The role of a Certified Nursing Assistant (CNA) is foundational to providing direct, hands-on care within the healthcare system. The state certification exam requires competence in a specific set of practical tasks, commonly referred to as the 22 core skills. These skills form the practical foundation of the profession, ensuring prospective CNAs possess the basic clinical abilities necessary for safe and effective patient support. Mastering these procedures confirms the candidate is prepared to uphold standards of safety, dignity, and infection control. The evaluation focuses on the precise, step-by-step performance of these tasks, measuring readiness for the workforce.
Foundational Safety and Infection Control
The integrity of patient care begins with strict adherence to safety protocols and infection prevention measures. Proper hand hygiene is the single most important procedure and is always evaluated during the skills exam. This involves washing hands with soap for at least 20 seconds, applying friction to all surfaces, and using clean paper towels to dry hands and turn off the faucet. Correct handwashing technique is a non-negotiable prerequisite that must be performed before and after any direct patient interaction.
A core safety measure involves the correct use of Personal Protective Equipment (PPE), such as donning and removing a gown and gloves. The orderly removal of PPE is important to prevent contamination of the CNA’s clothing and skin. CNAs must also provide privacy by closing curtains or doors before performing intimate procedures to respect the patient’s dignity. This commitment to privacy is assessed during almost every skill demonstration.
Personal Care and Patient Hygiene
Maintaining a patient’s cleanliness and comfort is a significant portion of the CNA’s daily duties and involves several distinct hygiene skills. Giving a modified bed bath requires washing the face, one arm, hand, and underarm while keeping the rest of the patient covered for warmth and privacy. This task demonstrates the CNA’s ability to manage water temperature and soap, and to maintain skin integrity through gentle washing and rinsing.
Oral care is another required procedure, which includes cleaning the teeth or dentures of a patient who cannot perform the task independently. When cleaning dentures, the CNA must handle them carefully to avoid breakage and ensure they are stored in a designated container with water to prevent warping. Perineal care for both male and female patients involves cleansing the genital and anal areas to prevent infection and skin breakdown. This intimate procedure requires the CNA to use appropriate supplies and techniques, always wiping from front to back to avoid introducing bacteria into the urinary tract.
Assisting a patient with dressing often tests the technique for dressing a patient with a weak or paralyzed side, such as a right-sided weakness. The correct method is to always dress the weak limb first and undress the weak limb last, which minimizes strain and maximizes comfort and participation. Applying a knee-high elastic stocking, or compression stocking, supports circulation and prevents blood clots. The stocking must be applied smoothly, without wrinkles, while the patient is lying down to ensure proper blood flow.
Supporting Patient Mobility
Safe patient mobility skills are paramount for preventing falls and musculoskeletal injuries. A primary skill involves transferring a patient from a bed to a wheelchair using a gait belt. The gait belt is positioned around the patient’s waist, providing a secure grasp to assist the patient in standing and pivoting safely. Proper body mechanics must be used throughout the transfer to protect the CNA’s back and ensure the patient’s feet are flat on the floor before standing.
Assisting a patient with ambulation, or walking, utilizes the transfer belt to offer steady support and reduce the risk of a fall. The CNA must walk slightly behind and to the side of the patient, maintaining a firm grip on the belt while monitoring the patient for signs of dizziness or fatigue. Positioning a non-ambulatory patient on their side prevents pressure ulcers, which can develop rapidly. This procedure, called turning and repositioning, requires careful technique to avoid shearing the skin against the bed linens.
Range of motion (ROM) exercises include performing passive ROM on the shoulder, knee, and ankle. Passive ROM means the CNA moves the patient’s joints gently through their normal range to maintain flexibility and promote circulation. The CNA must support the limb above and below the joint being moved and stop the exercise immediately if the patient reports pain.
Accurate Monitoring and Documentation
The collection of objective data about a patient’s physical status directly impacts the medical team’s treatment decisions. Measuring and recording vital signs, including the radial pulse and respirations, are standard procedures. To accurately count respirations, the CNA observes the patient’s chest movement for one full minute immediately after counting the pulse, without alerting the patient, as awareness can alter the breathing rate.
Measuring blood pressure manually requires the use of a stethoscope and sphygmomanometer. The CNA must listen for the Korotkoff sounds to determine the systolic and diastolic pressures. The measurement must be within a close range of the evaluator’s reading to pass the skill, as a deviation could lead to incorrect clinical assumptions.
Measuring and recording a patient’s weight is a necessary data collection task, often done using an upright scale for an ambulatory patient. Consistent weight monitoring helps the medical team track fluid retention or nutritional status changes over time. All collected data must be documented immediately and precisely to ensure the patient’s chart reflects the most current and reliable information.
Specialized Procedural Tasks
The final set of skills involves procedures related to elimination and nutritional support. Assisting with the use of a bedpan is common for patients unable to use a toilet, requiring the CNA to correctly position the device, provide privacy, and ensure proper post-care hygiene. After the patient uses the bedpan, the contents are measured and emptied, and the bedpan is rinsed before being placed in a designated dirty supply area.
Measuring and recording urinary output tracks a patient’s fluid balance, often part of Intake and Output (I&O) monitoring. This task requires the CNA to accurately read the volume of urine in a calibrated container and record the amount precisely. Catheter care for female patients is another specialized skill that involves cleaning the area around the urinary catheter to prevent infection, always cleaning away from the body’s opening.
Feeding a patient who is unable to feed themselves involves providing nourishment and ensuring the patient does not aspirate food into their lungs. The CNA must sit at the same level as the patient and offer small, manageable amounts of food while monitoring for swallowing difficulty. The CNA must also measure and record the amount of food and fluid consumed to contribute to the overall nutritional assessment.