Your students WANT to pass the CNA Skills Exam.

You NEED your students to pass the CNA Skills Exam. If your pass rate falls below the average, your program can be placed on probation. Your district’s CTE funding may be affected. And your students will lose confidence in your instruction…and may not try to test again.

What if I told you that you there are only 13 things the students need to know to pass the Skills part of the exam?

It really is that easy. Thirteen things to learn. Just 13. Not thousands of little details. Not hundreds of important points. Not 21 full skills. Just 13 things to get a perfect score on the test.

Master the Principles to Master the Test.

Patricia Laramee, RN - 4YourCNA Tweet
The Big 3 Principles

The Principles

So, we have learned that CNAs follow the care plan. The Care Plan, the Whole Care Plan and Nothing But the Care Plan. CNAs also report all observations to the nurse. This concept is the first of 13 basic Principles that guarantees success in student performance. It applies to every single skill the student will perform. Read the care plan, do the task as it instructs. Easy, peasy.

But just like every skill will follow the care plan, every skill will start with an Opening. The steps are always the same. And every skill will end with the Closing. The steps are always the same. So, about 1/3 of every single skill on the state exam is exactly the same. EXACTLY the same. If the students learn these steps, and do them every single time for every single skill, they will check off about 30% of the skill’s checkpoints… before they even start on skill-specific steps.

There are many other steps that are repeated across multiple skills. And when those steps apply, there are Rules that must be followed. We grouped these repeated steps into Principles – and developed Rules to keep the students in compliance with the testing standards. And the good news is that all-together, there are only 13 Principles that the students need to learn to be truly successful in passing the Skills Exam. Just 13.

These 13 Principles can be summed up by:

  • If you are doing a skill, follow the Care Plan (Skill Rules apply)
  • Every skill starts with an Opening, every Opening starts with a Knock (Opening Rules apply)
  • If you are using supplies, you need a barrier (Barrier Rules apply)
  • If you might touch any body fluids, personal skin or non-intact skin, you need gloves (Glove Rules apply)
  • If the patient will be uncovered or undressed during the skill, they need a privacy blanket (Privacy Blanket Rules apply)
  • If you will be using ANY linens, you must think about infection control (Linen Rules apply)
  • If you are moving the patient at all, they must end in the center of the bed (Scoot & Roll Rules apply)
  • If you are Washing ANYTHING, the Washing Rules apply
  • If you have used any type of Basin, it must be cleaned properly (Basin Cleaning Rules apply)
  • If the patient’s feet hit the floor, we talk about their shoes (Shoe Rules apply)
  • Every skill ends with the Closing and clean hands (Closing Rules apply)
  • Some skills have specific rules (Skill Specific rules apply)
  • You are the Protector of Rights – for every skill, on every patient (Patient Rights Rules apply)

By teaching these groups of steps that are ALWAYS applied the same way, training is simplified and the student has a concrete set of steps to follow. Every single time. 

When teaching skills, it helps to break down the steps and identify the Rule that that particular step addresses. For instance, let’s look at a simple skill: Provide Passive Range of Motion to the Elbow and Wrist. Take a look at the testing Checklist (used by Prometric Skills Testing NAEs to determine competency).

Testing Checklist

The Checklist

To understand how the Principles work, take a look at the Opening Skill Rule (to the right).  Now, look at the checklist – the first bullet point under “Promote resident’s rights during care? (IC)”: notice it assesses if the candidate announced self or knocked before entering room.

Look at the first step in the Opening: Knock. Every single skill checklist for every single skill on the test contains this checkpoint. So every skill has to start with a Knock. This step is graded for every skill. Each Principle in a Rule always corresponds to the specific checkpoints on the checklists.

You can easily cross reference the testing checklist and the Principles steps to make sure that all material has been addressed. In this case below, there are only 2 specific checkpoints that are not addressed with these Principles.

The majority of the skill above has been covered by these three Principles: Skill Rules, the Opening and the Closing. But what about those last two checkpoints that aren’t covered? What do you do about those?

There are some checkpoints that are very skill-specific. These checkpoints don’t appear in the other principles because they are not commonly repeated steps that appear in many skills. They have their own category and will need to be taught separately through classroom demonstration, lecture and discussion. 

You can see some of these topics to the left. 

  • Anytime a body part is lifted, for any reason, it should be supported from below. 
  • When walking a patient, they should be your entire focus, so walk slightly behind and to the side. 
  • When undressing and dressing a resident with a weak arm, Undress Strong Arm First (USA First) – then dress weak arm first. 
  • Use pillows anytime bony areas will rub together to minimize skin breakdown. 
  • Protect clothing from food, toothpaste or grooming products. 
  • Many skills, like bedpan, require the head of the bed to be adjusted for proper skill performance – pay attention to these steps – they are important. 
  • Always work to minimize exposure of the patient – be vigilant. 
  • If your hands need to be washed (before feeding, after bedpan), the patients’ hands need to be cleaned too! 
  • Never carry an open container of urine – anywhere! 
  • Know how to use your supplies (gait belt, wheelchair, drainage bag, linens, gloves, etc.) – this is a big one. 
  • And no matter what – never cause injury. Look for signs of pain, don’t over-extend, look for obstacles, keep patients safe.

If you use the Principles from the beginning, the students become familiar with them – they see them again and again. Because they are familiar with the Principles, they will be familiar with a LOT of any new skill you introduce. This means less time learning all the small steps and more time to focus on skill-specific issues (like above).

Understanding that the entire skills exam is contained in these 13 Principles helps simplify your teaching. It also helps students remember what to do at test time so that they pass more easily. But most importantly, these steps will continued to be performed when they transition to a work environment because they will make sense to the student. They become important, not for the test, but for the PATIENT. 

When they are practicing in your skills lab, correcting them is easy – one statement from you will trigger awareness. Such as, “The first thing your gloves should touch is the patient,” immediately makes the student consider how they are cross-contaminating. Or saying, “Anytime the patient is uncovered or undressed, they need a…”, causes the student to stop and look at the patient, helping them identify unnecessary exposure. “When we get water, we check it and the…..,” (patient checks it) reminds the students that the patient must be involved in establishing the comfort of the water temperature (an important checkpoint). 

12 Principles

Using these banners in your classroom, if you have the classroom space, helps visually coordinate the Principles they are learning to the actions required in the lab. It is also gratifying for students to be able to visually assess how much they have learned, and what is still left to cover. 

The CNA Principles Card game takes this concept to a whole new level of fun! Each student must collect a complete set of Rules in a Principle while avoiding Crappy Caregivers (negative soft skills for employability training) and Penalty Cards (like HIPAA Violations, Call Off Crisis, Forgetting to document, FIRE Drills and more) reinforce important topics in healthcare. Learning the important steps of the Skills has never been so fun! This deck can also be used as a flashcard set for independent study as well!

The truth is, when you Master the Principles, you will Master the Test. And repetition makes it easy to Master the Principles!

Leave a Reply

Your email address will not be published. Required fields are marked *