Washington CNA common mistakes
Washington CNA · Understand the traps and how to avoid them.
Skipping hand hygiene or glove changes at the required points during a skill, such as touching the bed controls, overbed table, or door handle and then continuing resident care without cleaning hands or changing gloves.
Candidates focus on the visible procedure steps and treat hand hygiene and glove changes as optional interruptions, especially when the skill is timed.
What to do instead
Before each skill, state the infection-control sequence aloud: hand hygiene, gather supplies, hand hygiene, gloves, care, remove gloves, hand hygiene. Treat every contact with equipment or the environment as a trigger to re-check glove status.
Exposing the resident during personal care by leaving the door open, not pulling the privacy curtain, or leaving the chest, abdomen, or perineal area uncovered longer than necessary.
Candidates concentrate on completing the task quickly and forget that privacy and dignity are scored throughout the skill, not only at the start.
What to do instead
Make privacy a fixed first action: close the door or curtain, uncover only the area being washed, and re-cover it immediately. Verbalize privacy steps so the evaluator observes them.
Leaving the bed at working height, leaving wheels unlocked, or failing to lower the bed and place the call light within reach before finishing a bed-related skill.
Candidates finish the main task and step away without completing the safety closing sequence.
What to do instead
Use a closing checklist for every bed skill: bed wheels locked, bed lowered to lowest position, side rails in correct position, call light within reach, personal items within reach, resident comfortable. Say each item aloud before exiting.
Applying a gait belt loosely, placing it over clothing incorrectly, or transferring/ambulating without checking the belt and without standing on the resident’s weaker side.
Candidates rush the transfer and assume the resident can bear weight or that the belt is secure without testing it.
What to do instead
Before moving the resident, tighten the belt so two fingers fit under it, check that it is not over bare skin or under the breasts, lock the wheelchair or bed, and position yourself on the resident’s weak side. Verbally cue the resident to stand on a count.
Performing range-of-motion exercises without supporting the joint above and below, moving past the point of pain, or bouncing the joint at the end of the range.
Candidates imitate the motion but do not understand joint support and pain limits, and they try to match an expected range rather than the resident’s actual range.
What to do instead
Support the limb above and below the joint, move slowly to the point of resistance or pain, stop, and ask the resident whether they feel pain. Never force or bounce; document the range actually achieved.
Taking vital signs without allowing rest, using the wrong blood pressure cuff size, or counting pulse and respirations for too few seconds and multiplying incorrectly.
Candidates treat vital signs as a quick checklist and skip rest periods or cuff-size checks under time pressure.
What to do instead
Have the resident rest at least five minutes before blood pressure, select a cuff that fits the arm circumference, count pulse for a full 60 seconds if irregular, and count respirations for 30 seconds and multiply by two only when regular.
Feeding a resident too quickly, with the resident lying too flat, or without checking for swallowing difficulty and food remaining in the mouth.
Candidates focus on getting food into the resident and do not pace the meal or monitor for aspiration risk.
What to do instead
Raise the head of the bed as tolerated, offer small bites, alternate food and fluids, allow time to chew and swallow, check the mouth for pocketed food, and stop feeding and report if the resident coughs, chokes, or has a wet voice.
Cleaning the perineal area or catheter in the wrong direction, reusing a washcloth or wipe for more than one stroke, or allowing catheter tubing to pull on the meatus.
Candidates do not consistently follow front-to-back and one-stroke-one-wipe principles, and they forget to secure tubing during catheter care.
What to do instead
Use a clean area of the washcloth or a new wipe for each stroke, clean from the urinary meatus outward and front to back, and secure the catheter tubing so it does not tug. State the direction aloud during the skill.
Starting a skill without introducing yourself, explaining the procedure, or asking the resident for permission and preferences.
Candidates treat communication as optional because it is not a physical step, and they become task-focused once the skill begins.
What to do instead
Open every skill with a scripted sequence: knock, introduce name and role, explain what you will do, ask permission, and ask about comfort or preferences. Repeat key information before turning or repositioning.
Failing to report or document an abnormal finding, such as reddened skin, a change in urine output, a fall risk, or a resident complaint, and instead completing the task without telling the nurse.
Candidates assume the evaluator only scores the physical procedure and do not recognize reporting as a required nurse aide role.
What to do instead
At the end of every skill, state the finding and the reporting action explicitly: what was observed, who will be told, and when. Include documentation of the finding and the report in the closing verbal summary.