked so the team uses the same approach.