Making an Unoccupied Bed for CNAs: Step-by-Step Guide and Exam Tips

An unoccupied bed is made while the resident is out of the bed, which happens more often than you might expect during a shift. A resident may be sitting in a chair during morning care, eating in the dining room, walking the hallway, or away for a therapy appointment. Any time the bed is empty and the linen needs changing, you will use the unoccupied bed-making technique. The process is faster and easier than making an occupied bed because you can move freely around both sides of the mattress without working around the resident.

This skill is taught in every CNA program in the country, though it is not an officially tested NNAAP clinical skills exam skill the way hand washing or catheter care are. You will not be evaluated on it during your state certification skills test. However, you will do this task dozens of times per week as a working CNA, and programs include it in training because proper technique keeps residents comfortable, prevents skin breakdown, and follows infection control rules. Understanding the mitered corner, the toe pleat, and the differences between bed types will make you confident on the floor from your first day.

Why This Skill Matters in CNA Training

A correctly made bed is not just about appearance. Wrinkles and loose linen underneath a resident cause pressure on the skin, which over time contributes to pressure injuries (also called bedsores). For residents who spend many hours in bed, a smooth, tightly tucked bottom sheet is an actual skin protection measure. The toe pleat at the foot of the bed serves a similar purpose: sheets pulled tight against the tops of the toes can cause toe pressure injuries or discomfort. These are not details that exist for neatness. They exist because of real clinical harm that happens when they are skipped.

Infection control is the other reason technique matters. Soiled linen carries bacteria and pathogens. Shaking a soiled sheet releases those particles into the air where they land on surfaces and can be inhaled or transferred. Rolling soiled linen inward and placing it directly in a linen bag without setting it on the floor or draping it over the bedrail keeps contamination contained. Your CNA program will evaluate your infection control habits throughout lab practice even when this skill is not on the certification exam.

Three Types of Unoccupied Beds

Before you start, you need to know which type of bed you are making, because the finishing step is different for each:

• Closed bed: The top sheet, blanket, and spread are pulled all the way up to the head of the bed and tucked in neatly. A closed bed is made in a room that is currently unoccupied, meaning no resident is currently assigned to it. It signals that the room is ready but no one is moving in immediately.
• Open bed: The top linen is fan-folded toward the foot of the bed, leaving the bottom sheet exposed and the bed ready to get into. An open bed is made when a resident is expected back soon, such as after a meal or a therapy session. Most unoccupied bed-making in active care settings produces an open bed.
• Surgical bed (also called a post-op or stretcher bed): All top linen is fan-folded to one side of the bed so that a resident arriving on a stretcher can be slid into the bed without having to lift covers out of the way. This type is prepared when a resident is returning from a procedure and will be transferred from a stretcher rather than walking back to the room.

For most of your CNA training, you will practice the open bed, since that is what you make most often during a shift.

What You Need

• Bottom sheet (flat or fitted, depending on facility)
• Top sheet
• Blanket
• Bedspread (if used by the facility)
• Pillowcase
• Linen bag or hamper
• Disposable gloves (for removing soiled linen)

Step-by-Step: Making an Unoccupied Bed

1. Wash your hands. Begin every skill with hand hygiene. This is a habit that must become automatic before you start working with residents.
2. Gather clean linen and place it on a clean surface. Collect all the linen you need before entering the room, or gather it at the start of your linen run. Stack items in the order you will use them, with the bottom sheet on top. Place the stack on a clean chair or clean countertop in the room. Never place clean linen on the floor or on another resident's bed.
3. Apply gloves. Put on disposable gloves before handling soiled linen. Linen that has been against a resident's body is considered contaminated.
4. Remove soiled linen from top to bottom. Start with the bedspread, then the blanket, then the top sheet, and finally the bottom sheet. Roll each piece inward as you remove it, so the soiled inner surface is hidden inside the roll. Do not shake linen at any point. Shaking releases bacteria and dust into the air. Set nothing on the floor. Place each piece directly into the linen bag or hamper as you remove it.
5. Remove the pillowcase. Turn the pillowcase inside out over your hand, gather it off the pillow in one motion so the soiled side stays inside, and place it in the hamper. Set the pillow on a clean chair while you work.
6. Apply the bottom sheet. Unfold the bottom sheet and center it on the mattress. If using a flat sheet, align the center fold line with the center of the mattress. Pull enough of the top edge over the head of the mattress to tuck generously underneath.
7. Form a mitered corner at the head. This is the most important technique step in unoccupied bed-making. After tucking the top edge of the sheet under the head of the mattress, stand at the top corner of the bed. Lift the side of the sheet up about 12 inches, so the sheet forms a triangular flap. Hold the flap against the side of the mattress with one hand. With your other hand, tuck the hanging portion of the sheet that is below the flap under the mattress. Now fold the triangular flap down over the corner you just tucked, and tuck it under the mattress as well. When done correctly, the corner looks like a tightly folded envelope. A mitered corner holds far better than a simple tuck and keeps the sheet smooth under the resident.
8. Tuck the bottom sheet along the side and form a mitered corner at the foot. Pull the sheet tight from head to foot along one side, smoothing out any wrinkles, and tuck the entire side under the mattress. Form a second mitered corner at the foot of the bed on this side. Move to the other side of the bed and repeat: tuck the head corner (mitered), pull tight along the side, tuck the side, and form a mitered corner at the foot.
9. Apply the top sheet. Spread the top sheet with the wide hem at the head of the bed, face down (the finished side of the hem should face up when the cuff is folded back in a later step). Center it on the bed and leave the top edge even with the top of the mattress.
10. Apply the blanket and bedspread. Place the blanket on top of the sheet, centered, with the top edge about 6 inches below the head of the mattress. Add the bedspread if your facility uses one. The 6-inch gap allows you to fold the top sheet back over the blanket and bedspread to create a clean, finished cuff at the head of the bed.
11. Make a toe pleat. At the foot of the bed, lift the top sheet and blanket together and make a horizontal fold of about 3 to 6 inches straight across the bed. Press the fold toward the foot of the mattress. This creates a pocket of slack in the linen over the toes. Without this pleat, the top linen pulls tight against the tops of the feet when tucked in, which puts pressure on the toes for hours at a time. The toe pleat prevents this.
12. Tuck the foot and form mitered corners. Tuck the top sheet, blanket, and bedspread together under the foot of the mattress. Form a mitered corner on each bottom corner, as you did with the bottom sheet.
13. Fold back the cuff at the head. At the head of the bed, fold the top edge of the top sheet back over the blanket and spread to create a neat 6-inch cuff. This exposes a clean, smooth surface for the resident's face to rest against rather than the blanket fabric.
14. Change the pillowcase. Hold the pillow at its center. Turn the new pillowcase inside out over your dominant hand. Grasp the center of the pillow through the pillowcase fabric, then pull the case right-side out over the pillow in one smooth motion. Position the pillow at the head of the bed with the open end of the pillowcase facing away from the door. This is a traditional positioning choice that keeps the open end out of the sightline when entering the room.
15. Fan-fold the top linen for an open bed. Starting at the head cuff, grasp the top linen and fold it back toward the foot in even accordion folds, stopping about halfway down the bed. This opens the bed for easy resident entry. The bottom sheet is now fully visible from the head of the bed to the midpoint.
16. Remove gloves and wash hands. Peel off gloves by rolling them inside out, dispose of them, and wash hands. Contaminated gloves were touching soiled linen throughout this process.

What Instructors and Evaluators Look For

• Gloves are applied before removing soiled linen
• Soiled linen is rolled inward and placed directly in the hamper, not shaken or set on the floor
• Clean linen is placed on a clean surface, not the floor
• Mitered corners are formed at all applicable corners of the bottom sheet
• The bottom sheet is smooth and tightly tucked with no wrinkles
• A toe pleat is made in the top linen at the foot of the bed
• The cuff at the head is neat and even
• Pillowcase is changed and pillow is positioned correctly
• Top linen is fan-folded for an open bed (if that is the type being made)
• Hands are washed after removing gloves

Common Mistakes to Avoid

• Shaking soiled linen. This is an infection control violation. Rolling linen inward before removing it contains any contamination within the bundle. Shaking it releases airborne particles that can spread pathogens throughout the room.
• Setting soiled linen on the floor. The floor is one of the most contaminated surfaces in any healthcare setting. Nothing clean should touch it, and soiled linen set on the floor picks up additional contamination before going in the hamper.
• Skipping the mitered corner. A simple tuck at the corner allows the sheet to loosen and slide out quickly, leaving the mattress exposed and wrinkled under the resident. The mitered corner creates a locked, flat corner that holds throughout the shift.
• Forgetting the toe pleat. Top linen tucked tightly at the foot without a pleat creates continuous downward pressure on the tops of the toes. For residents who spend hours in bed, this is a real source of discomfort and a contributing factor to toe pressure injuries.
• Placing clean linen on the floor or on another resident's bed. Clean linen must go on a clean surface only. Using the floor, a bedrail, or a neighboring bed contaminates the linen before it is even applied.
• Not smoothing the bottom sheet before applying top linen. Every wrinkle in the bottom sheet becomes a pressure point against the resident's skin during the hours they spend in bed. Take an extra few seconds to pull the sheet tight and smooth before moving on.

Printable Practice Checklist

Use this checklist when practicing in your lab or at home. Check off each step as you complete it.

1. Washed hands
2. Gathered clean linen and placed on clean surface
3. Applied gloves
4. Removed bedspread (rolled inward, placed in hamper)
5. Removed blanket (rolled inward, placed in hamper)
6. Removed top sheet (rolled inward, placed in hamper)
7. Removed bottom sheet (rolled inward, placed in hamper)
8. Removed and discarded pillowcase
9. Applied bottom sheet centered on mattress
10. Tucked top edge under mattress at head
11. Formed mitered corner at head on first side
12. Tucked side of bottom sheet from head to foot
13. Formed mitered corner at foot on first side
14. Moved to other side and repeated mitered corners and side tuck
15. Smoothed bottom sheet with no wrinkles
16. Applied top sheet (wide hem at head, face down)
17. Applied blanket (top edge 6 inches below head of mattress)
18. Made toe pleat at foot of bed
19. Tucked foot under mattress and formed mitered corners
20. Folded top sheet cuff back over blanket at head
21. Changed pillowcase and placed pillow at head of bed
22. Fan-folded top linen toward foot for open bed
23. Removed gloves
24. Washed hands

Mitered corners and proper sheet tucking are easier to learn in person than from written steps. Find a CNA program in your state with a skills lab where you can practice bed making.

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