CNA Clinical Skills Training Guide: All 22 Step-by-Step Checklists & Video Modules
Every state clinical competency exam (Credentia NNAAP, Headmaster D&SDT, and Prometric) scores candidates on exact procedural order, infection control, and bolded safety checkpoints. Rehearse the universal opening/closing sequences, video demonstrations, and step-by-step checklists for all 22 testable CNA skills below.
1. Universal Opening & Closing Steps (Scored on Every Single Skill)
Opening 5 Steps (Before Every Skill)
Knock → ID → Explain → Wash → Curtain
(1) Knock before entering; (2) Introduce yourself by name and title; (3) Verify the resident's ID band; (4) Explain the procedure and ask permission; (5) Perform hand hygiene and pull the privacy curtain completely closed.
Closing 5 Steps (After Every Skill)
Low Bed → Call Light → Curtain → Wash → Record
(1) Lower bed to its lowest horizontal position and confirm wheels are locked; (2) Place the call light/signaling device in the resident's hand or within easy reach; (3) Open the privacy curtain; (4) Perform hand hygiene; (5) Report and record observations.
2. Domain A: Infection Control & Clinical Measurements (Skills 1–5)
Measurement skills require recording your reading on the official Candidate Recording Form within the evaluator's exact tolerance range:
| Clinical Skill | Sequential Step-by-Step Procedure | Bolded Safety & Accuracy Checkpoints |
|---|---|---|
| Skill 1: Hand Hygiene (Handwashing with Soap & Water) | Address client by name; turn on water at sink and wet hands and wrists thoroughly with warm water; apply soap to hands; rub hands together using friction and lathering all surfaces of hands, wrists, and between fingers for at least 20 full seconds while keeping fingertips pointed downward below elbow level; clean fingernails by rubbing fingertips against opposite palm; rinse all surfaces of hands and wrists with fingertips pointed downward; dry hands and wrists completely with clean paper towels starting at fingertips; turn off faucet using a separate clean dry paper towel and discard towel into waste container without touching bin. | Automatic-Fail Risks: Lathering for less than 20 seconds; touching the inside of the sink basin at any time; turning off the faucet with bare washed hands or with the damp paper towel used to dry hands. |
| Skill 2: Counts & Records Radial Pulse | Perform Opening 5 Steps; support resident's arm resting comfortably across chest or on mattress; place fingertips (index and middle fingers—never the thumb) over the radial artery on the thumb side of the wrist; count beats for one full minute (60 seconds) using a watch with a second hand; place call light within reach; wash hands; record exact pulse rate on recording sheet. | Tolerance Checkpoint: Recorded pulse rate must be within ±4 beats per minute of the RN evaluator's simultaneous reading. |
| Skill 3: Counts & Records Respirations | Perform Opening 5 Steps; keep fingers on radial pulse position (so resident does not alter breathing pattern) and observe chest rise and fall; count each complete inhalation-exhalation cycle for one full minute (60 seconds); ensure call light is within reach; wash hands; record respiratory rate on candidate form. | Tolerance Checkpoint: Recorded respiratory rate must fall within ±2 breaths per minute of the evaluator's count. |
| Skill 4: Measures & Records Manual Blood Pressure | Clean stethoscope earpieces and diaphragm with alcohol pad; position resident's bare upper arm resting at heart level with palm facing upward; locate brachial artery pulse at inner elbow; wrap blood pressure cuff snugly 1 inch above brachial artery with arrow centered over artery; palpate radial pulse, inflate cuff until radial pulse stops, add 30 mmHg (or inflate to 160–180 mmHg per vendor rubric); place stethoscope diaphragm firmly over brachial artery; deflate valve smoothly at 2–4 mmHg per second; note first Korotkoff sound (systolic) and disappearance of sound (diastolic); deflate cuff completely and remove; wash hands and record BP. | Tolerance Checkpoint: Both systolic and diastolic numbers must be within ±4 to ±8 mmHg of the evaluator's dual-head stethoscope reading. Never place diaphragm over clothing or inside the cuff. |
| Skill 5: Measures & Records Weight of Ambulatory Resident | Perform Opening 5 Steps; balance/zero the standing beam or digital scale before resident steps on; assist resident to sitting position on side of bed and put non-skid footwear on both feet before standing; assist resident to walk safely to scale and stand centered on platform with arms at sides (not holding scale frame); balance weights (or read digital display); assist resident back to bed; remove shoes if desired; place call light within reach; wash hands and record weight. | Safety & Tolerance: Scale must be zeroed prior to weighing; resident must wear non-skid shoes while walking to scale; recorded weight must be within ±0.5 to ±2 lbs (or ±0.2 kg). |
3. Domain B: Personal Hygiene, Grooming & Nutrition (Skills 6–12)
| Clinical Skill | Sequential Step-by-Step Procedure | Bolded Safety & Accuracy Checkpoints |
|---|---|---|
| Skill 6: Performs Mouth Care (Conscious Resident) | Perform Opening 5 Steps; raise head of bed to upright sitting position (45–90 degrees); put on clean gloves before touching mouth or toothbrush; drape towel across chest; wet toothbrush and apply toothpaste; brush upper and lower teeth (inner, outer, and chewing surfaces) using gentle motion and brush tongue; offer water cup to rinse and hold emesis basin under chin; wipe mouth dry; remove towel/basin; remove gloves inside-out and wash hands; perform Closing 5 Steps. | Safety Checkpoint: Must wear gloves before brushing teeth or handling emesis basin; head of bed must be elevated to prevent choking/aspiration. |
| Skill 7: Cleans Upper or Lower Denture | Perform Opening 5 Steps; put on clean gloves; line the bottom of the sink basin with a cloth towel or washcloth and fill halfway with cool/lukewarm water; remove denture from cup and rinse under cool running water; apply denture paste to brush and brush all surfaces of denture (outer, inner, gum line, and palate); rinse denture thoroughly under cool running water; rinse denture cup and lid and fill cup with clean cool water; place denture in cup and close lid; clean sink, remove gloves, and wash hands. | Safety Checkpoint: Sink must be lined with a towel before cleaning denture to prevent breakage if dropped; never use hot water (warps denture plastic). |
| Skill 8: Gives Modified Bed Bath (Face, Arm, Hand & Underarm) | Perform Opening 5 Steps; fill basin with warm water, test water temperature with thermometer or wrist, and ask resident to verify comfort; cover resident with bath blanket and remove top sheet/gown while maintaining privacy; wash eyes from inner canthus to outer canthus using a clean corner of wet washcloth with water only (no soap on face); wash, rinse, and pat dry face; place towel under bare arm; wash, rinse, and pat dry arm, hand, fingers, and axilla (underarm) using soap and clean strokes; apply clean gown; dispose of linen/water; wash hands. | Safety Checkpoint: Test water temperature before bathing; never use soap around the eyes; keep resident covered with bath blanket to protect dignity. |
| Skill 9: Provides Foot Care on One Foot | Perform Opening 5 Steps; fill basin with warm water and test temperature; put on gloves; place basin on towel on floor and support resident's foot and ankle while placing foot into basin; wash entire foot and between toes with soap-wet washcloth; rinse entire foot and between toes; remove foot onto towel and pat dry thoroughly—especially between the toes; warm lotion in hands and apply to top and sole of foot (never apply lotion between the toes); wipe excess lotion; put on sock/footwear; clean basin, remove gloves, and wash hands. | Safety Checkpoint: Must dry thoroughly between toes and never leave lotion between the toes (moisture between toes promotes fungal skin breakdown in diabetic/elderly residents). |
| Skill 10: Provides Fingernail Care on One Hand | Perform Opening 5 Steps; fill basin with warm water and test temperature; put on gloves; soak resident's fingernails in warm water for 3–5 minutes; wash hand with soapy washcloth, rinse, and pat dry on towel; use blunt orangewood stick to gently clean under each fingernail, wiping tip on towel after each nail; use emery board to smooth rough nail edges in one direction; apply lotion to hand and massage gently; empty/clean basin, remove gloves, and wash hands. | Safety Checkpoint: CNAs never clip fingernails of diabetic or anticoagulated residents (and never clip toenails of any resident); only file smooth with an emery board. |
| Skill 11: Dresses Client with Affected (Weak) Right Arm | Perform Opening 5 Steps; keep resident covered with bath blanket while removing hospital gown (remove gown from unaffected/strong left arm first, then gently slide off weak right arm); ask resident to choose shirt; gather sleeve and slide shirt onto the affected/weak right arm first, supporting the weak arm's elbow and wrist; assist resident to place unaffected left arm into the other sleeve; button/straighten shirt comfortably; perform Closing 5 Steps. | Memory Rule ("TOW — Take Off Strong, Put On Weak"): Always insert the weak/affected arm into the sleeve first when dressing, and remove from the strong arm first when undressing. |
| Skill 12: Feeds a Dependent Resident | Perform Opening 5 Steps; position resident upright in bed or chair at 45 to 90 degrees; verify name and therapeutic diet card on tray; wash or sanitize resident's hands before eating; sit at eye level facing resident; protect clothing with napkin/clothing protector; describe foods on tray; offer small spoonfuls (half-full) alternating solid bites with sips of liquid; allow ample time to chew and swallow completely before offering next bite; wipe mouth gently as needed; leave resident upright for at least 30 minutes after meal; record percentage of solid food and mL of fluid consumed. | Safety Checkpoint: Resident must be sitting upright (45–90 degrees) before feeding; wash resident's hands prior to meal; alternate liquids and solids and check for swallowing. |
4. Domain C: Perineal Care, Elimination & Urinary Output (Skills 13–16)
| Clinical Skill | Sequential Step-by-Step Procedure | Bolded Safety & Accuracy Checkpoints |
|---|---|---|
| Skill 13: Provides Female Perineal Care | Perform Opening 5 Steps; fill basin with warm water and test temperature; put on gloves; place waterproof pad under buttocks and cover resident with bath blanket; using soapy washcloth, separate labia and wipe front to back down center, then left side, then right side—using a clean section of the washcloth for each single downward stroke; rinse front to back with a clean wet washcloth using clean sections; pat dry front to back; assist resident to turn onto side away from you; wash, rinse, and pat dry rectal area from vagina toward spine using clean strokes; remove pad, change water/gloves, and wash hands. | Automatic-Fail Risk: Wiping back-to-front or reusing the same section of washcloth for more than one stroke (introduces E. coli into the urinary tract). |
| Skill 14: Provides Indwelling Urinary Catheter Care | Perform Opening 5 Steps; fill basin with warm water and test temperature; put on gloves; place waterproof pad under buttocks; expose only catheter/perineal area; check that tubing is coiled free of kinks and drainage bag hangs below bladder level attached to the non-movable bed frame; hold catheter securely at the urethral meatus with non-dominant hand to prevent tension; with a soapy washcloth, clean at the meatus and move at least 4 inches down the catheter tubing away from the meatus using a clean section of cloth for each stroke; rinse 4 inches down away from meatus and pat dry; remove pad/gloves and wash hands. | Automatic-Fail Risk: Pulling or tugging on the catheter at the meatus, cleaning toward the meatus, or hanging the drainage bag on a movable side rail. |
| Skill 15: Assists with Use of Bedpan | Perform Opening 5 Steps; put on clean gloves; place waterproof pad on bed; assist resident to raise hips (or roll onto side) and position standard or fracture bedpan comfortably under buttocks with rounded rim facing toward head of bed; raise head of bed to comfortable sitting position; place toilet tissue, hand wipe, and call light within reach; remove gloves, wash hands, and step behind curtain for privacy; when called, wash hands, don clean gloves, lower head of bed, remove bedpan carefully, clean/dry perineal area front to back, empty/rinse bedpan into toilet, wash resident's hands, remove gloves, and wash hands. | Safety Checkpoint: Must remove contaminated gloves before touching bed controls or curtains, and wash/sanitize the resident's hands after toileting. |
| Skill 16: Measures & Records Urinary Output | Perform Opening 5 Steps; put on clean gloves; place clean paper towel on flat floor/surface and set graduated measuring container on it; unclamp urinary drainage bag spout (or pour bedpan contents) into graduate without touching spout to inside of graduate; re-clamp and secure spout in holder; place graduate on a flat, level surface and read urine volume at eye level in milliliters (mL/cc); empty urine into toilet, rinse graduate and pour rinse into toilet; remove gloves, wash hands, and record exact mL on candidate form. | Tolerance Checkpoint: Recorded urinary output must be within ±25 mL (or ±30 mL) of the evaluator's reading, measured at eye level on a flat surface. |
5. Domain D: Positioning, Transfers, Range of Motion & Environment (Skills 17–22)
| Clinical Skill | Sequential Step-by-Step Procedure | Bolded Safety & Accuracy Checkpoints |
|---|---|---|
| Skill 17: Transfers from Bed to Wheelchair Using Gait Belt | Perform Opening 5 Steps; position wheelchair beside bed and lock both wheelchair brakes; fold footrests up; verify bed is at lowest height with bed wheels locked; assist resident to sitting position on edge of bed with feet flat on floor and put on non-skid shoes; apply gait belt snugly around waist over clothing (2 fingers fit underneath); stand facing resident with feet shoulder-width apart and knees braced against resident's knees; grasp gait belt on both sides with an upward underhand grip; on count of three, rock and stand resident smoothly, pivot until backs of legs touch wheelchair seat, and lower gently into chair; remove gait belt, position feet on footrests, and place call light in reach. | Automatic-Fail Risks: Forgetting to lock both wheelchair brakes or bed wheels prior to standing resident; standing resident in socks without non-skid shoes; grasping resident under the axillae (armpits) instead of the gait belt. |
| Skill 18: Assists Resident to Ambulate Using Gait Belt | Perform Opening 5 Steps; verify bed is low and wheels are locked; assist resident to sit on edge of bed (dangle to check for dizziness) and put on non-skid shoes; apply gait belt snugly around waist over clothing; use upward underhand grip on gait belt to assist resident to stand; walk slightly behind and to the side (on the weak side if applicable) while holding the back of the gait belt with an underhand grip for 10 feet and back; assist resident safely back into bed; remove gait belt and perform Closing 5 Steps. | Safety Checkpoint: Walk slightly behind and to the side holding the gait belt continuously; never walk backward in front of the resident during ambulation. |
| Skill 19: Positions Resident on Side (Lateral Position) | Perform Opening 5 Steps; lower head of bed flat; move resident in segments toward the side of the bed opposite the direction they will turn; cross resident's arms over chest and cross far ankle over near ankle; stand on the side resident is turning toward and gently roll resident onto their side; place a supportive pillow lengthwise behind the back/sacrum, a pillow under the head/neck, a pillow under the upper flexed arm, and a pillow between the knees and ankles; check that bottom shoulder is not compressed underneath the body; perform Closing 5 Steps. | Safety Checkpoint: Must place pillows behind back, under top arm, and between knees/ankles so bony prominences do not rub together; keep resident away from edge of mattress. |
| Skill 20: Performs Passive Range of Motion (PROM) — One Knee & Ankle | Perform Opening 5 Steps; instruct resident to tell you immediately if any pain or discomfort occurs; expose one leg while keeping resident covered; support the limb with one hand under the knee and one hand under the ankle; gently bend the knee and hip toward the chest (flexion) and straighten back to mattress (extension) 3 complete times; support the ankle and foot and gently push toes/foot upward toward the knee (dorsiflexion) and point foot downward toward the foot of the bed (plantar flexion) 3 complete times; cover leg and perform Closing 5 Steps. | Safety Checkpoint: Always support joints above and below; move slowly and smoothly; never force a joint past resistance; ask or monitor for pain throughout all 3 repetitions. |
| Skill 21: Performs Passive Range of Motion (PROM) — One Shoulder | Perform Opening 5 Steps; instruct resident to report any pain immediately; support the resident's arm at the elbow and wrist throughout the exercise; raise the straightened arm forward and upward toward the head of the bed (flexion) and lower back to the side (extension) 3 complete times; move the straightened arm outward away from the side of the body toward the shoulder level (abduction) and bring back to the side of the body (adduction) 3 complete times; perform Closing 5 Steps. | Safety Checkpoint: Support both the elbow and wrist joints continuously; perform 3 smooth repetitions of flexion/extension and 3 repetitions of abduction/adduction without causing pain. |
| Skill 22: Makes an Occupied Bed (and Dons/Doffs PPE Gown & Gloves) | Perform Opening 5 Steps; put on clean gloves; loosen bottom linen; raise far side rail (or ensure evaluator guards far side) and assist resident to roll onto side facing away from you; roll soiled bottom sheet tightly toward center of bed against resident's back (tucking dirty side inward); change gloves if soiled; place clean bottom sheet on mattress, unfold to half-width, secure corners, and fan-fold clean half next to soiled roll; assist resident to roll safely over the linen bundle onto clean side; pull soiled sheet from bed and place directly into hamper (never on floor); pull clean bottom sheet taut and secure corners; place clean top sheet and blanket over resident and slide soiled top sheet out from underneath; make mitered corners at foot of bed and loosen toe pleat; change pillowcase without holding pillow against uniform; perform Closing 5 Steps. | Automatic-Fail Risks: Letting soiled linen touch the floor or your clean scrubs; leaving the resident unguarded near the open edge of the bed while rolling; pulling tight sheets over the toes without a toe pleat. |
6. CNA Clinical Training Video Demonstrations
Watch the clinical care and dementia communication training modules below, then test your written exam readiness on our 25-Question Interactive CNA Practice Exam:
Module 1: Patient Comfort & Bedside Positioning
Demonstrates bedside positioning, pillow offloading for bony prominences, and comfort rounds.
Module 2: Assisting with Activities of Daily Living
Covers resident dignity, privacy curtain protocols, infection control, and safe ADL assistance.
Module 3: Dementia Redirection & Behavioral Care
Shows de-escalation, validation therapy, and re-approaching strategies when a resident refuses care.