Skills Evaluation Format & Key Steps

Skills Evaluation Format & Key Steps

The Skills Evaluation is the practical, hands-on portion of the Oregon Certified Nursing Assistant (CNA) exam. It requires candidates to demonstrate clinical safety, technical proficiency, and professional communication in a simulated patient care environment. Conducted under the watchful eye of an RN Test Observer, this evaluation measures not just what you know, but how safely and respectfully you perform direct patient care.

Skills Test Design and Environment

The skills exam is held at a designated regional test site. The testing room is set up to mirror a resident's room in a long-term care facility, complete with a hospital bed, call light, bedside table, privacy curtain, wheelchair, sink, and various care supplies (such as basins, towels, gowns, and measuring devices).

Three individuals are present in the room during your evaluation:

1. The Candidate: You, the person being tested.
2. The RN Test Observer: The evaluator who observes your performance and marks off steps on a checklist. The observer will not offer help, prompts, or feedback during the exam.
3. The Actor or Model: A real person (usually another candidate or a volunteer) who plays the role of the resident. You must treat this person as a living, breathing resident who deserves dignity, privacy, and clear communication.

Test Duration and Task Selection

• Number of Tasks: Candidates are assigned a set of 3 or 4 tasks to demonstrate.
• Time Limit: The entire evaluation takes between 30 to 40 minutes. The exact time limit is displayed on your instruction card and is determined by the specific skill set randomly assigned to you by the TMU computer system.
• The Mandatory Task: Handwashing is always evaluated. It is typically the first task you must perform, or it is embedded as the initial step of another skill (such as perineal care). Because hand hygiene is the cornerstone of infection control, it is graded with extreme detail.

Passing Criteria and the Concept of Key Steps

To pass the Skills Evaluation, candidates must meet two strict criteria simultaneously. Failing either of these criteria will result in failing the entire skills exam:

1. 80% Minimum Score Per Task: You must correctly perform at least 80% of the total steps within each of your assigned tasks. Doing well on three tasks cannot compensate for scoring 70% on a fourth task.
2. 100% of Bolded Key Steps: Every task has specific steps that are bolded and underlined in the Headmaster candidate handbook. These are Key Steps (also known as critical safety steps). Key steps represent actions that directly affect client safety, privacy, infection control, or legal rights. If you miss a single bolded key step on any task, you fail that task and the entire skills exam, regardless of your overall percentage score.

Examples of Bolded Key Steps

• Locking the wheelchair brakes and bed brakes before transferring a resident.
• Checking the temperature of warm water and asking the client to verify that it is comfortable before applying it to their skin.
• Ensuring the resident's call light is within reach before leaving the room.
• Washing your hands with soap and water for a minimum of 20 seconds, using friction, without touching the inside of the sink.
• Placing a barrier (such as a clean towel) on the bedside table before placing clean supplies on it.

Skills Retake Fee

If you do not pass the skills evaluation, you must register for a retake in TMU. The fee for retaking the skills portion of the exam is $45.

Crucial Strategies for Success

The clinical environment can be stressful, but employing specific strategies can help you maintain focus and perform each task safely.

The Power of Communication

Even though you are working with an actor, you must maintain excellent interpersonal communication. Evaluators look for these communication milestones:

• Knock on the door and wait for permission to enter.
• Introduce yourself by name and state your role (e.g., "Hi, my name is John, and I'll be your nursing assistant today").
• Identify the resident by checking their ID band and calling them by their preferred name.
• Explain the procedure in plain language before starting (e.g., "I'm going to help you brush your teeth now, is that okay?").
• Check for comfort and safety throughout the skill, asking if they are comfortable or if they need anything adjusted.
• Provide privacy by closing the door or pulling the privacy curtain before exposing any part of the client's body.

Correcting Mistakes During a Task

One of the most generous rules of the Headmaster skills exam is the mistake correction protocol. Candidates are allowed to correct any step they realize they performed incorrectly, provided they follow these rules:

1. You must realize the mistake yourself. The RN Test Observer cannot point it out.
2. You must verbally state to the evaluator: "I want to correct a step on the task I am currently performing."
3. You must physically go back and perform the step correctly.
4. Timing is critical: You can only make corrections during the active task. Once you have verbally declared to the observer, "I have completed my task," and moved on to the next skill, you cannot go back to correct a previous task.

The Beginning and Ending Procedures

Every single task follows a standard sequence of steps at the beginning and the end. Memorizing these "bookends" ensures you do not lose easy points:

• Beginning Procedure (Indirect Care): Knock, introduce yourself, identify the client, explain the procedure, wash your hands (or use hand sanitizer depending on the task), assemble supplies, pull the privacy curtain, and lock bed/wheelchair wheels.
• Ending Procedure (Indirect Care): Ensure the client is comfortable, place the call light in their hand, lower the bed to its lowest safe position, open the privacy curtain, dispose of dirty supplies/linens in the proper containers, wash your hands, and record/report if required by the task.