You’ve completed your CNA training program and are preparing for your competency exam. While the written CNA test simply assesses your knowledge base and memory, the skills portion will test your competence. Many test-takers experience anxiety about demonstrating hands-on skills in front of an evaluator. Let’s highlight the expectations, some of the common mistakes that occur, and how you can breeze through your exam with confidence.
In this article:
- What to Expect: Exam Format and Structure
- The Skills Breakdown
- Mistakes to Avoid
- Memorizing Core Competencies of Each Skill
- Essential Tips for Test Day
- Don’t Forget to Practice
What to Expect: Exam Format and Structure
Knowing what to expect before your skills exam will help you feel more at ease. First, understand that the skills you will be required to perform are assigned at random. Thus, it is important for you to feel comfortable demonstrating all CNA skills. The number of skills you will demonstrate depends on your state provider (Prometric, Credentia, or Headmaster) and will range from 3 to 6 skills.
Skills are performed live in front of a Nurse Aide Evaluator (NAE) in a room or setting that is set up similar to a resident’s room and contains necessary supplies like water, toothbrushes, and bedpans. Some skills, such as perineal care or mouth care, will be performed on a medical mannequin. Other skills, like measuring vital signs, may be performed on a volunteer or another test-taker. The clinical skills test is timed and will depend on the skills you are assigned, though 25-35 minutes is usually allotted.
The Skills Breakdown
There is a pool of over 20 CNA skills that you may be tested on. Every candidate will be required to perform handwashing as their first skill. Since hand hygiene is essential to infection control, it must be performed satisfactorily to pass the skills exam.
Indirect Care Behaviors
These are skills that you are not directly told to do, but are assumed behaviors that the evaluator will monitor for with each skill. Indirect Care includes:
- Infection Control (hand hygiene, standard precautions).
- Communication (greeting the resident, introducing yourself).
- Resident Rights (asking about preferences or evaluating comfort level).
- Safety (call light within reach, bed lowered and locked).
Skills You May be Assigned to Demonstrate
The following list includes the CNA skills you may be assigned to perform. This list may vary by state and testing provider, so candidates must be prepared for any of the following:
Hygiene & Personal Care:
- Partial Bed Bath (face, arm, hand, and underarm).
- Catheter Care (female).
- Perineal Care (female).
- Mouth Care (brushing teeth).
- Denture Care (cleaning upper or lower denture).
- Foot Care (soaking, washing, and drying one foot).
- Hand and Nail Care.
- Dressing a Resident with a Weak Arm.
- Changing an Occupied Bed.
Mobility & Positioning:
- Ambulation using a Gait Belt.
- Transfer from Bed to Wheelchair using a Gait Belt.
- Positioning Resident on Side (lateral position).
- Range of Motion (ROM) Exercises: Shoulder.
- Range of Motion (ROM) Exercises: Knee and Ankle.
Measurement & Data:
- Manual Blood Pressure.
- Radial Pulse.
- Respirations.
- Urinary Output (measuring from a drainage bag).
- Weight of an Ambulatory Client.
Toileting & Nutrition:
- Assisting with the use of a Bedpan.
- Feeding a Dependent Resident.
Mistakes to Avoid
Critical Element Steps are steps that, if missed or performed in the incorrect order, result in an automatic failure of the skill. Common areas of critical element failures include:
- Safety: Forgetting to lock wheelchair brakes before a transfer.
- Infection Control: Cleaning from “dirty to clean” instead of “clean to dirty” during peri-care.
- Measurement: Recording a blood pressure or pulse reading that is outside the allowable margin of error (e.g., +/- 4 beats for pulse).
- Communication: Failing to explain to the resident the procedure you are about to perform.
Five Skills That Students Fear
Some skills are considered “harder” than others, often because they require more steps and more room for error. Here’s how to avoid common mistakes with these skills:
- Hand Washing:
- The Trap: Touching the sink faucet with clean hands.
- The Fix: Use a dry paper towel to turn off the faucet.
- Manual Blood Pressure:
- The Trap: Hearing the wrong number or letting the needle drop too fast.
- The Fix: Practice with a dual-head stethoscope. Also, remember that manual gauges are marked in increments of 2, so your answer should typically be an even number.
- Ambulation with a Gait Belt:
- The Trap: The candidate forgets to ensure the resident is wearing non-skid shoes before standing, or fails to use an underhand grasp on the belt.
- The Fix: Always ask “Are you dizzy?” before standing.
- Feeding a Dependent Resident:
- The Trap: Not asking the resident about comfort or needs.
- The Fix: Offer fluids every few bites and allow time to swallow.
- Occupied Bed Making:
- The Trap: Unsafe resident positioning or neglecting privacy.
- The Fix: Ensure side rails are up on the side the resident is turning toward.
How to Correct Mistakes
You will be nervous, and mistakes may happen. If you realize during a skill that you have performed a step incorrectly or omitted a step completely, you can correct it. Simply alert the evaluator that you would like to correct a step and then verbalize or demonstrate it.
Ending a Skill
When you feel you have performed all components of a skill correctly, you will verbalize this by stating, “My skill is complete.” You will not be able to go back and make corrections once you end a skill.
Memorizing Core Competencies of Each Skill
The following acronyms can help you remember how to begin and end each skill. These are often considered Critical Element Steps and are crucial to success.
- Start of Skill (SWIPE):
- Supplies (gather them)
- Wash hands
- Identify resident & Introduce self
- Privacy (close the curtain)
- Explain procedure
- End of Skill (LOVER):
- Low bed position
- Open curtain
- Verify safety (call light in reach)
- Equipment away
- Record/Report & Wash Hands
Essential Tips for Test Day
- Dress the Part: Scrubs, a watch with a second hand, and non-skid shoes are recommended. Keep fingernails short and natural (no acrylics). Limit jewelry or accessories, as you may be asked to remove them.
- Verbalize Everything: If you don’t say it or do it, the evaluator didn’t see it. Narrating your actions (“I am now checking that the water is a safe temperature”) helps the evaluator check off the box and helps you from missing any steps.
- Read the Candidate Handbook: Before your clinical skills test, you may be given instructions that cover the various checkpoints of a task or how you will be graded. Consider this your “cheat sheet” to familiarize yourself with what is expected.
- Treat the Mannequin Like a Person: The best way to overcome your nerves and perform at your best is to act as if you are truly performing a skill on a real person. Block out the evaluator, and what you have learned will come naturally.
Don’t Forget to Practice
Practice, practice, practice. Practice is the key to mastering CNA skills. Take time to practice on your family members at home, in skills labs, or even on your own. Verbalize each step you are performing so it becomes ingrained in your brain.
The CNA skills test is about assessing your ability to perform skills safely, not perfectly. Keep infection control, patient comfort, and communication at the forefront, and you are bound to pass on the first try!
