5.3 Passing the NNAAP Skills Evaluation
Key Takeaways
- The NNAAP Skills Evaluation gives you five skills total: hand hygiene (handwashing) is ALWAYS performed, plus four other skills randomly selected by the Credentia-trained evaluator
- Critical Element Steps are bolded on the checklist; missing or wrongly performing even one critical step fails that entire skill, regardless of other performance
- Indirect-care points are scored on every skill: privacy, communication/courtesy, resident comfort, safety, infection control (hand hygiene), and placing the call light/signal within reach before leaving
- You have about 30 minutes to complete all five skills, with a five-minute warning; you control the pace and should not rush
- Common failure traps: skipping or shortening hand hygiene, contaminating clean linen/equipment, forgetting the call light, not providing privacy, and rushing through measurement steps
How the NNAAP Skills Test Works
The skills evaluation is where many candidates fail — not because the tasks are hard, but because of nerves and missed required steps. In New Jersey the NNAAP skills test is delivered through Credentia with a trained nurse-aide evaluator observing you, usually in a clinical lab setting with a live volunteer (or sometimes the evaluator) acting as the resident.
- You are assigned five skills total
- Hand Hygiene (handwashing) is ALWAYS one of the five — it is listed first on the checklist to remind you of its importance, and you can count on performing it
- The other four skills are randomly selected by the evaluator from the published list of NNAAP skills
- You have about 30 minutes to complete all five skills; the evaluator gives a five-minute warning when time is running low
- You perform on a volunteer who acts as your resident, treating them as if the care were real
A useful exam fact: although hand hygiene is its own scored skill, for the OTHER skills you generally do not have to physically wash your hands each time — you can verbalize to the evaluator, "Now I would wash my hands," stating when you would do so in real practice. Always confirm this in your current Credentia candidate handbook before test day, because it removes a major time pressure when used correctly.
Critical Element Steps vs. Indirect-Care Points
Every skill checklist contains two kinds of points, and confusing them is a top reason candidates fail.
| Type | What It Means | Effect of Missing It |
|---|---|---|
| Critical Element Steps | Steps essential to safety, accuracy, dignity, or infection control — printed in bold on the checklist | Missing or wrongly doing ONE fails the entire skill |
| Indirect-care points | Courtesy and safety behaviors scored on every skill | Lowers your score; you must also complete enough of these to reach the passing threshold |
Performing only the bolded critical steps is not enough — you must complete enough of the supporting steps to meet the passing standard for the skill. But the inverse is fatal: doing every supporting step while missing one critical step still fails the skill.
Indirect-Care Checkpoints — Scored on EVERY Skill
These behaviors are evaluated on all five skills. Build them into the opening and closing of every skill so they become automatic and you never lose easy points.
| Checkpoint | What to Do | Category |
|---|---|---|
| Greet & identify | Knock, introduce yourself, identify and address the resident by name | Communication |
| Explain | Tell the resident what you are going to do before you do it | Communication / Rights |
| Privacy | Close the door/curtain and drape the resident | Resident Rights |
| Hand hygiene | Wash or verbalize hand hygiene as required | Infection Control |
| Safety | Lock wheels, lower the bed, use a gait belt, keep the area clear | Safety |
| Comfort | Ask if the resident is comfortable; reposition for comfort | Resident Rights |
| Call light/signal in reach | Place the call signal within reach before leaving the resident | Safety |
High-Yield Skill Walkthroughs
Handwashing (the universal skill): turn on the water, wet hands and wrists, apply soap, lather with friction over all surfaces for at least 20 seconds keeping fingertips pointed down, rinse fingertips down, dry with a clean paper towel, then use a new dry paper towel to turn off the faucet so you do not recontaminate. Do not touch the inside of the sink.
Measuring blood pressure / pulse / respirations: your reported reading must fall within the evaluator's accepted range — accuracy is a critical step. Do not talk while counting respirations, and keep the resident's arm supported at heart level for blood pressure.
Indwelling catheter care / perineal care: wash front to back, use a clean area of the washcloth for each stroke, and keep the resident draped. Keeping the drainage bag below the level of the bladder (and off the floor) is a critical step that prevents backflow and infection.
Transfer with a gait belt: apply the belt snugly over clothing, lock the wheels, stand on the resident's weak side, use a wide base, bent knees, and your legs (not your back).
Range-of-motion (ROM): support the joint above and below, move slowly and smoothly, and stop at the point of resistance or pain — forcing a joint is a critical failure.
Common Failure Traps
| Trap | Fix |
|---|---|
| Skipping or shortening hand hygiene | Always do or verbalize it first and last; it is always one of your five |
| Touching the floor or a dirty surface with clean linen | Keep linen and clean items off your body and the floor |
| Forgetting the call light before leaving | Make it the very last action of every skill |
| Not providing privacy or explaining the task | Build both into your standard opening for every skill |
| Rushing and skipping comfort or measurement steps | Slow down — you control the pace, the timer does not control you |
Practice each published skill aloud until it is automatic. The goal is muscle memory so that test-day nerves cannot erase a required step.
A Universal Opening and Closing for Every Skill
The smartest way to protect your indirect-care points is to run the same opening and closing on every skill, so they happen reflexively no matter which four random skills you draw. Memorize them as two short routines.
Opening (before the skill): knock and wait, greet and identify the resident by name, introduce yourself, explain what you will do, perform or verbalize hand hygiene, gather and arrange supplies, provide privacy (curtain/door and drape), and raise the bed to a safe working height.
Closing (after the skill): make the resident comfortable and ask if they need anything, lower the bed to its lowest position, place the call light within reach, open the curtain/return the room to order, dispose of soiled items correctly, and perform or verbalize hand hygiene again. Forgetting the closing — especially the call light — is the most common avoidable point loss.
Managing Time, Nerves, and Order
You have about 30 minutes for all five skills, and you control the pace. A smart strategy is to do the quick measurement and hygiene skills first so you bank time for the longer ones such as a transfer or perineal care. Read the instruction card carefully, plan your order, and do not panic at the five-minute warning — it means time to finish, not time to rush. If you realize you skipped a non-critical step, you may often go back and complete it; stay calm and keep moving rather than freezing.
Measurement Accuracy Is a Critical Step
Because one of your four random skills is always a measurement skill (radial pulse, respirations, electronic blood pressure, weight, or urine output), drill these until accurate and automatic. Count pulse and respirations for a full 60 seconds, keep the arm supported at heart level for blood pressure, read a graduate at eye level on a flat surface for urine output, and record the reading on the form — an unrecorded or inaccurate value fails the skill even when your technique looked correct. The reported number must fall within the evaluator's accepted tolerance, so practice with a real watch and real equipment, not from memory.
During the NNAAP skills evaluation in New Jersey, a candidate performs every step of indwelling catheter care correctly but forgets to secure the drainage bag below the level of the bladder. The candidate completes the remaining assigned skills well. What is the most likely result?
A New Jersey CNA candidate finishes measuring a resident's blood pressure accurately during the skills test, thanks the resident, and walks toward the evaluator to report the reading — leaving the resident in bed. What indirect-care point did the candidate most likely miss?
How many skills does a candidate perform on the NNAAP skills evaluation, and how is hand hygiene handled?