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.”

CNA/Nursing Assistant Scope of Practice

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Nursing assistants must possess a firm understanding of their scope of practice to deliver the safest care. In the simplest terms, scope of practice means staying in one’s lane without deviation, or sticking to the tasks one is permitted to do. In more official phrasing, scope of practice dictates the tasks and workplace duties that a trained healthcare worker is deemed competent to perform and allowed to engage in, under the terms of his or her professional license and/or certification.

Why is the concept of scope of practice something that nursing assistants must know about? Scope of practice legally determines what types of procedures nursing assistants can and cannot do. Scope of practice is the fine line between what nursing assistants are permitted to do versus the tasks that are not legally permissible for them to do. Each state’s nurse aide certification registry and/or board of nursing has documentation with activities that fall into the scope of practice for nursing assistants. 

Therefore, nursing assistants who complete tasks that are not included on the documented range of acceptable activities may be held liable for poor outcomes to patients and/or lose their state-issued certifications. This is because they did not follow the predetermined scope of practice for the state in which they work. In other words, nursing assistants who do not stay in their lane and work outside their scope may suffer the consequences of their decisions.

A nursing assistant helps the nursing team within a limited scope of care duties and responsibilities under a licensed nurse’s supervision (PracticalNursing.Org, 2020). As a multifaceted allied healthcare worker, a nursing assistant is allowed to perform a variety of tasks and duties. Most nursing assistants secure employment in positions that involve direct care tasks at the patient’s bedside. A nursing assistant’s workplace responsibilities may include (PracticalNursing.Org):

  • Answering patient call lights
  • Serving and feeding patient meals
  • Transporting patients
  • Making beds
  • Cleaning up patient rooms
  • Reporting changes in condition to nursing staff
  • Assisting with elimination, also known as toileting
  • Turning and positioning patients
  • Assisting with ambulation (walking)
  • Measuring and recording vital signs
  • Activities of daily living such as bathing and dressing
  • Following the patient’s predetermined care plan
  • Performing personal care such as foot care and back rubs


PracticalNursing.Org. (2020). Licensed Practical Nurse (LPN) Vs. Certified Nursing Assistant (CNA). Retrieved December 17, 2020 from