Toileting Assistance and Bedpan Use for CNAs: Step-by-Step Guide and Exam Tips

Toileting assistance is one of the most personal and sensitive skills a CNA performs. For a resident who cannot get out of bed to use the toilet, a bedpan is how they eliminate waste. Your job is to make this process as private, comfortable, and dignified as possible while following the clinical steps that keep the resident safe and allow the care team to monitor their urinary and bowel output. This skill is an official NNAAP exam skill, and examiners watch closely for both technique and respect for the resident's dignity throughout.

If you have never seen a bedpan before, it is a molded plastic or metal pan shaped to fit under the buttocks while the resident lies in bed. The resident sits on it much as they would on a toilet seat, but while lying at a slight angle rather than sitting upright. Once use is complete, the CNA removes the pan, measures and observes the contents, documents the output, and completes perineal care. Every step in this process matters for the resident's health and comfort.

Why This Skill Matters on the CNA Exam

Measuring and recording urinary output is not a formality. The care team uses output data to detect dehydration, kidney problems, urinary tract infections, and medication side effects. A resident whose output drops sharply, changes color, or develops an unusual odor may be developing a serious condition. CNAs are the people who observe these changes first, and documentation is how that observation reaches the nurse and physician.

The positioning required for bedpan use also has a clinical rationale. Raising the head of the bed to 30 to 45 degrees and asking the resident to bend their knees uses gravity to assist voiding and defecation. Voiding while lying completely flat is difficult and uncomfortable for most people, and it increases the time the resident spends on the pan.

The examiner also evaluates whether you respond promptly when the resident calls for pan removal. Leaving someone on a bedpan for an extended time puts continuous pressure on the sacrum and coccyx, the bony area at the base of the spine that contacts the pan. This is a high-risk area for pressure injuries, and prolonged contact with a bedpan is a known contributing factor.

Two Types of Bedpan

You need to know both types before your exam:

• Standard bedpan: The most common type. It is larger and has a rounded contour. The flat, wider end is placed under the buttocks, and the narrower curved end faces forward. This type works for most residents who can lift their buttocks off the mattress to allow proper placement.
• Fracture pan (also called a slipper pan): This is a smaller, flatter pan with a lower profile. It is used for residents who cannot lift their buttocks, such as those in hip spica casts, with hip fractures, or in traction. The thin, flat end slides under the buttocks from the side or front without requiring the resident to raise their hips significantly. Despite its name, it is used any time elevation of the hips is contraindicated or difficult, not just for fractures.

What You Need

• Bedpan (standard or fracture pan, appropriate for the resident)
• Bedpan cover
• Toilet tissue
• Graduate (a plastic measuring container marked in milliliters, used for measuring urine)
• Disposable gloves
• Supplies for perineal care (washcloth, basin, warm water)
• Call light

Step-by-Step: Toileting Assistance with a Bedpan

1. Wash your hands. Perform hand hygiene before gathering supplies or entering the resident's room.
2. Gather supplies. Collect the bedpan, bedpan cover, toilet tissue, graduate, gloves, and any supplies needed for perineal care. Having everything ready before you begin means you will not have to leave the resident mid-procedure.
3. Identify the resident. Check the resident's name band when you enter the room.
4. Explain the procedure. Tell the resident what you are going to do. This respects their right to know about their own care and helps them cooperate with positioning.
5. Provide privacy. Close the room door and draw all curtains fully around the bed. Toileting is among the most private activities a person performs. Do not skip or rush this step.
6. Apply gloves. Put on disposable gloves before handling the bedpan or touching the resident for this procedure.
7. Warm a metal bedpan if applicable. Most modern bedpans are plastic and do not require warming. If your facility uses metal bedpans, run warm water over the pan and dry it before placing it. Cold metal against skin causes a startle reflex that can be painful and distressing for the resident.
8. Position the resident. Raise the head of the bed to 30 to 45 degrees. Ask the resident to bend their knees and place their feet flat on the mattress. This position assists with voiding and allows the hips to lift more easily.
9. Place the bedpan.
   • If the resident can lift: Ask them to press their feet into the mattress and raise their hips. Slide the standard bedpan under the buttocks with the wider, rounded end beneath the resident and the narrower end toward the front. Ensure the pan is centered.
   • If the resident cannot lift: Roll the resident to one side away from you, holding the pan against their buttocks. Roll them back onto the pan. Check that the pan is centered and properly positioned before releasing the resident.
10. Raise the head of the bed slightly and cover the resident. Raise the head of the bed to a comfortable position for toileting (up to 45 degrees). Replace the top covers over the resident for privacy and warmth.
11. Place toilet tissue within reach and provide the call light. Make sure the resident can reach both without stretching or straining. Explain that you will leave to give them privacy and will return as soon as they signal. Step out of the room or behind the curtain, stay close enough to hear the call light.
12. Respond promptly when the resident calls. Return to the room as soon as the call light activates. Do not delay. If you are with another resident when the light goes on, arrange for a colleague to respond. Prolonged bedpan use is uncomfortable and contributes to pressure injury.
13. Apply gloves if you removed them. Put on fresh gloves before handling the bedpan and performing perineal care.
14. Remove the bedpan carefully. Ask the resident to press their feet into the mattress and lift their hips if possible. Hold the bedpan level as you slide it out from under the resident. If the resident cannot lift, roll them to the side while you hold the pan level, then remove it. Spilling the contents is an infection control issue and is distressing for the resident. Cover the bedpan immediately with the bedpan cover and set it aside on a protected surface.
15. Provide perineal care. Use toilet tissue first to clean the perineal area. Then perform perineal hygiene with a washcloth, warm water, and cleanser as needed. Always clean from front to back for female residents to prevent fecal bacteria from entering the urethra. See the Perineal Care lesson for detailed technique.
16. Assist the resident to wash their hands. Offer a damp washcloth or walk the resident to the sink if they are able to get up after toileting. Hand washing after toileting is standard hygiene.
17. Ensure the resident is comfortable. Lower the head of the bed to the resident's preferred position, smooth the linen, and ensure the call light is within reach before leaving the bedside.
18. Take the covered bedpan to the bathroom. Carry the covered bedpan to the bathroom without uncovering it in the room.
19. Measure and observe urine. Pour the urine into a graduate. Read the amount in milliliters by looking at the measurement scale at eye level, with the bottom of the liquid curve (called the meniscus) aligned with the scale marking. Record the volume. While measuring, note: the color (pale yellow is normal, dark amber may indicate dehydration, orange or pink may indicate blood), the clarity (clear versus cloudy), the odor (unusually strong or foul odor can indicate infection), and the presence of any unusual material. Report any abnormal findings to the nurse promptly.
20. Clean and store the bedpan. Empty, rinse, and clean the bedpan per facility policy. Return it to the designated storage location, typically the resident's bedside cabinet or a shelf in the bathroom. Each resident has their own bedpan, labeled with their name, to prevent cross-contamination.
21. Remove gloves and wash hands. Remove gloves by rolling them inside out, dispose of them, and perform hand hygiene.
22. Document output. Record the amount of urine in the intake and output record. Note the time, amount in mL, and any observations about color, odor, or clarity. Report any concerning findings to the nurse.

What the Examiner Looks For

• Privacy is provided with both door and curtain before starting
• Gloves are applied before any contact with the bedpan or the resident
• Head of bed is raised to 30 to 45 degrees for placement
• Bedpan is centered correctly under the resident
• Call light is placed in the resident's hand before the CNA steps away
• Bedpan is removed level and covered immediately
• Perineal care is provided after removal
• Resident's hands are cleaned after toileting
• Urine is measured in a graduate and recorded accurately
• Output is documented with time, amount, and any observations
• Bedpan is cleaned and stored appropriately
• Gloves are removed and hands washed at the end

Common Mistakes to Avoid

• Not providing full privacy. Closing only the curtain while leaving the door open, or partially drawing the curtain, does not give the resident adequate privacy for a personal hygiene activity. Close the door and draw all curtains fully.
• Leaving the resident on the bedpan too long. Once a resident is on the bedpan, you must stay within earshot and respond immediately to the call light. Prolonged bedpan use causes pressure on bony prominences and is painful.
• Not measuring or recording output. Carrying the bedpan to the toilet and emptying it without measuring is a documentation failure. Output data is a critical part of the resident's medical record and can signal serious health changes.
• Not observing urine before discarding it. Color, clarity, and odor changes in urine can be early warning signs of dehydration, infection, or kidney problems. Look before you empty the pan.
• Not performing perineal care after bedpan removal. The perineal area may have been contaminated during bedpan use. Skipping or rushing perineal care increases infection risk and leaves the resident uncomfortable.
• Spilling bedpan contents during removal. Tipping the pan during removal causes unnecessary contamination of the bed linen, the resident, and the work surface. Keep the pan level throughout removal and transport.

Printable Practice Checklist

Use this checklist when practicing with a lab partner. Check off each step as you complete it.

1. Washed hands
2. Gathered all supplies
3. Identified resident
4. Explained procedure
5. Closed door and drew curtains for full privacy
6. Applied gloves
7. Raised head of bed to 30 to 45 degrees
8. Asked resident to bend knees
9. Placed bedpan correctly (wide end under buttocks)
10. Covered resident and raised head of bed to comfortable position
11. Placed toilet tissue within reach
12. Put call light in resident's hand
13. Provided privacy, stayed close
14. Responded promptly to call light
15. Applied fresh gloves
16. Removed bedpan level and covered immediately
17. Provided perineal care
18. Assisted resident to wash hands
19. Ensured resident comfort and lowered bed
20. Measured urine in graduate at eye level
21. Observed urine: color, clarity, odor
22. Recorded output with time and amount
23. Cleaned and stored bedpan
24. Removed gloves and washed hands
25. Reported any abnormal observations to nurse

Toileting assistance is one of the skills that benefits most from supervised practice in a skills lab. Find CNA programs near you to get that training before your exam.

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