Reference check questions for certified nursing assistants

A certified nursing assistant gives much of the hands-on care in a nursing home and on many hospital units: bathing, feeding, toileting, turning and moving residents and patients, and answering call lights. The nurse relies on what the aide sees. An aide who notices that a resident has stopped drinking or has a red heel gives the nurse time to act. One who does not leaves the problem to surface later as a wound or a fall.

The nurse aide registry tells you whether the aide is certified. It cannot tell you whether they use the lift when the care plan calls for one, answer a call light that is not on their assignment, or speak to a resident with dementia as the adult they are. The nurses and instructors who watched them work can.

Who to ask

• The charge nurse or nurse supervisor who made the aide’s assignments and checked on their residents.
• The staff development coordinator or director of nursing, for in-service attendance, skills checks and any retraining.
• The clinical instructor from the aide’s training program, for a newly certified CNA without a work history.
• For a hospital role, the nurse manager or a nurse who shared many of their shifts.

Questions to ask, by competency

Choose the competencies that matter most for the position and two or three questions from each. Ask every reference the same set, and when an answer is a rating, ask for the example behind it.

Transfers and mobility

Moving residents is where a hurried shortcut can injure a resident or the aide, and the pull toward shortcuts grows when the floor is busy.

1. When a resident’s care plan called for a mechanical lift or two staff, did the candidate wait for one even when the hall was busy?
2. Tell me about a time a resident began to slide or lose their footing during a transfer the candidate was doing. What did they do?
3. On a scale from 1 to 5, how safely does the candidate move and reposition residents, and what did you see that sets that score? (rating)

Reporting to the nurse

Changes in skin, intake and behavior usually show up first during hands-on care, and they help only if the nurse hears about them before the shift ends.

1. How did the candidate tell you about a resident who was eating less, refusing fluids or more confused than usual: right away, at the end of the shift or only in the chart?
2. How accurate were the candidate’s entries for meals, fluids, vital signs and toileting in the documentation system?
3. Did you ever learn about a skin tear, a fall or a refused shower from someone else when the candidate should have told you?

Dignity and resident rights

For a resident, the aide is the person who closes the curtain, knocks before entering and asks what they would like to wear.

1. How did the candidate protect a resident’s privacy and choices during bathing, dressing and toileting?
2. How did the candidate respond to a resident who hit, scratched or shouted at them during care?
3. Did the candidate know the facility’s steps for reporting suspected abuse or neglect, and did you ever see them follow those steps?

Teamwork on a short-staffed floor

When an aide calls off, the others absorb the extra residents, and those shifts show more about the candidate than a fully staffed one.

1. Tell me about a shift when the unit was short an aide. Which residents did the candidate see to first, and did anything get missed?
2. How often did the candidate answer call lights for residents who were not on their assignment?
3. How dependable was the candidate’s attendance, including the weekends and holidays they were scheduled to work?

Close the reference

End every reference the same way: ask whether they would hire or work with the candidate again and why, what support would help the candidate do their best work, and whether there is anything else you should know. The general question bank explains why the first of these matters most.

Checks a reference does not replace

• The nurse aide registry. For Medicare- or Medicaid-certified nursing homes, check the work state and seek information from every other state registry the facility believes may hold information on the aide, including all known prior residence and employment states. Under 42 CFR 483.35(d)(4), competency verification has limited exceptions; (d)(5) requires multi-state inquiries before the aide serves. In other settings, confirm the state and setting requirements.
• The federal exclusion list. The HHS Office of Inspector General advises health care employers to check its exclusion list before hiring and periodically after, because employing an excluded person can bring civil monetary penalties.
• The background check your state requires. Rules differ by state and setting. CMS’s National Background Check Program has supported checks on direct patient access employees of long-term care providers in the states that joined it.

Warning signs to follow up

• A charge nurse who calls the candidate fast but cannot describe how they handled a transfer, a refusal or a resident in distress.
• A registry status, name or certification date that does not match what the candidate told you.
• A reference who answers everything else freely but goes quiet when you ask how the candidate treated residents.
• Every reference is another aide, and no nurse who assigned the candidate’s residents is on the list.

One warning sign is a reason to ask another question, not a verdict. Reference check red flags covers how to check a concern fairly.

Questions to leave out

Ask only about the work. Before an offer, the EEOC’s guidance says an employer may not ask a third party, such as a former employer, any question it could not ask the candidate directly. Leave out health, medical leave, age, family plans and other protected characteristics. What to leave out has the full list.

This article is general information, not legal advice. Confirm the requirements that apply to your organization, and in your state, with your counsel or HR policy office.