Wyoming CNA common mistakes
Wyoming CNA · Understand the traps and how to avoid them.
Carries on with a task after the resident says 'stop' or pulls away - for example finishing a bed bath or continuing to reposition a resident who is refusing - and then does not report the refusal.
Candidates memorize 'the resident has the right to refuse' as a definition but freeze when a refusal happens during a timed skills check, because they believe stopping means failing the skill. They also fear the nurse will think they did not complete their assignment.
What to do instead
Rehearse the script out loud: stop immediately, say 'I hear you - you don't want your bath right now, and that's your choice,' cover the resident, offer a choice of when to try again, and tell the charge nurse. Document the refusal and the offer you made, not the care you were unable to give.
Finds a resident on the floor and immediately tries to lift them back into bed alone, or grabs them under the arms to pull them up.
The instinct to 'help right away' overrides training, and candidates worry that leaving the room to get help looks like abandoning the resident. Many also assume a fall is only serious if the resident is unconscious.
What to do instead
Practice the sequence until it is automatic: do not move the resident; check responsiveness and breathing; call loudly for help or use the call light; stay with them; check for injury, pain, and bleeding only after help arrives; the nurse decides when and how to move them. Document time found, position, and what the resident said.
Treats gloves as a substitute for hand hygiene - pulls on gloves without washing first, moves from a soiled task to a clean task on the same pair of gloves, or peels gloves off and goes straight to the next resident.
Gloves feel like a barrier that makes hands clean, and during a skills demonstration candidates focus on the messy task itself and forget that hand hygiene is the first and last step of every procedure.
What to do instead
Build hand hygiene into the first and last ten seconds of every skill: wash with soap and friction for at least 20 seconds (or use alcohol-based rub when hands are not visibly soiled) before gloving, change gloves between dirty and clean steps, and wash again immediately after removing gloves.
Washes the resident in whatever order is convenient - face, then perineum, then back - without changing washcloths or water, and wipes the eyes from the outer corner inward.
Candidates concentrate on getting the resident clean and finishing on time, and do not think of the body as having a clean-to-dirty gradient. Eye direction is a small detail that is easy to skip when rushed.
What to do instead
Follow a fixed head-to-toe, clean-to-dirty order: eyes first (inner corner outward, using a different area of the cloth for each eye), then face, trunk, arms, legs, back, and perineum last. Change washcloths and water when soiled, and never put a used cloth back into clean water.
Records a blood pressure of 188/104 or a temperature of 101.8°F on the flow sheet, says nothing to the nurse, and continues with the next task.
Candidates see the number as a data-entry job and assume 'the nurse will look at the sheet later.' Many also cannot state the normal ranges, so they do not recognize the reading as abnormal.
What to do instead
Memorize the reportable thresholds (for example temperature at or above 100.4°F, systolic under 90 or over 160, diastolic over 100, pulse under 60 or over 100, respirations under 12 or over 20, and any oxygen saturation below the facility's stated range) and report verbally to the nurse at the time of the reading, then chart the value, the time, and to whom it was reported.
Feeds a resident who is lying nearly flat or has slid down in bed, and places the next spoonful in the mouth while the resident is still chewing or talking.
Candidates focus on getting the tray emptied and on the resident's complaint of hunger, and do not connect body position to the risk of aspiration. A resident who is eating eagerly does not look like someone in danger.
What to do instead
Before the first bite, raise the head of the bed to at least 45 degrees (as high as tolerated) and sit the resident fully upright; offer small bites, alternate with fluids, allow time to chew and swallow, check the unaffected side for pocketing, stop and report any coughing, choking, wet voice, or difficulty swallowing, and keep the resident upright for at least 30 minutes after the meal.
Gives perineal care wiping back to front, or wipes the catheter tubing and then the meatus with the same washcloth, and does not report a change in urine color, odor, or the amount of output.
The direction rule is memorized as a phrase rather than understood as a way to keep fecal bacteria away from the urethra, and catheter care is treated as 'just washing the tube.' Output is often emptied and discarded without being looked at.
What to do instead
Wipe front to back, using a clean area of the cloth for each stroke and changing gloves when soiled. For catheter care, wash from the meatus outward, never back toward the meatus. Measure and note urine color, clarity, odor, and volume, and report cloudy, bloody, foul-smelling urine or a sudden drop in output.
Transfers a resident with the bed at hip height or higher, wheels unlocked, no gait belt, and pulls the resident up by the arms or under the shoulders with the body twisted.
Candidates mirror what they have seen on television or in a rushed facility, and under observation nerves make them forget the setup steps and go straight to the lift. Locking brakes and raising the bed feel like delays rather than the procedure itself.
What to do instead
Verbalize the setup before touching the resident: lock the wheels, raise the bed to your mid-thigh working height, lower the rail on the working side, apply the gait belt, stand close with feet apart, bend the knees and keep the back straight, and get a second staff member for any resident who cannot bear weight. Never lift by the arms or armpits.
Charts opinions and conclusions rather than observations - 'resident was fine,' 'resident was uncooperative,' 'ate well,' 'seemed to have a good day' - or fills in a flow sheet at the end of the shift for care given hours earlier, and charts a task someone else performed.
Candidates believe the chart is a place to record a general impression, and end-of-shift charting feels efficient. Writing 'uncooperative' can also feel like a way to protect themselves when a resident refused care.
What to do instead
Chart only what you saw, did, and were told, with numbers and quotes: 'ate 50% of breakfast,' 'refused bath at 0800, stated "not today"; nurse notified.' Chart as care is given or as soon as possible, sign only your own entries, and report events you did not witness to the nurse instead of documenting them yourself.
Corrects or argues with a resident who has dementia - insisting 'your husband died ten years ago,' or telling an agitated resident to calm down and stop being difficult.
Candidates are trained to be truthful and treat the resident's statement as a factual error to fix. Arguing feels like the honest response, and 'calm down' feels like reassurance.
What to do instead
Respond to the feeling, not the fact: acknowledge ('you must miss him'), redirect to a safe activity or topic, and avoid arguing, quizzing, or correcting. Lower your voice and slow down, give space, and report escalating agitation, new confusion, or sudden behavior change to the nurse rather than managing it alone.