Prometric CNA State Exam: Opening Steps

The opening steps, also called pre-stepsopening procedures and beginning steps, are the steps a nursing assistant takes before starting a direct patient care skill at the CNA state exam. Even though a solid knowledge of the opening steps is needed to pass the hands-on skills evaluation portion of nursing assistant certification examinations in most states, these measures also have usefulness in real-world healthcare settings when giving direct patient care.

The opening steps must be the very first steps the nursing assistant performs before moving into the actual part of any patient care procedural skill (Tanner, 2020). Prior to starting a procedural skill at the state certification exam to become a certified nurse aide, the test taker must take eight specific actions as part of the opening steps. These steps include knocking, introducing oneself, identifying the patient, describing the skill, obtaining consent, providing privacy measures, washing one’s hands, and gathering clean supplies.

The opening steps are tightly related to the four connected concepts of safety, privacy, comfort and infection control. Nursing assistants are entrusted with the important duty of keeping their patients and residents safe, comfortable and cleanly while upholding their privacy at all times. To quickly recall the four concepts, it is extremely useful to use the acronym P.I.C.S., which stands for Privacy + Infection Control + Comfort + Safety

Repeated in a somewhat different way, the certified nursing assistant’s role revolves around keeping all of their patients safe, ensuring their comfort, upholding their privacy, and protecting them from preventable healthcare-acquired infections whenever patient care tasks are completed. The individual measures that comprise the opening steps are listed below.

  • Knock
  • Introduce Oneself
  • Identify the Patient
  • Describe the Skill
  • Obtain Consent
  • Provide Privacy
  • Wash Hands
  • Gather Clean Supplies

Always be very mindful that the opening steps require outstanding communication skills on the part of the nursing assistant. A normal opening steps announcement sounds really similar to this: “Knock, knock. Good morning, Mrs. Taylor! My name is Ronald and I will be your nursing assistant today. I am going to assist you with using the bedpan. Is that okay? Alright! I will provide you with some privacy, wash my hands, gather supplies and start in just a moment.”

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