Updated Nurse Aide Program Policy Manual Published

Updated Nurse Aide Program Policy Manual Published
Office of Health Facility
Licensure & Certification
Effective Date: May 2016
Nurse Aide Program
Policy Manual
Contents
How to Use this Manual................................................................................................................................ 4
Purpose ......................................................................................................................................................... 4
Administration .............................................................................................................................................. 4
Requirements................................................................................................................................................ 4
Instructional Program ................................................................................................................................... 5
Program Approval ......................................................................................................................................... 5
Application ................................................................................................................................................ 5
Action by the OHFLAC-NAP ....................................................................................................................... 6
Program Identifier ................................................................................................................................. 6
Post-Approval Review and Monitoring ................................................................................................. 6
Enforcement ......................................................................................................................................... 7
Federal Prohibition of Program Approval ............................................................................................. 7
Federal Waiver of Prohibition of Nurse Aide Training Program ........................................................... 8
Withdrawal of Approval ........................................................................................................................ 8
Program Monitoring ..................................................................................................................................... 9
On-Site Reviews and Surveys .................................................................................................................... 9
Suspension and Revocation ...................................................................................................................... 9
Program Operation ....................................................................................................................................... 9
Class Setting and Size .......................................................................................................................... 10
Clinical Setting ..................................................................................................................................... 10
Clock Hour Requirements ................................................................................................................... 13
Expectations for Record Retention ..................................................................................................... 13
Skills Performance Record .................................................................................................................. 13
Student Absenteeism .......................................................................................................................... 14
Instructor Absenteeism....................................................................................................................... 14
Textbooks ............................................................................................................................................ 14
Grades ................................................................................................................................................. 14
Classroom Laboratory Requirements ................................................................................................. 15
Documentation ................................................................................................................................... 15
Clinical Requirements ......................................................................................................................... 16
Complaint File ..................................................................................................................................... 16
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Instructor Availability and Accessibility .............................................................................................. 16
Facility-Based Programs ...................................................................................................................... 17
Notification of Substantial Changes in the Program ........................................................................... 17
Student Clinical Orientation ................................................................................................................ 17
Class Orientation ................................................................................................................................. 18
Charging For Nurse Aide Education and Testing......................................................................................... 18
Program Faculty .......................................................................................................................................... 19
Program Director ................................................................................................................................ 19
Primary or Program Instructor ............................................................................................................ 19
Coordinator Instructor ........................................................................................................................ 20
Resource Instructors ........................................................................................................................... 20
Clinical Instructor ................................................................................................................................ 20
Refresher Instructor ............................................................................................................................ 21
Faculty Active Status ........................................................................................................................... 21
Application Requirements for Faculty .................................................................................................... 21
Educate-the-Educator Workshop ........................................................................................................... 21
Reporting Program Changes ................................................................................................................... 22
Student Nurses............................................................................................................................................ 22
Eligibility Requirements ...................................................................................................................... 22
Nurse Aide Registry ..................................................................................................................................... 23
Establishment of the Registry ............................................................................................................. 23
Registry Content ................................................................................................................................. 24
Inclusion on the Registry ..................................................................................................................... 24
Transfer to Other States ..................................................................................................................... 25
Reporting a Change ............................................................................................................................. 25
Reportable Nurse Aide Employment .................................................................................................. 25
Renewal or Reregistration Application Requirements ....................................................................... 26
Competency Examination (Testing) .................................................................................................... 26
Refresher Course................................................................................................................................. 27
Alternative Sanction............................................................................................................................ 28
Facility Employment Requirements .................................................................................................... 28
Nurse Aide Retraining ......................................................................................................................... 29
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Facility In-Service Requirement .......................................................................................................... 29
West Virginia Clearance for Access: Registry and Employment Screening (WV CARES) ............................ 29
What is WV CARES? ................................................................................................................................ 29
Nurse Aide Competency Evaluation ........................................................................................................... 30
Testing Vendor .................................................................................................................................... 30
Demonstration of Skills ....................................................................................................................... 30
Administration of the Competency Evaluation................................................................................... 30
Oral Competency Evaluation .............................................................................................................. 30
Successful Completion of the Competency Evaluation Program........................................................ 30
Unsuccessful Completion of the Competency Evaluation Program ................................................... 31
Evaluator Qualifications ...................................................................................................................... 31
Testing Site Criteria ............................................................................................................................. 31
Regional Test Site ................................................................................................................................ 31
In-Facility Test Site .............................................................................................................................. 32
Appendix A: Commonly Used Acronyms ................................................................................................... 33
Appendix B: Glossary of Terms .................................................................................................................. 34
Appendix D: Contact .................................................................................................................................. 37
Appendix E: Minimum Curriculum Requirements ..................................................................................... 38
Orientation .............................................................................................................................................. 38
Communication and Social Interaction ................................................................................................... 38
Basic Nursing Skills .................................................................................................................................. 39
Personal Care Skills ................................................................................................................................. 40
Basic Restorative Services ....................................................................................................................... 41
Rights of Residents .................................................................................................................................. 41
Dementia................................................................................................................................................. 42
Appendix F: Skills Performance Tasks ........................................................................................................ 43
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How to Use this Manual
This manual incorporates and replaces all manuals, program instructions, memorandums, and other
printed materials about the Nurse Aide Program previously issued by the Office of Health Facility Licensure
and Certification.

Appendix A contains a list of frequently used acronyms.

Appendix B contains a glossary of terms.

Appendix C contains a list of resources.

Appendix D contains specific contact information for the West Virginia Nurse Aide Program.
Please refer to this to direct your questions and general inquiries.

Appendix E contains the minimum curriculum requirements for a nurse aide training and
competency program.

Appendix F contains the skills performance list.
Forms referenced in this manual can be found at: ohflac.wv.gov
Purpose
The purpose of this manual is to provide detailed information about the nurse aide training and
competency evaluation program (NATCEP) regulations, and the Nurse Aide Abuse and Neglect Registry in
West Virginia. This manual is intended to assist nurse aide training program instructors, competency
evaluation program examiners, and nurse aides in understanding their roles and responsibilities.
Administration
The NATCEP was established under the federal Omnibus Reconciliation Act (OBRA) of 1987, 1990, and
1999. This Act requires states to establish a NATCEP and maintain a long-term care nurse aide registry by
coordinating the following activities:
1. Approve and monitor the nurse aide training programs;
2. Oversee the nurse aide competency evaluation program;
3. Manage the Nurse Aide Abuse and Neglect Registry; and
4. Authorize the renewal process for nurse aides.
The NATCEP is managed by the Office of Health Facility Licensure and Certification (OHFLAC) Nurse Aide
Program (NAP) within the West Virginia Department of Health and Human Resources (WVDHHR).
Requirements
1. All providers conducting nurse aide training programs must be approved by the OHFLAC-NAP;
2. All Medicare and/or Medicaid certified nursing facilities have the potential to serve as clinical sites
and/or offer the instructional training program. Nursing homes that are not Medicare/Medicaid
certified are not eligible.
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3. Each area vocational center, community college, or nursing facility conducting nurse aide training
programs must designate a qualified registered professional nurse (RN) to oversee training and
instruction and a program director.
4. Each program must have a primary instructor and clinical instructor. The program director and
the primary instructor cannot be the same person. The responsibilities related to the program
are distinctively different.
5. There must be valid contact phone number, mailing address, email and fax number for the
program director and instructors provided.
Instructional Program
An instructional program is a training program for nurse aides approved by the OHFLAC-NAP. The purpose
of an instructional program is to provide a basic level of both knowledge and demonstrable skills for
individuals who provide nursing-related services to residents in the nursing home setting, and who are
not licensed health professionals or volunteers who provide services without monetary compensation.
Each nurse aide training program must be competency based. The program must contain behavioral
objectives for each unit of instruction. Each objective must state performance criteria which are
measureable and which will serve as the basis for the competency evaluation. The objectives must be
reviewed at the beginning of each unit so the students have an understanding of what is expected.
The goal of each educational program must be to prepare an entry-level nurse aide who will provide
quality care to the residents of nursing facilities.
In West Virginia, the OHFLAC-NAP approves nurse aide training programs that satisfy standards outlined
in federal and state laws and regulations.
The OHFLAC-NAP reviews the curriculum of each approved training program sporadically following the
initial approval date to determine whether the program continues to satisfy the required standards.
The OHFLAC-NAP may suspend, revoke, or impose a plan of correction (POC) on a training program that
does not meet the required state and federal standards or does not operate under the conditions of the
approved application.
Program Approval
Application
In order for a facility-based or non-facility based program to be approved, the following documents must
be completed and submitted.
1. The OHFLAC-NATCEP Microsoft Excel Calendar Workbook;
2. A faculty data and/or resource instructor form; and
3. For non-facility based programs, copies of the contracts with the nursing facilities where the
clinical experience requirement will be met.
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The program shall provide any additional information requested by the OHFLAC-NAP during the review of
the application. The program shall designate a director who will be responsible for the operation and
compliance of the program. All aspects of the program shall be in compliance with all applicable federal,
state and local laws.
Action by the OHFLAC-NAP
1. Upon receiving a training program application, the OHFLAC-NAP will determine whether it meets
federal and state compliance requirements, including the following:
a. Program content, length and ratio of classroom instruction to skills training;
b. Qualifications of instructors;
c. Clinical setting and type of clinical supervision;
d. Provision for written evaluation of the program;
e. Reasonable accommodations for prospective students with disabilities;
f.
Criteria for successful completion; and
g. Appropriate furnishing of physical facilities to meet classroom instruction and skills
training needs.
2. Within 30 days after receiving a training program application, the OHFLAC-NAP shall either issue
a preliminary approval or deny the application. Preliminary approval is only granted for a period
of six months to allow the qualified RN to attend the educate-the-educator session. If the
application is denied, the OHFLAC-NAP shall provide the applicant written notice detailing the
reasons for the denial.
Program Identifier
At start-up, each training program will be issued a program identification number. The program number
and the program’s full name shall be placed on each correspondence submitted into the OHFLAC-NAP for
review, including emails. The NATCEP faculty staff members will be assigned or linked to their approved
training program.
Post-Approval Review and Monitoring
1. The OHFLAC-NAP shall conduct a review of the program every two years after the date of the
initial program approval. The department may conduct an announced or an unannounced on-site
review of the program at any time to verify that the program remains in compliance with the
requirements.
2. If the program is found out of compliance with the requirements, the program director shall
submit a POC to the OHFLAC-NAP. The POC shall be submitted on the form provided by the
OHFLAC-NAP, and shall include any additional information requested during the review of the
program. The primary instructor shall provide reasonable means for the OHFLAC-NAP to examine
records and gather requested information.
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3. The primary instructor or program coordinator shall submit for approval any substantial change
in the program to the OHFLAC-NAP in writing. A program may not implement the proposed
change without written approval of the OHFLAC-NAP. "Substantial change" means a change in
the program’s faculty staff members, including the director, curriculum, course hours, or program
site.
4. If training has not been conducted within 24 consecutive months, the approved program may be
deemed “inactive status.”
5. If at any time the OHFLAC-NAP determines a program has failed to comply with the requirements,
written notice will be provided to impose a POC on the program, or suspend or revoke approval
of the program.
Enforcement
The department may deny or withdraw approval of a training program for one or more of the following
reasons:
1. The program cannot provide evidence they meet the program standards and requirements as
outlined in the approval;
2. The program did not conduct any training classes within the previous 24 consecutive months; and
3. The program fails to allow the department to conduct an on-site visit of the training program.
The OHFLAC-NAP may withdraw program approval immediately or prescribe the timeframe the
deficiencies identified during an onsite review shall be corrected. All written notices of deficient practices
shall be provided to the Program Director. With the assistance of the primary instructor, the program
director shall submit a POC to the OHFLAC-NAP. If the program fails to correct the deficient practice within
the specified time, the approval may be withdrawn.
When a program is withdrawn for any reason, the program shall submit a plan to allow for the enrolled
students to continue the training and competency program through another approved NATCEP program.
Federal Prohibition of Program Approval
The OHFLAC-NAP shall not approve a NATCEP offered by or in a facility, if in the prior two years the facility
was:
1. Operated under a waiver because the facility was unable to provide nursing care for a period in
excess of 48 hours per week;
2. Subjected to an extended (or partial extended) health recertification or complaint investigation
survey;
3. Terminated as a provider under Medicare or Medicaid;
4. Subjected to the penalty of denial of payment under Medicare or Medicaid;
5. Assessed a civil money penalty of more than $5,000;
6. Subjected to penalty of an appointment of a temporary manager to oversee operations;
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7. Operated under a waiver of the requirement of a registered nurse for at least eight consecutive
hours, seven days a week; and
8. Closed or had its residents transferred due to state action.
Federal Waiver of Prohibition of Nurse Aide Training Program
Pursuant to 42 USC 1396r(f)(2), a facility-based program (nursing home) may request a waiver of the two
(2) year prohibition when the facility has been assessed a civil money penalty of less than $5000, and the
deficiency was not related to the “quality of care furnished to residents.” To request a waiver, the facility
must make the request in writing to the Long-Term Care Program at OHFLAC. Requests will only be
considered if:
1. There is no such program offered in that area or region;
2. Assures, through an oversight effort, that an adequate environment exists for operating the
program in the facility, and
3. Provides notice of such determination and assurances to the state long-term care ombudsman.
The Long-Term Care (LTC) Program within OHFLAC will review each waiver request and make a
recommendation to the Centers for Medicare and Medicaid Services (CMS). The CMS will make the final
determination whether to approve or deny the waiver request. Each determination will be made on a
case by case basis.
A federal waiver of disapproval may not exceed two (2) years, but will be withdrawn earlier if the facility
is subsequently found to no longer meet the waiver criteria. When two (2) periods of program disapproval
overlap, the programs will not be restored until the second two year disapproval period has been
completed.
If a federal waiver of disapproval is requested and granted by the OHFLAC Long-Term Care Program and/or
CMS, the program must re-apply as a new program with the OHFLAC-NAP.
Withdrawal of Approval
The OHFLAC-NAP shall withdraw approval of any program if any of the following identified requirements
are not met:
1. Refusing to permit visits, investigations, or inspections by state survey agency officials;
2. Operating outside the minimum standards as identified in the approval;
3. Operating without an approved POC following an on-site review;
4. Using faculty who do not meet the required qualifications;
5. Failing to submit required documents in a timely manner; and/or
6. Failing to have a pass rate in any class of 40 percent or higher and/or a pattern of frequent failures.
When withdrawing approval from a NATCEP, the OHFLAC-NAP will:
1. Notify the program in writing, indicating the reason(s) for withdrawal of approval; and
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2. Permit students who have already started a program to finish. (However, these students are not
eligible to take the competency evaluation, unless they transfer and complete the program with
an approved NATCEP.)
Program Monitoring
On-Site Reviews and Surveys
Federal regulations require on-site reviews of all approved programs be conducted by the NATCEP office.
These reviews will be unannounced.
The OHFLAC-NAP will conduct a review of the program within one (1) year of the date of the initial
approval of the program. One year after the initial approval, the training program will be scheduled for a
survey; subsequently ever two years thereafter.
Surveyors may conduct an on-site review of the program at any time to verify compliance. The on-site
survey will include a visit to the clinical site, as well as the classroom site. During the review the surveyor
may request time during the pre- and post- conference to interact with the students to educate the
students about their role in the evaluation process and the purpose for the nurse aide registry.
Surveyors will conduct observation of the program implementation, including student performance and
the expected outcomes of the curriculum. As part of the survey, the surveyor will review program records
to ensure documents are maintained within the guidelines. The surveyor also has the authority to remove
the students from the clinical setting if the safety of the residents is jeopardized.
The program shall provide any additional information requested by the surveyor during its review of the
program. If documents related to the program are kept electronically, the instructor must have the ability
to print the documents immediately upon requests.
Suspension and Revocation
The OHFLAC may suspend or revoke approval of a NATCEP when the program:
1. Fails to comply with any of the nurse aide training program requirements;
2. Violates federal or state requirements;
3. Refuses to permit an on-site visit by surveyors; and
4. Obstructs or interferes with the survey process during the on-site visit.
The OHFLAC will notify the program in writing of the reasons for suspending or revoking approval of the
nurse aide training program. Students enrolled in a course that began before the date of the suspension
or revocation will be permitted to finish the session; however, they will not be eligible to take the
competency examination as long as the program remains in noncompliance.
Program Operation
To meet the federal and state approval requirements, a training program must provide all of the following:
1. Access to an approved clinical setting;
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2. Qualified faculty members for both the classroom and skills portions of the training;
3. An adequate number of clinical instructors in the clinical session to provide safe and effective
supervision and assistance; and
4. Classroom space that is adequate to meet the needs of the program.
The training program must present their policies and class syllabus for review to OHFLAC-NAP regarding
class attendance, grades, uniform and badges, confidentiality, how complaints will be handled, and other
pertinent topic areas.
Students, who are also employees of the certified Medicare/Medicaid nursing homes, are not responsible
for any costs associated with this training, including deposits for textbooks, supplies or testing. The
instructor shall communicate this clearly to the students.
Class Setting and Size
If residents are doing activities in an area, it cannot be designated as a classroom or laboratory in a
program.
The size of the classroom is not specified; however, the instructor must ensure that the classroom and lab
facilities are adequate to meet the needs of the program based on the number of students enrolled and
how the space is utilized.
The instructor must ensure the classroom and skills labs have adequate temperature controls, clean and
safe conditions, adequate space and lighting, and all the required training equipment.
The program shall make reasonable accommodations for students and prospective students with
disabilities.
Clinical Setting
Supervised practical training is defined as training in a laboratory or other setting in which the student
demonstrates knowledge while performing tasks for individuals under the direct supervision of a qualified
registered professional nurse (RN). Before a student performs any resident-related services, the RN
primary instructor shall determine that the student has been trained and found proficient in providing the
services listed on the skills performance record.
The training program shall ensure all of the following are included:
1. Access to a clinical setting approved by the department that is adequate to meet the needs of the
program.
2. Clinical settings shall be in compliance with state and federal law. The program director or primary
instructor and the health care provider with whom the program has contracted are responsible
for verifying that the clinical facility is in compliance with state and federal law. Compliance is
based on the most recent nursing home survey. This nursing home’s verification of compliance
shall be documented in the training program's files and shall be available during the evaluation
process.
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3. Any contractual agreement between the program and the clinical setting shall be renewed
annually and upon any change of facility or administration change. A copy of the agreement and
any amendments shall be submitted to the OHFLAC.
4. During classroom and lab instructions, students shall be oriented to the various forms used to
document resident information. Instructors shall supervise documentation on the appropriate
flow sheets and forms during the clinical rotation.
5. Before a student begins a clinical rotation, the primary and clinical instructor shall evaluate and
document that the student successfully demonstrated the ability to perform a skill.
6. The hours allotted for orientation and pre- and post- conference are not included in the total
hours approved for the training program.
7. Within the minimum 120 hours of training, at least 55 hours must be devoted to supervise
practical training in the clinical setting where the student demonstrates knowledge while
performing tasks on an individual under the direct supervision of an RN.
8. At least a total of 55 hours of training of the minimum required curriculum must be completed
prior to any direct contact with the resident.
9. Students may not give hands-on care to a resident who is not assigned to the student unless the
student is under the direct supervision of the clinical instructor.
10. Students who are under the general supervision of the clinical instructor may not be paired, during
the student's clinical rotation, with nurse aides who are employed by the health care provider.
11. Students shall maintain safe practices, infection control precautions and respect resident rights
at all times.
12. Student shall not be assigned to perform a task independently until he or she has received
instruction and has been determined capable of performing the task without direct supervision.
13. Students shall demonstrate knowledge regarding their assigned residents' diagnoses and
identified needs.
14. Students and instructors shall wear clothing that is in compliance with program policy and that is
appropriate for performing resident care. The clothing shall include a nametag that designates
the name of the nurse aide training program and the person's status as a student or instructor.
The name tag must also list individual’s legal first and last name. Nick names or initials are
prohibited.
15. The scheduled clinical hours shall provide experiences that meet expected outcomes outlined in
the program curriculum.
16. The length of the clinical day may not exceed 10 hours. Clinical hours of eight (8) hours or greater
must allow the students break periods.
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17. A nursing home may serve as the site of clinical instruction for up to two nurse aide training
programs at the same time. This decision shall be made by the OHFLAC-NAP in conjunction with
the facility’s administrative staff on a case-by-case basis.
18. The training program shall not be used as a substitute for staff orientation or staff education
programs.
19. There must be an adequate number of instructors in the clinical setting to provide safe and
effective supervision and assistance to students.
20. Clinical or the primary instructor shall not function in any other role while supervising students in
the clinical or classroom setting.
21. A ratio of 20 students per one instructor (20:1) in the classroom and 10 students per one instructor
(10:1) in the clinical setting is considered to be adequate in most circumstances.
22. The primary instructor shall evaluate and document a student has demonstrated the ability to
correctly perform a skill before the student begins a clinical rotation.
23. The instructor shall make all student clinical assignments with the approval of the director of
nursing. The instructor shall complete a review of each resident's chart to retrieve pertinent
information needed by the students to provide the required care. Care plan information shall be
reviewed at the beginning of each clinical experience, including new orders or changes in each
resident’s status.
24. A student's assignment shall be shared with the clinical setting to which the student is assigned
before the student arrives at the clinical setting.
25. Each student shall be given an individual assignment. More than two students shall not be
assigned to the same resident at the same time.
26. Clinical assignments shall include the care of residents with varied levels of care needs, and the
opportunity to be evaluated on organizational skills and time management.
27. The primary instructor is responsible for supervising the clinical performance of each clinical
instructor and resource staff.
28. The class training calendar must be sent to the OHFLAC-NAP at least two weeks before the
beginning of each new class.
29. The calendar must show dates and times the students will be in class and clinical, the program
name, program number and list the names of all of the instructors that will be involved with
training that class.
30. At the end of the first day of class, the initial class roster with all of the student signatures must
be submitted to OHFLAC-NAP.
31. The instructor must provide each student with a copy of the class syllabus and lesson plans. In
the syllabus the instructor shall discuss classroom conduct, learning objectives, activities and
outcomes, student/teacher ratio, dress code and badge, minimum passing score for classroom
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and clinical performance, method used for evaluation of skills lab practice and clinical
performance, the nurse aide’s role as a caregiver and what part they play in the health care team,
their responsibilities, and why they are a mandatory reporter.
Clock Hour Requirements
The minimum time required for a nurse aide training program is 120 clock hours. At least 55 of the 120
hours must be instructor supervised clinical practice. The remaining hours must be classroom instruction
and skills development in the classroom laboratory. The length of a training course must be, at a
minimum, four weeks.
Expectations for Record Retention
A training program must maintain a master copy of the Skills Performance Record and summary of the
knowledge that a student is expected to have upon completion of the training program.
The primary instructor must individually record when a student satisfactorily performs each required task
or skill and provide a copy of the student’s performance record to the student. The instructor will
document this with the date of completion and place his or her initial in the appropriate box. When a
student has satisfactorily completed all required skills and competencies, attained the necessary
knowledge, and achieved the stated course completion criteria, the student qualifies to take the state
competency test.
The training program must retain all required records for at least three years, including the student’s:
1. Legal name;
2. Social Security Number;
3. Attendance record (dates and hours);
4. Skills checklist;
5. Course evaluations; and
6. All documents related to training.
The program must provide all students who successfully complete the training course with a certificate of
completion. The certificate must have the student’s full name, name of the program and program
identification number, instructor’s name and title, number of hours completed and the completion date.
Skills Performance Record
The training program shall maintain a skills performance record, or a list of competency skills a student
must demonstrate.
The primary instructor shall verify the student has satisfactorily performed each skill by placing his or her
initials and date on the skills performance record. Upon the satisfactory completion of all the required
skills and competencies in the course completion criteria, the trainee qualifies to enter a competency
evaluation program.
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The primary instructor shall provide a copy of the skills performance record to the student at the
conclusion of the training.
Student Absenteeism
Student absences shall be monitored by the instructor. At the instructor’s discretion, a student may be
given the opportunity to make up missed assignments and clinical rotations. The number of absences
allowed and how to make up days of missed instruction must be clearly outlined in the program’s policy.
If students are allowed to miss clinical or classroom days, there must be enough makeup days scheduled
on the calendar for both clinical and classroom for the same amount of days missed. Individuals that miss
greater than one week of class must be dis-enrolled and encouraged to join the next scheduled training
class session.
Instructor Absenteeism
If a primary or clinical instructor becomes ill during a session and is unable to continue instruction, another
approved NATCEP instructor may substitute and complete the assignment. In order for the substitute
NATCEP instructor to fulfill this obligation, the prospective NATCEP instructor/coordinator will need to
notify the OHFLAC-NAP office of this faculty change, unless the prospective instructor’s name was already
listed on the calendar when the initial approval was issued.
Textbooks
The use of up‐to‐date textbooks is an important learning resource for students and it is important that
the faculty staff select the most appropriate textbook to meet their students learning needs.
Supplemental reference tools are permitted; for example, videos and printed materials. Textbooks shall
be replaced five (5) years after the publishing date.
Grades
Each training program must decide the grading scale method used for its nurse aide training and
competency program (NATCEP). This information is to be included in the class syllabus.
Grading may be based on a combination of the following components: quizzes, tests, projects, homework
assignments, worksheets, and/or a final examination.
Competency education is based on the concept of mastery of behavioral objectives with sufficient time
allotted for the individual to achieve mastery. To pass the practical (laboratory and clinical) portion of the
NATCEP, the individual must be proficient in demonstrating all skills.
Proficiency is defined as the ability to perform a skill in a competent and safe manner. Students must be
evaluated and deemed proficient in a skill prior to performing that skill in the clinical setting for a resident.
Pursuant to the child labor laws issued by the Department of Labor, individuals under 18 years of age
cannot operate mechanical lifts/hoists in the long-term care setting. These individuals must have clear
identification of their age limitations in their documentation and record. When the students go to clinical,
the students who are younger than 18 will observe the other students perform this particular skill(s).
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Classroom Laboratory Requirements
The laboratory portion of the training is completed in the classroom setting where the student is able to
practice the skills demonstrated and taught by the primary instructor. Guided student practice is best
performed right after skill demonstration. During this type of student practice, the educator observes the
practice sessions and provides descriptive feedback. The educator must be astute and correct errors
during guided practice to prevent the repetition of errors.
Proficiency check‐offs, also known as skills check‐offs, are held after demonstration and student practice
has taken place. At a minimum, students must be evaluated and deemed by the instructor to be proficient
in each of the skills listed on the Skills Performance Record in order to pass the laboratory requirement,
as well as clinical. At this time, the instructor’s role changes and the instructor becomes an evaluator. The
evaluator observes a student’s performance of the skill, and then actively checks‐off each skill step on the
sheet. The evaluator does not prompt, cue, or assist the student.
Based on the instructor’s definition of proficiency, the student either passes the skill and is evaluated as
proficient, or does not pass the skill. Students who pass the skill must continue to independently practice
the skill correctly in order to achieve long‐term retention of skill performance. Students who fail
proficiency check‐offs should repeat guided practice and independent practice, and then be checked‐off
again. Per federal regulations, students may not perform a skill with a resident in the clinical setting until
the student is deemed proficient by the RN instructor in that specific skill.
Documentation
Calendar and Roster Submission
Each approved NATCEP is required to submit a calendar to OHFLAC-NAP for review two (2) weeks prior to
actually starting its class session, except for the High School Career Technical Schools (HS-CTC). High
School Career Technical Schools may submit their calendars two weeks prior to the start of their clinical
rotation.
Class rosters are due at the end of the first day of class (orientation day), except for the HS-CTC. The HSCTC initial class roster is due prior to the class going to clinical or nursing home rotation. Adult Career
and Technical Programs (A-CTC) calendars and rosters are to follow the same guidelines as the facilitybased programs when it comes to calendar and roster submission.
Skills Performance Record Documentation
The instructor is responsible for maintaining the Skills Performance Record. A copy may be given to the
student, but the instructor is responsible for maintaining the master copy.
The instructor completes this document for each student, as directed, and maintains the completed
document in the student’s record for a minimum of three years. A completed Skills Performance Record
documents proficiency of skills demonstration both, in the laboratory and in the clinical settings.
The instructor shall keep the master copy updated and current at all times. All skills must be checked off
at the time the student demonstrates the task and not at the end of the day.
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When a skill is introduced in class and/or laboratory, then demonstrated in laboratory by the instructor,
the skills check sheet will serve as a valuable resource for the student. The skills check sheet also serves
as a reference for the student during practice.
The instructor must use the skills sheet to evaluate proficiency of skills demonstration by the student.
When the instructor evaluates a student as proficient in a particular skill using the skill check sheet, they
date and initial the Skills Performance Record. The skills performance record must be maintained in the
student’s individual file.
Each student must receive copies of all course documents at the beginning of the course.
Rosters
There are three types of rosters:
1. Class roster, often referred to as the initial class roster;
2. Completion roster; and
3. Refresher roster.
All rosters must be typed. The initial class roster must be submitted to the OHFLAC-NAP office by the end
of the first day of class (orientation day) or within 24 hours after the first day of class. Orientation day is
considered the first day of class for both the facility-based and the non-facility programs. The completion
roster and refresher roster must be submitted to OHFLAC-NAP no more than 30 days following the last
day of class. Program completion roster will not be accepted if a calendar has not been submitted for that
class. This means that the students will not be eligible to take the state test.
Clinical Requirements
In order to successfully complete the classroom requirement, the primary instructor first must document
on the skills performance list that the skill was demonstrated and taught in the classroom setting, and
that the student performed all skills listed on the Skills Performance Record in a proficient manner, while
under the RN’s supervision prior to clinical rotation.
Then, in the clinical setting the clinical instructor will allow the student first to practice their skills
independently without coming into contact with the residents. Once proficient, students may be issued
an assignment and allow them to deliver care to the resident.
Complaint File
Each training program is responsible for developing its own process in which the student have the
opportunity to communicate anonymously any concerns or complaints they might have related to the
NATCEP. Documentation of complaint resolution must be part of the file. The location of the complaint
file or box must be accessible to all during the entire class and clinical session.
Instructor Availability and Accessibility
While students are in the clinical setting, the instructor must be easily accessible and within visual range.
Students cannot provide care in different parts of a facility without an instructor. For example, if the
students are assisting resident with eating in the dining room, the instructor should be physically present
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in the dining room or have the student within his or her visual range. Students should not be in a separate
wing, floor or part of the building or out of the view of the instructor. There are times when the building
floor plan will hinder the “visual range” requirement, in that case the instructor must still be accessible to
the student.
If for any reason the instructor must leave the clinical area, the students must also leave the clinical area.
The instructor is responsible and accountable for his or her students behavior while in the nursing home
setting.
Facility-Based Programs
Training of nurse aides may be performed under the general supervision of the director of nursing (DON)
for a facility; however, the DON is prohibited from acting as the primary instructor or as a clinical
instructor.
Notification of Substantial Changes in the Program
An approved nurse aide training program must report all substantial changes within 24 hours to the
OHFLAC-NAP prior to implementation. A substantial change means any changes in the program designee
or faculty staff member, curriculum, clinical site, classroom and program site.
The program must report this change to the OHFLAC-NAP in writing prior to the implementation of the
change. Failure to provide this notification of a substantial change may result in suspension or revocation
of approval of the training program or faculty.
Student Clinical Orientation
The goal of the nurse aide student orientation at a clinical facility is to provide the student and faculty
with important information about the facility and any other information related to the facility day- to- day
functions prior to a student getting involved in resident care.
All students will receive an orientation program which includes, but is not limited to, an explanation of
the organizational structure and policies and procedures of the facility.
The facility policies and procedures must include:
1. The philosophy of care of the facility;
2. Tour of the facility;
3. Fire and safety plan;
4. Daily routines and organizational structure;
5. The description of the resident populations and the general requirements of the facility; and
6. Employee rules and legal and ethical aspects.
All students must attend a two hour facility orientation prior to the clinical rotation. This two hour facility
orientation is not included in the total hours for the program.
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Class Orientation
Orientation day is considered the first day of class. On this day the instructor communicates the class
introduction and expectations. The instructor will also:
1. Introduce textbooks, policy, copy of calendar, skills check list, course outline, lesson plans with
goals and objectives;
2. Explain dress code for class and clinical instruction;
3. Discuss behavioral expectations, including absences and tardiness;
4. Explain the purpose and procedures for filing classroom and state-level complaints;
5. Discuss the student to instructor ratio, and that the students cannot be in the facility without an
RN Instructor;
6. Explain the nurse aide’s roles and the responsibilities;
7. Explain the reregistration every two years with the OHFLAC-NAP;
8. Explain the purpose for the Nurse Aide Abuse and Neglect Registry;
9. Explain how to report a change in the student’s contact information, such as, name, mailing
address, and marital status.
10. Introduce the federal and state laws and regulations related to abuse, mistreatment, neglect and
misappropriation of property;
11. Facility in-service requirements (12 hours); and
12. State testing requirements.
Charging For Nurse Aide Education and Testing
According to federal regulation, “No nurse aide who is employed by, or who has an offer of employment
from a facility on the date the nurse aide begins a NATCEP may be charged for any portion of the program
(including any fees for textbooks or other required course materials).
Facility-based programs cannot charge their employees, or those individuals offered employment, prior
to the beginning of the NATCEP. Nor can the facility offer contingency plans prior to the start of the
NATCEP class where the applicant must work for the company for a specified number of days, or enforce
a stipulation where the applicant must pass the test in order to get a refund.
If an employee is attending class at a non-facility-based program which charges a fee, the facility, not the
employee, must pay that fee.
At the discretion of the nursing home sponsor, if an employee is classified as a “no show” by the vendor
for testing, the facility may elect not to pay for any future testing for that individual.
If an individual becomes employed by, or receives an offer of employment from, a facility within 12
months after completing a NATCEP, Medicaid will reimburse the first facility that employs the nurse aide
on a pro rata basis during the period in which the individual is employed as a nurse aide.
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Program Faculty
Only approved NATCEP instructors assigned to the training program can teach the minimum curriculum
requirements. If an organization has multiple programs or satellite offices, an instructor cannot switch
between those programs without first being assigned to the program. In the technical career center, a
substitute teacher within the school system cannot teach the nurse aide class.
Program Director
The program director shall be an individual who is responsible for the operation and compliance of the
program and is generally not involved in the day-to-day function of the program. During the application
process the program shall note the director on the application for approval.
The director may be the principal or vice principal of a school, the administrator or assistant administrator,
or the DON or assistant DON of the nursing facility. Only one program director is allowed per program.
This person cannot share the role of instructor or coordinator, unless this person is also a registered nurse.
Primary or Program Instructor
The primary instructor for a training program shall be a registered nurse licensed to practice in West
Virginia, who has at least two years of continuous or equivalent experience working as a registered nurse.
At least one year of full time status or equivalent (2080 hours) experience shall be actual work experience
in a certified nursing home, or distinct part of a hospital that meets the requirements of Sections 1919(a),
(b), (c) and (d) of the Social Security Act. The program shall maintain documented evidence of the
instructor’s education, license, and work requirements in their files.
The primary instructor, sometimes referred to as the program instructor, must have completed a course
in teaching adults or completed the “Educate-the-Educator” training course for instructors approved by
the OHFLAC-NAP, or must have a vocational certificate from the West Virginia Department of Education.
The department may waive this requirement for an instructor who has at least one year of experience as
an instructor in a college or university nursing program accredited by the West Virginia Board of Nursing
or any other state and has had clinical teaching experience of at least six months in a nursing home setting.
The number of primary instructors required is determined by the needs of the program.
Instructors must not be involved in more than one role while supervising students in the classroom or
clinical area.
The primary instructor is responsible for:
1. Maintaining the day-to-day class and clinical activities related to the program;
2. Supervising all faculty staff, except the program director;
3. Planning and evaluation of each segment of the curriculum;
4. Monitoring the resource instructor(s) during initial job duties;
5. Maintaining his or her availability to the clinical instructor during the entire clinical teaching time;
6. Teaching the theory portion of the class; and
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7. Demonstrating the skills listed on the performance skills record and evaluating the return
demonstration.
Coordinator Instructor
The program coordinator, under the general supervision of the primary instructor, shall assist with all
planning and coordination activities for the NATCEP. This individual may also share roles with the primary
instructor and clinical instructor.
The coordinator’s responsibilities are:
1. Plan and coordinate the class and clinical portion of the course;
2. Complete all of the required paperwork needed for the program and submit to OHFLAC for
review;
3. Report program changes; and
4. Submit the rosters to the OHFLAC office.
Resource Instructors
Resource instructors are persons with specialized knowledge and information in a specific area who
provide expertise to enhance learning. Resources instructors may be, but are not limited to: licensed
registered nurses, licensed practical nurses, pharmacists, dietitians, social workers, registered sanitarians,
fire safety experts, health care administrators, gerontologists, psychologists, physical and occupational
therapists, activity therapists, speech and language pathologists, audiologists, and ombudsmen.
A resource instructor shall have at least one year of work experience in the area of training he or she will
provide.
A resource instructor shall work under the general supervision of the primary instructor. The resource
instructor shall not be used as a substitute instructor.
The resource instructor may not verify demonstrated competency in a task/skill through the Skills
Performance Record.
Clinical Instructor
The clinical instructor qualifications are the same as those for the primary instructor. However, he or she
is exempt from the Educate the Educator requirement. This individual is under the general supervision of
the primary instructor.
Clinical Instructor Duties
The clinical instructor is responsible for supervising the performance of the students while in the clinical
environment.
The clinical instructor is responsible for providing communication between the facility staff and the
students. At no time shall a student receive instruction from the facility staff. The clinical instructor can
only be involved in one role at a time while supervising students in the clinical area. The ratio of instructors
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to students in skills training must be adequate to ensure that each student receives safe and effective
assistance and supervision. A ratio of 10 students per one instructor is required in the clinical setting.
The clinical instructor makes all student clinical assignments with the approval of the DON or assistant
DON of the facility. The instructor must complete a review of the resident’s medical record to retrieve
pertinent information needed by the student to provide the required care. The instructor should provide
the information on a worksheet for each student. Care plan information is to be reviewed at the beginning
of each clinical experience and should include new orders or changes in resident status.
Student assignments should be shared with the appropriate professional clinical staff prior to the students
arrival at the clinical setting. During at least one clinical experience, it is recommended that each student
care for a minimum of two, but not more than four, residents during a specified clinical day. Students
should be given individual assignments. More than two students should not be assigned to the same
resident at the same time.
Clinical assignments shall include the following:
1. Care of residents with special care needs, such as aphasia or dementia;
2. The opportunity to practice organizational and time management skills; and
3. The opportunity to demonstrate skills, safety and infection control precautions.
Refresher Instructor
Instructors affiliated with an approved NATCEP shall have the privilege to teach the refresher course.
Once an instructor disassociates himself/herself from an approved program, he or she is no longer eligible
to teach the class.
Faculty Active Status
The status of a faculty member is considered active as long as the member remains affiliated with an
approved program. If the faculty member leaves the program, that individual's status will be deactivated.
The coordinator shall complete the bottom of the Faculty Data form, with the deactivation date and
submit to the OHFLAC-NAP. This form shall be submitted within one week after the date of deactivation.
Application Requirements for Faculty
To be approved as instructor or director an individual must submit the Faculty Data or Resource form, and
include all of the following:
1. WV RN license number;
2. Copy of train-the-trainer certificate or equivalent; and
3. Work experience as an RN in the long-term care setting, listing start and end dates formatted
month/date/year.
Educate-the-Educator Workshop
The primary instructor, sometimes referred to as the program instructor, must have completed a course
in teaching adults or completed the “Educate-the-Educator” training course for instructors approved by
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the OHFLAC-NAP; or must have a vocational certificate from the West Virginia Department of Education.
The department may waive this requirement for an instructor who has at least one year of experience as
an instructor in a college or university nursing program accredited by the West Virginia Board of Nursing
or any other state and has had clinical teaching experience of at least six months in a nursing home setting.
This is a three day course, and shall include the following areas:
1. Principles in adult learning and training techniques;
2. Formulating training objectives, including behavioral objectives which state measurable
performance criteria for competency evaluation;
3. Designing the curriculum to provide a logical organization of the material;
4. Developing a lesson plan;
5. Choosing appropriate teaching strategies and methodologies;
6. Developing learning materials;
7. Providing a mechanism for evaluating trainee learning;
8. Effectively supervising trainees’ clinical experience;
9. Defining criteria for successful achievement of training program objectives;
10. Developing a record-keeping system; and
11. Step-by-step instructions on how to seek calendar approval and how to use the NATCEP Microsoft
Excel Workbook and required documents from OHFLAC-NAP.
Participants who successfully complete the Educate-the-Educator workshop will receive a certificate of
completion.
Reporting Program Changes
When the program has faculty staffing changes, the program shall report these changes to the OHFLACNAP in writing 10 days prior to starting a new class or within 24 hours prior to continuing an existing class.
The program must apply for approval of a new faculty staff member on the designated form and submit
the required materials to the OHFLAC-NAP as soon as the identity of the replacement faculty member is
known.
Once received, the OHFLAC-NAP will issue a written response of approval or denial of the replacement
faculty staff member. A new faculty staff member may not begin instruction until the program receives
written approval from the OHFLAC-NAP.
Student Nurses
Eligibility Requirements
A student nurse who is currently enrolled in a school for professional nurses or a school for licensed
practical nurses, or who has successfully completed the fundamentals of nursing course of a school but
has not successfully completed the examination, falls within the federal definition of a nurse aide.
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A federally certified nursing home, when allowing a student nurse to perform the services of a nurse aide,
must verify the student nurse:
1. Is included on the Nurse Aide Registry as a result of completing an approved nurse aide training
and testing program; or
2. Has successfully completed an approved nurse aide competency test.
A student nurse may be allowed to provide direct nursing-related duties for which the student nurse has
been trained. The employer must ensure that the student nurse does not perform services for which he
or she has not been trained and found competent to perform. The student nurse can only permitted to
perform nurse aide duties.
Student nurses are NOT eligible to work as a nurse aide in a nursing home the four months prior to passing
the competency evaluation.
Student nurses may request to challenge the registry, but first the individual must be enrolled in an
approved higher education nursing program, or have successfully completed the fundamentals of nursing
courses within the last two (2) years,
A student nurses may challenge the registry, but he or she must first:
1. Be enrolled in an approved higher education nursing program; or
2. Successfully complete the fundamental of nursing within the last two (2) years with a “C” average,
or higher and successfully complete a minimum of 32 hours of clinical experience in a certified
Medicare/Medicaid nursing facility.
Student nurses must submit the following to OHFLAC-NAP for review:
1. A sealed, certified copy of candidate/student transcripts from the educational institution;
2. Letter of recommendation from the instructor, including verification that the candidate/student
has completed at least the minimum clinical requirements and the names and addresses of each
certified nursing facility at which the clinical experience was obtained; and
3. Letter from the candidate/student challenging the registered nurse aide competency evaluation,
including his or her full name, current mailing address, telephone number, date of birth, and social
security number.
Nurse Aide Registry
Establishment of the Registry
This registry includes identification of individuals who have successfully completed and passed the nurse
aide training and/or completed competency evaluation program with a passing score.
The registry also documents substantiated allegations of resident abuse, neglect or misappropriation of
resident property by a nurse aide in a nursing facility, including an accurate summary of the findings. If
the nurse aide disputes the findings, this information will also be entered into the registry.
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The OHFLAC-NAP shall investigate such complaints. Before a substantiated claim can be entered against
the nurse aide, he or she may choose to request a hearing to be conducted through the Board of Review.
Individuals whose names are listed on the Nurse Aide Abuse and Neglect Registry are no longer eligible to
work in skilled nursing facilities, nursing facilities, home health agencies, hospice care providers, longterm care hospitals, personal care services providers, adult day care providers, assisted living facilities,
intermediate care facilities for individuals with intellectual disabilities, and certain other health care
facilities.
Registry Content
The registry contains at least the following information on each individual who has successfully completed
the nurse aide training and competency evaluation program or a competency evaluation and has been
found to be competent to function as a nurse aide:
1. The individual’s full legal name, and other identifying information about the individual.
2. The date the individual became eligible for placement in the registry through successfully
completing a nurse aide training and competency evaluation program.
3. The following information on any findings by the department of abuse, neglect, or
misappropriation of property by the individual:
a. Documentation of the department’s investigation, including the nature of the allegation
and the evidence that led the department to conclude that the allegation was valid;
b. The date of the hearing, if the individual chose to have one, and its outcome;
c. A statement by the individual disputing the allegation, if he or she chooses to make one;
and
d. This information must be included in the registry within 10 working days of the findings
and must remain in the registry permanently, unless the findings were made in error, the
individual was found not guilty in a court of law, or the Nurse Aide Abuse and Neglect
Registry is notified of the individual’s death.
The registry will remove entries for individuals who have performed no nurse aide duties or nursing
related services for a period of 24 consecutive months, unless the individual’s registry entry includes
documented findings of abuse, neglect, or misappropriation of property.
Inclusion on the Registry
An individual can become eligible for inclusion on the registry by 1) successful completion of the
competency evaluation; 2) RN/LPN challenge; or 3) by reciprocity from another state. All training must
be done in the United States.
Individuals who are listed on other states’ registries must be in good standing and the other states’
requirements must be substantially the same as the West Virginia requirements for education and
competency evaluation in order to apply for inclusion on the Nurse Aide Registry. To request a transfer
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or reciprocity to West Virginia from another state, the Application by Reciprocity must be completed and
submitted with the required attachment(s) to the OHFLAC-NAP for review.
Transfer to Other States
If a nurse aide listed on the West Virginia Nurse Aide Registry wishes to be included on another state’s
nurse aide registry, the nurse aide must complete the following steps:
1. Make sure his or her employment eligibility status to work in a federally certified nursing facility
is current on the West Virginia Nurse Aide Registry;
2. Contact the transferring state’s registry and inquire about that state’s requirements; and
3. Complete that state’s application, following the directions from the state where they wish to
transfer.
A nurse aide may maintain employment eligibility to work in West Virginia by reporting their out-of-state
employment to the OHFLAC-NAP.
Reporting a Change
For the Registry to maintain current information, nurse aides must provide updated information to the
Registry whenever a name or address change occurs. A nurse aide can report a change to the OHFLACNAP in writing to explain what changes need to be made.
Name
A photocopy of the legal document that changed the nurse aide’s name must be provided (e.g., marriage
certificate, court order or divorce decree). Do not send the original document.
Address and Contact Number
Address changes may be reported either by indicating the change on the renewal application, email, fax
or by telephoning the OHFLAC-NAP.
Social Security Number
A photocopy of the document that verifies the correct Social Security Number must be provided in order
to process the change. Do not send the original document.
Reportable Nurse Aide Employment
Paid employment as a nurse aide under RN supervision in a direct care setting can be reported to renew
the nurse aide’s employment status on the Nurse Aide Registry. Only direct care settings that provide RN
supervision are acceptable. Direct care settings include the following:
1. Clinics;
2. Community-based residential facilities;
3. Emergency centers (immediate care centers, trauma centers);
4. Home Health Agencies;
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5. Hospitals;
6. Intermediate care facilities for individuals with intellectual disabilities; and
7. Nursing homes.
Other supervised paid nursing-related services may be considered on a case-by-case basis. Independent
private duty work is not considered reportable employment. Nurse aides who work for a staffing agency
must submit a letter from their employer validating eight hours of employment as a nurse aide or
performing nurse aide-related duties with their renewal application.
Renewal or Reregistration Application Requirements
Completion of the re-registration application is the responsibility of the applicant and not the facility or
employer. The following is required:
1. Re-registration of the nurse aide status on the registry is required every two (2) years.
2. The minimum amount of paid employment as a nurse aide is eight hours within the previous two
year period.
The following policy will be adhered to for nurse aide reregistration:
1. At least 60 days before the nurse aide’s registration expiration date, the OHFLAC-NAP will send
either an electronic notice or a reregistration application with instructions to the nurse aide
through the U.S. mail to his or her last known address.
2. The nurse aide must complete the reregistration application (hard copy or online) and return the
application prior to the expiration date.
3. For employers other than nursing homes such as staffing agencies or in-home care, the nurse aide
must complete the renewal application and have the non-facility based employer verify the nurse
aide worked at least eight hours performing paid nurse aide duties within the two years since the
last renewal.
4. When all requirements are met, the OHFLAC-NAP will send a letter to the nurse aide informing
him or her of renewal for another two years.
Employers are encouraged to validate the nurse aide’s status online using the OHFLAC web site prior to
hiring.
Competency Examination (Testing)
The competency evaluation will consist of both written (computer-based) and skills performance
components. Successful completion of both components is required. The written test is a computerbased examination.
Each candidate will have three (3) opportunities to pass the competency evaluation. If a candidate is
unable to pass the competency evaluation after three (3) attempts, the candidate will be required to
complete another full nurse aide training program. Upon completion, the candidate is eligible for three
(3) more opportunities to pass the competency evaluation.
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Candidates are expected to test during the first available competency evaluation following completion of
the education program.
All individuals must successfully complete the competency evaluation within 24 months of graduation
from an approved education program, unless that individual challenges the training program (RN/LPN
Challenge). In that instance, the individual has six (6) months to complete the competency evaluation.
If more than 24 months has elapsed since completion of a program, the individual must complete another
full nurse aide training program to be test-eligible.
Refresher Course
This is a condensed course that will allow the student to review the curriculum and performance skills
taught in the full course prior to taking the competency examination. The curriculum includes:
1. The health care delivery system
a. Role of the long-term care nurse aide
b. Ethical and legal considerations
i. Abuse and neglect
ii. Abuse definitions
iii. W.Va. Code of State Rules Title 69, Series 6
iv. Identifying and Reporting
c. Investigation process
d. Adult protective services
e. Ombudsman
f. Resident rights
2. Providing a secure environment
a. Infection control
b. Communicable diseases and OHSA requirements
c. Safety and accident prevention
d. Using good body mechanics
3. Communication skills
a. Observation, reporting and recording
b. Basic medical terminology
c. Communicating with residents and families
4. Special needs
a. Aging process
b. Confusion and behavior problems
c. Alzheimer’s disease
d. Care of the dying resident
5. Providing basic care
a. Moving and positioning
b. Ambulation
c. Personal care and hygiene
d. Vital signs
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6.
7.
8.
9.
10.
e. Nutrition and fluids
f. Elimination
g. Restorative care
Time and stress management
Resident’s chart review
Skills performance record
Nurse aide handbook or manual
Frequently asked questions and answers
The refresher course shall be offered by the contracted vendor or any approved NATCEP instructor that
is affiliated with an approved training program. The course is a minimum of 16 hours, but may be longer.
Nurse aides are eligible to take the refresher course if the following applies when he/she:
1. Has lost registry status due to the lack of, or inability, to fulfill federal requirements;
2. Has failed to reregister within the allowed time frame; and/or
3. Has been mandated to retrain in certain areas; and
4. Has been issued an alternative sanction by the OHFLAC-NAP instead of a stricter penalty.
Nurse aides who qualify under #3 or #4 of the above list must complete the refresher course and pass the
competency evaluation within 120 days from the issue date of the letter, or the time span listed in the
letter issued by the OHFLAC-NAP.
All nurse aides who qualify to take the refresher course have three (3) opportunities to successfully pass
the competency evaluation. After exhausting the three (3) testing attempts, the applicant shall be
required to complete another full nurse aide training course and competency evaluation. All testing
attempts following a refresher course must be completed six (6) months after class completion.
Alternative Sanction
The OHFLAC may require that the nurse aide receive retraining on a specific minimum curriculum topic or
task and/or successfully pass the competency exam. The facility may opt to assist the nurse aide with the
assigned task, but it is not required. However, the NATCEP faculty shall assist the nurse aide with
retraining, if approached. All expenses related to the retraining are solely the responsibility of the nurse
aide.
Facility Employment Requirements
A nursing facility shall not use any individual as a nurse aide for more than four months on a full time basis
unless the individual:
1. Has completed a training and competency evaluation program, or a competency evaluation
program approved by the state; and
2. Is competent to provide nursing or nursing-related services.
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Nurse Aide Retraining
Retraining may consist of taking a refresher or a full course. Completion of the competency exam is
required for both the refresher course and the full course. Applicants are eligible to take a refresher
course and test based on the following:
1. The refresher course when there is no reportable work history between two to four years or since
the most recent completion of NATCEP; or
2. The full course when there is no reportable paid work in nurse aide-related employment in the
past five years.
In order to be eligible to test, the applicant must complete the course and exhaust all three testing
attempts within the allotted time listed above. In case of a refresher, the applicant must complete the
test within six months after class completion.
Facility In-Service Requirement
There are no in-service or continuing education requirements related to maintaining an aide’s status on
the Nurse Aide Registry. However, facilities and agencies that employ nurse aides must comply with any
applicable in-service requirements under federal regulations.
Facilities are required to provide and document at least 12 hours of completed nurse aide in-service per
year. In-service requirements are not tracked by the Registry, but are enforced through the OHFLAC
Nursing Home Program.
West Virginia Clearance for Access: Registry and Employment Screening (WV CARES)
What is WV CARES?
WV Clearance for Access: Registry and Employment Screening is administered by the Department of
Health and Human Resources and the WV State Police Criminal Investigation Bureau (CIB) in consultation
with the Centers for Medicare and Medicaid Services (CMS), the Department of Justice (DOJ), and the
Federal Bureau of Investigation (FBI).
The program uses web-based technologies to provide employers a single portal for checking state and
national abuse registries and the state and national sex offender registries. The web-based system also
provide employers with access to Nurse Aide Registries for all 50 states and professional licensure
registries where available.
The web-based system provides an efficient and effective means for an employer to check an applicant's
status prior to paying the cost of a fingerprint-based criminal background check.
Through fingerprinting, this program provides a comprehensive search of federal and state criminal
history records that was not available under the previous reliance on name-based records searches.
The program relies on new technology to monitor criminal histories and alert officials when a subsequent
criminal event occurs.
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A monitored criminal history record means the cost of re-fingerprinting is not required for employees who
change employers in this industry (or apply for work at more than one employer) within the timeframe of
a valid background check.
The laws governing this program are found in W.Va. Code § 16-49-1 et seq. and 69CSR10.
Nurse Aide Competency Evaluation
Testing Vendor
The contracted vendor will administer the services as outlined in the contractual agreement with the
OHFLAC.
Demonstration of Skills
The skills demonstration must consist of randomly-selected items drawn from a pool of tasks generally
performed by nurse aides. The pool of tasks must include all of the personal care skills listed on the
performance skills list.
Administration of the Competency Evaluation
The competency examination (both written and skills demonstration) must be administered and
evaluated only by an approved entity which is neither the skilled nursing facility that participates in
Medicare nor a nursing facility that participates in Medicaid. The written competency examination is
computer-based. If an oral examination is provided, the competency evaluation will be read from a
prepared text in a neutral manner, or in a computer-based format.
The skills demonstration part of the evaluation must be:
1. Performed in a facility or laboratory setting comparable to the setting in which the individual will
function as a nurse aide; and
2. Administered and evaluated by a registered nurse with at least one year of experience in providing
care for the elderly or the chronically ill.
Oral Competency Evaluation
Oral testing must be made available to any prospective nurse aide for completion of the written,
computer-based portion of the examination. This may be at the request of the test taker, or to
accommodate a disability covered by the Americans with Disabilities Act.
An oral version of the written knowledge-based evaluation shall be provided. A proctor (human reader
or electronic recorded voice) shall administer the oral version. The oral version shall include a written
section to determine the ability of the candidate to read and understand job-related duties and
information.
Successful Completion of the Competency Evaluation Program
To complete the competency evaluation successfully an individual must pass both the written or oral
examination and skills demonstration. The written portion has 100 points possible with a minimum
30
passing score of 70 points. The skills portion has a possibility of 300 points with a minimum passing score
of 225.
There are certain steps in each skill that are marked as critical steps and each skill has a point value that
corresponds with each step to be performed.
1. Cannot perform any part of the skill;
2. Tells the rater they did not learn the skill;
3. Does not perform the critical steps in one or more skills; or
4. Puts the resident at risk for injury.
Each scenario mentioned above will be reviewed on an individual basis. The vendor may consult with the
OHFLAC-NAP for a final determination.
A record of successful completion of the competency evaluation must be included in the nurse aide
registry within 30 days if the individual is found to be competent.
Unsuccessful Completion of the Competency Evaluation Program
If the individual does not complete the evaluation satisfactorily, the individual must be advised of the
areas which he or she did not pass and be allowed to retest. The individual has three opportunities to
successfully pass the test then they will be required to retrain.
Evaluator Qualifications
The evaluator who conducts the competency evaluation of a student must be a registered nurse licensed
to practice in WV and have a minimum of two years of experience working as a registered nurse, one year
of which must be in the provision of long-term care.
Evaluators are employed or contracted by the vendor according to the specifications in the contract with
OHFLAC.
Testing Site Criteria
Nurse aide testing may be conducted at either a regional testing site or an in-facility testing site. All testing
sites must be approved by OHFLAC.
Regional Test Site
Regional testing sites are established throughout WV and used to test nurse aide candidates when infacility testing is not available. The vendor contracts with the organization and pays a fee for the use of
its facility to conduct nurse aide testing. The facility must:
1. Have all equipment and supplies,
2. Meet the requirements established, and
3. Be approved by OHFLAC.
31
In-Facility Test Site
An in-facility test site is generally a facility that sponsors a nurse aide training program and has been
approved for competency test administration. An in-facility test site is used for testing a training
program’s nurse aide candidates only. The department does not contract with the organization and does
not pay a fee for the use of the facility. The vendor will contact the training program and arrange a
mutually acceptable date and time for testing. The in-facility test site must be in compliance with state
and federal laws in order to be eligible to qualify as a testing site.
32
Appendix A: Commonly Used Acronyms
CFR
Code of Federal Regulations
CMS
Centers for Medicare and Medicaid Services
CPR
Cardiopulmonary Resuscitation
CSR
Code of State Rules
DON
Director of Nursing
GED
General Education Diploma
LTC
Long-Term Care
LPN
Licensed Practical Nurse
NA
Nurse Aide
NAP
Nurse Aide Program
NATCEP
Nurse Aide Training and Competency Evaluation Program
OBRA
Omnibus Budget Reconciliation Act
OHFLAC
Office of Health Facility Licensure and Certification
OIG
Office of Inspector General
POC
Plan of Correction
RN
Registered Nurse
RNA
Registered Nurse Aide or Long-term Care Nurse Aide
SOD
Statement of Deficiency
USC
United States Code
WV CARES
West Virginia Clearance for Access: Registry and Employment Screening
WVDHHR
West Virginia Department of Health and Human Resources
WVDOE
West Virginia Department of Education
33
Appendix B: Glossary of Terms
Abuse. The willful infliction of injury, unreasonable confinement, intimidation, or punishment with
resulting physical harm, pain or mental anguish. Abuse also includes the deprivation by an individual,
including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and
psychosocial well-being. This presumes that instances of abuse of all residents, even those unaware that
harm has occurred or those in a coma, cause physical harm, or pain or mental anguish. Abuse includes
emotional abuse, physical abuse, sexual abuse, verbal abuse and involuntary seclusion.
Board of Review. Means the board of review organized in the Department pursuant to W.Va. Code § 92-6(12).
Class Rosters. The purposes for the rosters are for informational purposes only. Each roster provides the
students’ demographics and contact information needed for inclusion on the registries. There are three
types of rosters: class roster, completion roster, and the refresher roster.
Department. West Virginia Department of Health and Human Resources.
Emotional Abuse. Subjecting or exposing a resident to behavior that may result in psychological trauma
or injury. Emotional abuse includes: humiliating, harassing, teasing or threatening; unreasonably
restricting a resident’s contact with family, friends or other residents; unreasonably ignoring a resident’s
requests; threats of punishment or deprivation; or willfully violating a resident’s rights, including
confidentiality. Emotional abuse may also be referred to as psychological abuse, mental abuse, or
psychosocial abuse.
Facility. A nursing home as defined in W. Va. Code § 16-5C-1 et seq. or an extended care facility operated
in connection with a hospital as defined in W. Va. Code § 16-5B-1 et seq.
Involuntary Seclusion. Separation of a resident against the resident’s will, or the will of the resident’s
legal representative. Seclusion includes separation of the resident from other residents, separation of the
resident from his or her room, or confinement of a resident to his or her room, with or without
roommates.
Misappropriation of Property. The deliberate misplacement, exploitation or wrongful use of a resident’s
belongings or money.
Neglect. The failure to provide goods and services necessary to avoid physical harm, or the significant
threat of physical harm, mental anguish or mental illness unless such actions are beyond the nurse aide’s
control. Failure to report an incident or failure to appear in response to a subpoena, or both shall be
considered neglect.
Nurse Aide or Nursing Assistant. Any individual who is not a licensed health care provider or registered
dietitian or volunteer who provides nursing or nursing related services for hire to residents in a facility
after successfully completing a state-approved training and competency evaluation program. The terms
nurse aide and nursing assistant are considered interchangeable and have the same meaning.
34
Nurse Aide Abuse and Neglect Registry. A list of names of nurse aides who have been found by the Nurse
Aide Program to have abused, neglected, or misappropriated the property of residents of a facility, along
with any additional information such as documentation of the state’s investigation, the hearing date and
the results, as well as any written comments by the nurse aide.
Nurse Aide Program (NAP). The program within the Office of Health Facility Licensure and Certification
(OHFLAC) responsible for oversight of the nurse aide training and competency evaluation programs
throughout the state and maintenance of the nurse aide registries including the Nurse Aide Abuse and
Neglect Registry.
Office of Health Facility Licensure and Certification (OHFLAC). The agency within the West Virginia
Department of Health and Human Resources, responsible for oversight of the Nurse Aide Program.
Physical Abuse. Abuse resulting from nurse aide-to-resident contact, including but not limited to, striking
the resident with a part of the body or with an object; shoving, pushing, pulling, pinching, tugging or
twisting any part of the resident’s body with fingers or nails; burning or sticking the resident with an
object; engaging in physical contact that is knowing, intentional, reckless or careless that causes or is likely
to cause death, physical injury, pain or psychological harm to the resident; inappropriate or improper use
of restraints or isolation; acts of retaliation; even in response to a physical attack. Physical abuse also
includes controlling behavior through corporal punishment.
Secretary. The Secretary of the Department of Health and Human Resources, or his or her designee.
Sexual Abuse. Sexual harassment, sexual coercion, sexual exploitation, or sexual assault, sexual contact,
or graphic images of a resident’s body, including but not limited to, private areas.
Supervised practical training. The training in a laboratory or other setting in which the student
demonstrates knowledge while performing tasks on an individual under the direct supervision of a
registered nurse. The nurse must ensure that the students do not perform any services for which they
have not trained and been found proficient by the instructor.
Test-Eligible Nurse Aide. Any individual who is not a licensed health care provider or registered dietitian
or volunteer, who provides nursing or nursing related services for hire to residents in a nursing home after
successfully completing a state-approved nurse aide training program, but who has not yet successfully
completed the state-approved competency test. An individual may not work as a nurse aide or nursing
assistant on a full-time basis for more than four months, unless the individual has passed the stateapproved competency test.
Verbal Abuse. The use of oral, written or gestured language that willfully includes disparaging and
derogatory terms to residents or their families, or within their hearing distance, regardless of their age,
ability to comprehend, or disability. Examples of verbal abuse include, but are not limited to, threats of
harm; saying things to frighten a resident, such as telling a resident that he or she will never be able to
see his or her family again; intimidation; humiliation; threats of hostility, or vulgarity.
35
Appendix C: Resources
Frequently Asked Questions:
http://ohflac.wv.gov/Programs/NA.html
Office of Health Facility Licensure and Certification
ohflac.wv.gov
West Virginia Nurse Aide Program
ohflac.wv.gov/Programs/NA.html
Code of Federal Regulations – Requirements for Long-Term Care Facilities 42 § 483
http://www.ecfr.gov
West Virginia Secretary of State, 69CSR6, Legislative Rule, Nurse Aide Abuse and Neglect Registry
apps.sos.wv.gov/adlaw/csr/ruleview.aspx?document=9544
Nurse Aide Educational Training Search
ohflac.wv.gov/Lookup/FacilitySearch
Under facility type, select “Nurse Aide Educational Programs” in the drop down box
Nurse Aide Verification
ohflac.wv.gov/NA/NALookup.aspx
West Virginia Clearance for Access: Registry and Employment Screening Legislative Rule
apps.sos.wv.gov/adlaw/csr/
West Virginia Clearance for Access: Registry and Employment Screening State Code
www.legis.state.wv.us/WVCODE/Code.cfm?chap=16&art=49#49
36
Appendix D: Contact
Office of Health Facility Licensure and Certification (OHFLAC)
Nurse Aide Program (NAP)
408 Leon Sullivan Way
Charleston, West Virginia 25301
Phone: 304-558-0050
In-State Toll Free Phone: 800-442-2888
Fax: (304) 558-1442
Email: [email protected]
To verify employment eligibility of a Nurse Aide: ohflac.wv.gov
To obtain an electronic version of the calendar, contact the NAP by emailing your request to the Nurse
Aide General Mailbox: [email protected], or fax your request to: 304-558-1442.
To submit your calendar for approval email: [email protected]
To request a waiver of a loss of a NATCEP due to the findings of a nursing home survey email:
[email protected]
Professional Healthcare Development (PHD)
Phone: (304) 733-6145
Fax: (304) 733-6146
Email: [email protected]
Website: www.profhd.com
Bureau for Medical Services (BMS)
Attn: Kelley Johnson
350 Capitol Street, Room 251
Charleston, WV 25301
Phone: (304) 558-1700 Toll Free: (888)483-0797
Website: www.dhhr.wv.gov/bms
Questions related to nurse aide training reimbursement, contact the Nursing Home Program.
West Virginia Clearance for Access: Registry and Employment Screening (WV CARES)
Attn: Meghan Shears
Contact Information: Phone: (304) 558-2018
Website: www.wvdhhr.org/oig/wvcares.html
37
Appendix E: Minimum Curriculum Requirements
A program shall include theory and practical component in all of the care areas listed under the minimum
curriculum requirements. The orientation section will not be part of the written competency evaluation.
This section only provides a set of standards for providing nurse aide trainees with orientation to the
program.
Orientation
1. Identify the textbooks, policies, class calendar, skills checklist, course outline, lesson plans with
goals and objectives;
2. Identify the appropriate dress wear for class and clinical rotation;
3. Demonstrate and comply with the behavioral expectations, including absences and tardiness;
4. Explain the purpose and procedures for filing a complaints at the state level;
5. Identify the student to instructor ratio and when not be in the facility without an RN Instructor;
6. Describe the skills performance tasks and the role and responsibilities of the nurse aide;
7. Identify guidelines for maintaining certification and explain purpose of the Nurse Aide Abuse
and Neglect Registry;
8. Describe how to report changes in name, mailing address or marital status to the NAR;
9. Identify the federal law related to Nurse Aide Registry, and abuse, mistreatment, neglect and
misappropriation of property;
10. Describe the yearly facility in-service requirements (12 hours);
11. Describe the State’s testing requirements and how to contact the testing vendor; and
12. Understand the facility day-to-day functions, safety precautions, and chain of command
hierarchy with-in the facility prior to getting involved in resident care.
Communication and Social Interaction
The program shall include the theory of and practice in communicating and interacting:
1. On a one-to-one basis with a resident;
2. As part of a team implementing resident care objectives;
3. Demonstrating sensitivity to a resident’s emotional social and psychological needs through
directed interactions; and
4. Skills that enable expressions of age-appropriate behavior by allowing a resident to make personal
choices and by reinforcing behavior that supports a resident’s sense of dignity.
After completion of this portion of the training program, a nurse aide shall do all of the following:
1. Identify the components of a caregiver-resident relationship and be able to recognize and
demonstrate understanding of:
a. The uniqueness of each resident, in terms of that person's age, disability, family status,
financial status, gender, marital status, race, and sexual orientation, cultural,
generational, social, ethnic, religious or other background, values or characteristics;
b. The needs of a resident with Alzheimer's disease, dementia, mental illness, intellectual
disability or other cognitive or developmental disabilities or impairments;
38
2.
3.
4.
5.
6.
c. Ways both nurse aides and residents can cope with stress;
d. What constitutes abuse, neglect and misappropriation of resident’s property; and
e. The messages conveyed by body language, speech and facial expressions.
Demonstrate an ability to establish effective relationships with residents and be able to:
a. Communicate with residents in a respectful manner that affords residents dignity;
b. Explain procedures and activities to residents before carrying out those procedures or
beginning those activities;
c. Demonstrate concern for residents who have long-term or disabling illnesses or who are
dying; and
d. Identify developmental tasks associated with the aging process.
Demonstrate an ability to use appropriate verbal and nonverbal communication skills with
residents and be able to:
a. Recognize effective listening techniques;
b. Distinguish assertive from aggressive responses;
c. Identify the difference between unacceptable and acceptable touching during job
performance; and
d. Identify therapeutic interventions and specialized techniques for responding to resident’s
wandering and confusion.
Recognize common barriers to communication, including language, vision changes, hearing loss,
speech problems, memory loss, disorientation and pain.
Demonstrate an ability to promote the independence of residents within the limitations of their
physical, mental and intellectual impairments by fostering self-help skills through appropriate
responses to residents' attempts to provide self-care, including recognizing residents' level of
ability in self-care activities.
Identify the role of the family and other persons of importance to the resident in the resident’s
care and as resources for resident emotional support.
Basic Nursing Skills
The program shall include the theory of and practice in basic nursing skills. A nurse aide shall be able to:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Use acceptable personal hygiene;
Recognize the components of working relationships;
Time management and organizational skills;
Identify how and when to seek guidance, using the supervisory channels of communication within
the facility or agency;
Use proper body mechanics;
Demonstrate an understanding of the meaning of common medical terms and abbreviations;
Observe and report changes in resident behavior and physical status, including signs and
symptoms of common diseases and conditions;
Recognize when a resident may be choking and respond appropriately;
Define infection prevention and discuss types of infections and communicable diseases;
Recognize the normal physical and psychological changes associated with aging;
39
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
Identify the basic principles of nutrition and hydration;
Recognize and report deviations from a resident’s normal food and fluid intake and output;
Recognize the basic requirements of commonly prescribed therapeutic diets;
Use common measures to promote a resident’s skin integrity, considering the resident’s ethnicity,
race and age;
Demonstrate appropriate techniques in walking, transferring, positioning and transporting
residents;
Recognize and respond appropriately to unsafe environmental conditions, including damp floors,
frayed electrical cords and loose hand rails;
Recognize and respond appropriately to emergency situations including following emergency
evacuation procedures;
Demonstrate appropriate hand washing techniques;
Understand and use commonly used alternatives to restraints in accordance with current
professional standards;
Maintain the safety and cleanliness of resident care areas;
Make use of proper isolation technique;
Perform commonly accepted infection control practices, including proper gloving technique and
proper disposal of blood and body fluids and secretions;
Make occupied and unoccupied beds;
Measure temperature, pulse and respiration;
Measure a resident’s weight and height;
Record objective information;
Apply nonprescription ointments to unbroken skin areas;
Recognize the general effects of prescribed routine medications;
Recognize therapeutic interventions and specialized non-pharmacological pain control
interventions;
Assist with care of residents when death is imminent;
Assist with post-mortem care; and
Maintain the safety and cleanliness of areas where food is stored.
Personal Care Skills
The program shall include the theory of and practice in basic personal care skills. A nurse aide shall
demonstrate the ability to:
1. Give a complete or partial bed bath to a resident and assist a resident in taking a bath or a shower;
2. Provide care of the resident’s perineal area;
3. Apply appropriate oral hygiene practices when assisting a resident with oral hygiene, including
caring for the resident’s dentures;
4. Care for a resident’s nails, hair and skin;
5. Shave and shampoo a resident, including applying nonprescription medicated shampoos;
6. Dress and undress a resident;
7. Prepare a resident for meals;
40
8. Assist in feeding a resident, including helping a resident use adaptive devices and feeding utensils
and encouraging a resident to eat nutritionally balanced meals; and
9. Assist a resident with bowel and bladder elimination.
Basic Restorative Services
The program shall include the theory of and practice in providing restorative services. A nurse aide shall
demonstrate the ability to:
1. Recognize the importance of bowel and bladder programs;
2. Recognize the method for maintaining and improving musculoskeletal functioning by promoting
joint mobility, body alignment and movement, including being able to do all of the following:
a. Position residents by use of pillows, towel rolls, padding and footboards;
b. Perform simple range of motion exercises; and
c. Assist residents in the use of crutches, walkers, wheelchairs, canes, prostheses and
appliances.
3. Transfer residents safely and according to principles of patient care ergonomics and with
proficiency in use of available equipment that is used to transfer residents;
4. Reinforce breathing exercises, including coughing and deep breathing; and
5. Help residents use hearing aids and visual aids.
Rights of Residents
1. The program shall provide instruction on the principles of and requirements relating to residents'
rights. The nurse aide shall demonstrate an understanding of:
a. Providing privacy for residents in treatment, living arrangements and personal care
needs;
b. Maintaining the confidentiality of resident health and personal records;
c. Allowing residents to make personal choices to accommodate the residents' needs;
d. Providing help residents need in getting to and participating in activities, including
resident and family group meetings;
e. Maintaining the personal possessions of residents in good and secure condition;
f. Interacting with residents without abusing or neglecting the residents;
g. Interacting with residents without misappropriating the residents' property; and
h. Reporting immediately to appropriate facility or agency staff every instance of abuse or
neglect of a resident or misappropriation of a resident's property as defined in federal
and state regulations.
2. The nurse aide shall demonstrate behavior that recognizes that residents have rights and that the
aide respects those rights. The nurse aide shall be able to:
a. Demonstrate respect and concern for each resident’s rights, preferences and awareness
of age, color, disability, family status, financial status, gender, marital status, race, sexual
orientation, and ethnic, cultural, social, generational and religious differences;
b. Show respect for cultural, ethnic and religious food preferences;
41
c. Recognize what constitutes abuse of residents and demonstrate an understanding of how
to interact with residents without abusing them or without appearing to abuse them;
d. Demonstrate prevention and intervention skills with combative residents that balance
appropriate resident care with a need to minimize the potential for injury to the aide and
others;
e. Recognize the role of state and federal regulatory agencies in licensing or otherwise
approving providers and in investigating complaints of abuse of resident property;
f. Demonstrate an understanding of the process by which a resident or staff member may
file a complaint on behalf of a resident and seek redress for a perceived violation of
resident rights;
g. Recognize the role of resident advocacy groups (i.e., Ombudsman, Adult Protective
Services) as resident resources;
h. Demonstrate awareness of how to file a complaint with the department regarding
operations within the provider setting.
Dementia
The program shall include instruction about dementia and specific techniques for meeting the basic needs
of residents with dementia. The nurse aide shall demonstrate an understanding of the:
1. Nature of dementia, including the cause, course and symptoms of the impairment;
2. Effect that brain changes have on the person's moods, abilities and functioning;
3. Effect on the resident of staff verbal and nonverbal communication with the resident and means
of modifying these communications and approaches to facilitate effective interaction between
residents and staff;
4. Feeding and fluid intake problems associated with dementia and the specialized techniques for
addressing those problems;
5. Effect of the environment on residents with dementia, and the appropriate environmental stimuli
to use with those residents to reduce stress and maximize normal functioning and how to
incorporate strategies that preserve function and prevent excess disability;
6. Possible causes of dementia related symptomatic behavior changes, specifically focusing on
understanding behavior as an attempt to communicate unmet needs and then how to address
the unmet need including an understanding of how pain impacts behavior;
7. Ways to help the person with dementia continue meaningful involvement in his or her day, the
importance of structure and routine and the incorporation of the person's life story and past
interests, routines, tastes, values and background; and
8. Stress involved for the resident, family and nurse aide in caring for a resident with dementia and
techniques for coping with this stress and ways to address the person with dementia's core needs
of having self-esteem boosted, being useful, giving and receiving love, and caring for self and
others.
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Appendix F: Skills Performance Tasks
Nurse aide candidates in the state of West Virginia must be able to perform five of the listed performance skills to
successfully complete the skills performance portion of the state-approved exam. Each skill has a point value
corresponding to each step to be performed.
The procedure for testing will require the student to perform:




Initial steps
Hand washing
Four additional skills
Completion steps
The student may also fail if he/she:




Cannot perform any part of a skill;
Tell the rater they did not learn the skill;
Do not perform the critical steps in one or more skills; or
Put the resident at risk for injury.
Each scenario mentioned above will be reviewed on an individual basis and the Nurse Aide Registry will make the
final decision.
Preparing to take the competency test:
Two forms of identification (ID) must be presented at the test site. One must be a photo ID (e.g., driver’s license,
government issued ID, employment badge) with a current photo and the other must be a Social Security card.
Photocopies will not be accepted.
Common Skill Requirements
All candidates will be required to perform “initial steps” at the beginning of each exam, and will not need to
perform those steps again during testing. At the end of all five procedures, “completion steps” will be required.
Throughout each procedure, the candidate must observe the resident’s privacy and safety as well as provide for
effective communication, proper infection control, and comfort.
Initial Steps are as follows:
1.
2.
3.
4.
5.
6.
7.
8.
Obtain instructions from the nurse about the resident’s needs, limitations, and abilities. This information
will be provided to each candidate prior to the exam.
Knock before entering the room.
Greet each resident by name and verify the resident’s identity.
Identify yourself and your job title.
Explain the procedure and encourage the resident to help when possible.
Get all needed supplies prior to beginning.
Wash your hands. For exam purposes, you will only have to wash your hands once unless they become
soiled.
Provide privacy.
43
9.
Raise side rails prior to raising the bed to a working height. Lower side rails on side that care is being
given. For exam purposes, assume that all residents have the necessary order for side rails.
10. Wear gloves as needed per standard precautions.
11. Use good body mechanics.
Completion Steps are as follows:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Use good body mechanics.
Position resident for comfort and in good body alignment.
Adjust side rails as ordered and lower bed.
Make sure the resident has everything he/she needs, and thank them.
Clean up the area according to facility policy.
Remove gloves and wash your hands when applicable.
Open drapes, curtains, etc. according to resident’s wishes.
Check safety of the environment, including ensuring call light is within the resident’s reach.
Report any unusual findings to the nurse.
Document procedures according to policy.
Skill 1: Hand Washing
1.
2.
3.
4.
5.
6.
7.
8.
Turn on water at sink
Wet hands and wrists thoroughly
Apply soap to hands
Lather all surfaces of fingers and hands, including above the wrists, producing friction, for at least 10
seconds
Rinse all surfaces of hands and wrists without contaminating hands
Use a new, clean, dry paper towel to dry all surfaces of hands, wrists, and fingers, without contaminating
hands
Use a new, clean, dry paper towel, or knee (if knee handle is available) to turn off faucet, without
contaminating hands
Dispose of used paper towel in waste basket immediately after shutting off faucet
Skill 2: Don and Remove Isolation Gown and Gloves
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
Wash hands
Unfold the clean gown so the opening is in the back. Do not shake the gown or allow it to touch an
unclean surface
Slide hands and arms through the sleeves of the gown
Make sure the gown is snug at the neck and covers uniform
Tie the ties at the neck of the gown, overlap the back of the gown to cover entire uniform
Fasten the ties at the waist of the gown
Gloves should be pulled up over the cuffs of the gown
Removing gown and gloves:
8. Remove gloves
9. Untie the ties at the waist and neck of the gown without touching your neck or the outside of the gown
10. Pull each sleeve off by grasping each shoulder on the inside of the gown, at the neckline. Do not touch the
outside of the gown. Turn the sleeves and gown inside out as your arms are sliding through them
44
11. Holding the gown away from your body by the inside of the shoulder seams, fold it inside out, bringing the
shoulders together
12. Roll the gown up with the soiled side inside and do not let it touch your uniform
13. Discard in appropriate container
Perform completion steps
Student must declare when they would wash hands in addition to the initial steps for skills 2 and 3.
Skill 3: Applying and Removing Face Mask
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
Wash hands
Gather mask
Remove jewelry, watch and eyeglasses, place in clean paper towel. If wearing long sleeves, push or roll
them up
Pick up the mask by the top strings or the elastic strap. Be careful not to touch the mask where it touches
your face
Adjust the mask over your nose and mouth. Tie top strings first, and then bottom strings. Never wear a
mask hanging from the bottom strings
Pinch the metal strip at the top of the mask (if part of the mask) tightly around your nose so that it feels
snug
Replace glasses, if worn
Removing mask:
8.
9.
10.
11.
12.
Wash hands
Untie lower tie of the mask first
Untie the upper tie of the mask last
Pull off face mask, using only the ties and drop into facility approved container
Wash hands
Perform completion steps
Student must declare when they would wash hands in addition to the initial steps for skills 2 and 3.
Skill 4: Make Occupied Bed
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Place clean linen, in order of usage, on clean surface within easy reach
Lower head of bed before moving resident
Loosen top linen from end of bed or working side
Raise side rail, assist client to turn onto side, moving away from self toward raised side rail
Loosen bottom soiled linen on working side
Move bottom soiled linen toward center of the bed
Place and tuck in clean bottom linen or fitted bottom sheet on working side (if flat sheet is used, tuck in at
top and working side)
Raise side rail and assist resident to turn onto clean bottom sheet
Remove soiled bottom linen, avoiding contact with uniform, place it in an appropriate location within the
room
Pull and tuck in clean bottom linen, finishing with bottom sheet free of wrinkles
Cover client with clean top sheet and appropriately remove soiled top sheet
Finish with the clean linen anchored and centered
Replace pillowcase
45
14. Avoid contamination of clean linen throughout procedure
Perform completion steps
Skill 5: Measure Oral Temperature with Electronic Thermometer
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
8.
9.
Make sure the oral probe is attached to the electronic thermometer
Insert the electronic probe firmly into the probe cover
Ask the resident to wet the lips, lower the tongue, and close the lips around the thermometer
Place the probe under the patient’s tongue, on one side of the mouth
Leave the probe in place until the thermometer signals
Remove the probe and read the temperature on the digital display
Discard the cover and return the probe to its holder
Make note of the resident’s name and temperature measurement
Return the electronic thermometer to the charging or storage unit
Perform completion steps
Skill 6: Taking a Tympanic Temperature
Perform initial steps
1.
2.
Pick up tympanic thermometer and insert in plastic cover. Make sure cover locks into place
Stand to the front of the resident’s head. Make sure hearing aid is carefully removed and that wax does
not block ear canal
3. Turn on thermometer. Wait until “ready” sign appears
4. Pull on ear following guidelines: Adults: pull up/back on pinna or outer edge of ear; Children and Infants:
pull ear straight back
5. Gently insert covered thermometer tip into ear, pointing the thermometer toward the front of the
resident’s head. Make sure you have a good seal
6. To take the temperature, press the button and hold for one full second (to make sure you wait one
second, say the words “one one-thousand”)
7. Remove from ear and read temperature on display screen
8. If facility policy is to take reading in both ears, repeat procedure using clean plastic cover for the other ear
9. Turn thermometer off (Some have an auto-off.)
10. Replace tympanic thermometer into holder, if available
Perform completion steps
Skill 7: Measure Axillary Temperature Using Electric Thermometer
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
8.
Make sure the oral probe is attached to the electronic thermometer
Insert the electronic probe firmly into the probe cover
Expose the axilla (underarm)
Place the probe into the center of the axilla. Place the residents arm over the chest
Hold the resident’s arm and the probe in place until the electronic thermometer signals
Remove the probe from under the arm, and discard the probe cover; straighten the resident’s clothes
Make a note of the resident’s name and temperature
Return the electronic thermometer to the charging or storage unit
Perform completion steps
46
Skill 8: Measure Apical Pulse
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
Place resident in comfortable position, lying down on back
Clean both earpieces, the diaphragm and bell sides of stethoscope
Place diaphragm of stethoscope under clothing on apical pulse site (on the left side of the chest, just
below the nipple). You may have to move the stethoscope to locate loudest pulse sound
Hold diaphragm or bell with two fingers firmly on the chest
Look at your watch and wait until the second hand gets to the 12 or 6
Count pulse (lub-dub) for one full minute
Replace clothing and move resident to a comfortable position
Perform completion steps
Skill 9: Measure Radial Pulse
Perform initial steps
1.
2.
3.
4.
Place fingertips on thumb side of resident’s wrist to locate pulse
Count beats for one full minute, noting the rhythm and strength of the pulse
Remove fingers from the pulse site and make a note of the residents name and the pulse rate
Report pulse within plus or minus 4 beats of evaluator’s reading
Perform completion steps
Skill 10: Measure Respiration
Perform initial steps
1.
2.
3.
Count one each time the chest rises
Count the respirations for one full minute* to determine the rate
Reports rate plus or minus 2 breaths of evaluator’s reading
Perform completion steps
* For testing purposes, the student must count for one full minute.
Skill 11: Give Back Rub Using Lotion
Perform initial steps
1.
2.
3.
4.
5.
Position resident so back is exposed, on side or prone
Place towel lengthwise on bed next to resident’s back
Pour small amount of lotion into hands, rubbing hands together to warm lotion and hands
Apply lotion in long, firm strokes upward from buttocks to back of neck and shoulders
Use firm pressure stroking upward and gentle pressure as downward motions. Use circular motion, as
hands should never leave the back. Strokes should be one continuous flowing motion
6. Repeat for at least 3 – 5 minutes
7. Pat the resident’s back with towel to remove excess lotion
Perform completion steps
47
Skill 12: Range of Motion (Active)
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
8.
Position resident in good body alignment
Check joints. If swelling, redness or warmth is present, or if resident complains of pain, notify nurse.
Continue procedure only if instructed
Support limb above and below joint
Begin range of motion at shoulders and include the shoulders elbows, wrists, thumbs, fingers, hips, knees,
ankles, and toes*
Slowly move joint in all directions it normally moves
Repeat movement at least five times
Encourage resident to participate as much as possible
Stop procedure at any sign of pain and report to nurse immediately
Perform completion steps
* For testing purposes, the joint to be manipulated will be designated.
Skill 13: Shave with Safety Razor
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
8.
9.
Fill bath basin halfway with warm water
Drape towel under resident’s chin
Put on gloves
Moisten beard with washcloth and apply shaving cream over area in a circular motion
Wet razor and shave in the direction of hair growth. Hold skin taut and shave beard in downward strokes
on face and upward strokes on neck
Rinse resident’s face and neck
Apply after-shave lotion as requested
Remove towel
Remove gloves
Perform completion steps
Skill 14: Denture Care
Perform initial steps
1.
2.
3.
Place towel on resident’s chest and emesis basin under the resident’s chin
Place paper towel/wash cloth in sink bottom to protect dentures
If resident is able, ask to remove own dentures—if not appropriate, remove upper dentures by pushing
down on upper plate to break suction and lift lower dentures out of bottom of mouth
4. Place dentures in basin and take to sink
5. Brush dentures with toothpaste and rinse under running water
6. Place dentures in clean, rinsed denture cup with cold water for storage
Perform completion steps
Skill 15: Administer Oral Hygiene
Perform initial steps
1.
2.
3.
Raise head of bed so resident is sitting up
Put on gloves
Drape towel below resident’s chin
48
4.
5.
6.
7.
8.
9.
Wet toothbrush and put on small amount of toothpaste
Brush the upper teeth first and then the lower teeth
Hold emesis basin under resident’s chin
Have resident rinse mouth with water and spit into emesis basin
If requested, give resident mouthwash diluted half with water
Check teeth, mouth, tongue, and lips for odor, cracking, sores, bleeding, discoloration and loose teeth.
Report any unusual findings to the nurse
10. Remove towel and wipe resident’s mouth
11. Remove gloves
Perform completion steps
Skill 16: Give Mouth Care to Unconscious Resident
Perform initial steps
1.
2.
3.
4.
5.
6.
Drape towel over pillow
Turn resident onto unaffected side
Put on gloves
Place emesis basin under resident’s chin
Hold mouth open with padded tooth blade
Dip swab in cleaning solution and wipe teeth, gums, tongue and inside surfaces of mouth, changing swab
frequently
7. Rinse with clean swab dipped in water
8. Swab with lemon glycerin swabs if available
9. Check teeth, mouth, tongue, and lips for odor, cracking, sores, bleeding, discoloration, and loose teeth.
Report unusual findings to nurse
10. Cover lips with available lubricant
11. Remove gloves
Perform completion steps
Skill 17: Eye Care for Unconscious Resident
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
8.
9.
Position resident in comfortable position, using pillows if needed
Obtain basin of clean warm water
Put on gloves
Place towel and emesis basin under the resident's chin
Using either a washcloth or cotton balls, whichever is used in your facility, dip into water and clean eyes,
moving from the inner canthus (corner) of the eye to the outer canthus of the eye
When using a washcloth, use a clean washcloth for each eye. When using cotton balls, use clean cotton
ball for each eye
If there is an increased amount of dried secretions, you may be asked by the nurse to apply warm
compresses to loosen
Dry the eye area completely using a clean towel
Add lubricant to the eye if ordered by the physician or directed by the nurse
Perform completion steps
Skill 18: Clean/File Fingernails
Perform initial steps
1.
Place basin with warm water on over-bed table
49
2.
3.
4.
5.
6.
7.
Ask resident to soak hands in basin 3 – 5 minutes
Wash, rinse, dry, and place the resident’s hands on a clean, dry towel
Clean under the nails with the orangewood stick
Inspect the hands
Trim the fingernails using the nail clipper, clipping straight across and removing sharp edges with an
emery board
Apply lotion to the hands, gently massaging from fingertips to wrists to stimulate circulation
Perform completion steps
Skill 19: Care of Eyeglasses
Perform initial steps
1.
2.
3.
4.
Carefully remove eyeglasses and place in emesis basin
Secure the resident. Raise the side rails if necessary and lower the bed
Line the sink with a towel
Wash eyeglasses in lukewarm water, rinse and place inside emesis basin. While washing observe for loose
screws, or broken or loose lenses
5. Dry with soft 100 percent cotton cloth or lens cleaning tissue. Do not dry with tissues as they may scratch
eyeglasses
6. Store eyeglasses in special eyeglass case or prepare to replace on the resident
7. Return to bedside
8. Replacing eyeglasses on resident: Place gently over the ears and position comfortably. Observe for proper
fit
Perform completion steps
Skill 20: Hair Care
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
Raise head of bed so resident is sitting up
Drape towel over pillow if resident is confined to the bed. If resident is sitting in a chair, place the towel
around the resident's shoulders
Remove resident’s glasses and any objects in hair
Brush hair by separating into small sections and gently combing or brushing two inch sections at a time
from the ends of hair to scalp
If the hair is tangled, use a small amount of detangler or leave-in conditioner if available. Hold the lock of
hair just above the tangle and gently comb or brush through the tangle
Use any personal items that residents request and style as requested
Offer mirror
Perform completion steps
Skill 21: Dress and Undress a Dependent Resident
Perform initial steps
1.
2.
3.
4.
5.
6.
Help resident to choose clothes
Help resident move to his/her back
Remove garments resident is wearing, always beginning with the unaffected limb
Assist resident to dress, always beginning with the affected side first. Residents should always wear
undergarments
If resident can stand, put shoes on before resident stands up to prevent falls. Protect linen from shoes by
putting a towel under feet
If resident cannot stand, roll resident from side to side to eliminate wrinkles caused by clothing
50
Perform completion steps
Skill 22: Move Resident Up in Bed with Lift Sheet (Two co-workers)
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
8.
Ask for help from another health care worker
Place pillow upright at head of bed to protect resident’s head from headboard
Position one worker on each side of resident and roll sheet toward resident's body
Using good body mechanics, with hands and fingers facing upwards grasp the sheet at the resident’s
shoulders and hip
Ask the resident to raise his/her head, place hands across chest and bend knees, push with heels, if
possible, on the count of three
Count one, two, three, and then lift
Replace pillow under resident's head
Straighten bed linens
Perform completion steps
All positioning skills are for a one-person technique unless otherwise designated
Skill 23: Move Resident Up in Bed if Resident Can Assist
Perform initial steps
1.
2.
3.
Move pillow against the headboard. If resident can tolerate, lay bed flat
Assist resident to bend knees up and place his/her feel flat on the bed. Place one arm under the resident’s
shoulders and the other under the resident’s upper thighs
On the count of three, have resident push down with the feet and lift up the buttocks (called bridging)
while you help the resident move toward the head of the bed
Perform completion steps
Note: If possible, the resident may use the side rails of the bed to assist.
All positioning skills are for a one-person technique unless otherwise designated
Skill 24: Turn Resident Toward You
Perform initial steps
1.
2.
3.
4.
5.
Cross the resident’s arms over the chest
Cross the resident’s leg farthest away over the leg closest to you
Place one hand on resident’s far shoulder, place the other hand on resident’s farthest hip and gently roll
the resident toward you
Move arm on the side that the resident is being turned to out of the way
Support the resident’s back with a pillow
Perform completion steps
All positioning skills are for a one-person technique unless otherwise designated
Skill 25: Sit on Edge of Bed (Dangling)
Perform initial steps
1.
2.
Adjust bed height to lowest position
Move resident to side of bed closest to you
51
3. Raise head of bed to sitting position, if necessary
4. Place one arm under resident’s shoulder blades and the other arm under resident’s thighs
5. On count of three, slowly turn resident into sitting position with legs dangling over side of bed
6. Support for 10 to 15 seconds, check for dizziness
7. Assist resident to put on shoes or slippers
8. Move resident to edge of bed so feet are flat on floor
Perform completion steps
All positioning skills are for a one person technique unless otherwise designated
Skill 26: Move Resident to the Side of Bed
Perform initial steps
1.
2.
3.
4.
5.
6.
Place pillow at the head of the bed against headboard
Stand on the same side of the bed to which you are moving the resident
Spread your feet apart and slightly bend your knees to protect your back
Gently slide hands under the head and shoulders of the resident and move toward you
Gently slide hands under the midsection and move toward you
Gently slide your hand under the hips and legs and move them toward you
Perform completion steps
All positioning skills are for a one-person technique unless otherwise designated
Skill 27: Turn Resident Away from You
Perform initial steps
1.
2.
3.
4.
5.
6.
Stand on side of bed opposite to where resident will be turned
Move resident to side of bed nearest you using steps in Skill 26
Cross the resident’s arms over his or her chest. Move arm on the side that the resident is being turned to
out of the way
Cross resident’s legs. (If possible, bend the resident’s knee nearest you. If the knee cannot bend, cross the
near leg over the far leg
Place one hand on resident’s shoulder and other hand on the hip. Roll the resident over as one unit
toward the other side of bed (toward the raised bed rail)
Support the resident’s back with a pillow
Perform completion steps
All positioning skills are for a one-person technique unless otherwise designated
Skill 28: Pivot Transfer of Hemiplegic Resident
Perform initial steps
1.
2.
3.
4.
5.
6.
Make sure the resident is wearing non-skid shoes and the bed is in the low position
Position the chair/wheelchair on the resident’s unaffected side at a 45 degree angle to the bed. If transfer
is to a wheelchair, lock both brakes and put up foot pedals
Assist the resident to sit on the edge of the bed with legs and feet hanging over the edge. Put gait belt on
resident
Stand in front of the resident and firmly grasp the gait belt. Have the resident put his/her arms around
your waist
Using good body mechanics, stand so that the affected leg of the resident is between your knees
Help the resident stand, supporting the affected leg with your knees
52
7.
8.
9.
Have the resident use the unaffected hand to grasp the armrest of the chair/wheelchair
Pivot your body, helping the resident to pivot toward the non-affected leg
Using good body mechanics (bending knees, keeping back straight) help the resident sit in the chair,
adjusting as needed
Perform completion steps
All positioning skills are for a one-person technique unless otherwise designated
Skill 29: Transfer Resident From Bed To Chair/Wheelchair
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
8.
Position the chair with the back even with the head of the bed. If wheelchair is used, make sure brakes
are locked and pedals are up
Make sure resident has nonskid shoes on
Assist the resident to dangle at the edge of the bed
Brace your knees against the resident’s knees and block his feet with your feet
Bring the resident to a standing position by putting your arms around resident’s underarms or using a gait
belt
Ask the resident to grasp the chair arms as you support him/her
Using good body mechanics, bend your knees as you lower the resident to the chair
Use pillows as necessary for positioning the resident in correct body alignment
Perform completion steps
All positioning skills are for a one-person technique unless otherwise designated
Skill 30: Pull Resident Up in Chair/Wheelchair
Perform initial steps
1.
2.
Lock the wheels on the wheelchair and move the footrests aside
Stand behind the chair, placing your arms around the resident’s upper body under the arms and lift. Do
not lift by the arms. If possible, ask the resident to place feet on floor and use hands on arm rests to assist
in repositioning
3. Replace footrests if applicable and place positioning devices as necessary
Perform completion steps
All positioning skills are for a one-person technique unless otherwise designated
Skill 31: Position Resident on Side in Bed in Proper Alignment
Perform initial steps
1.
2.
3.
4.
Lower head of bed and raise side rail toward you
Move resident’s body toward you
Slowly roll resident onto side toward raised side rail while supporting resident’s body
Proper alignment: head supported by pillow, shoulder adjusted so resident is not lying on arm, top arm
supported, back supported by pillow/wedge, top knee flexed and supported by supportive device (pillow)
with hip in proper alignment
5. Cover resident with top linen
Perform completion steps
All positioning skills are for a one-person technique unless otherwise designated
53
Skill 32: Assist Resident to Ambulate Using Gait Belt
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
Make sure resident has on nonskid shoes
Place gait belt snugly around resident’s waist
Assist the resident to stand, standing to the resident’s side until balance is regained, keeping hold of the
gait belt
While holding onto the gait belt, change the position of your hands. One hand should be holding the belt
at the side nearest you and the other holding the belt in the back
Assist the resident to walk, staying slightly behind and to the side of the resident, holding firmly to the
gait belt
Encourage the resident to stand straight and walk as normally as possible
Return resident to chair or bed
Perform completion steps
Skill 33: Measure and Record Input and Output
Perform initial steps
Input
1.
2.
3.
Measure the fluid left in the container before the dishes are removed from the resident’s bedside/table
Subtract the amount left in the container from the amount offered
Record immediately on appropriate document
Output without a catheter
4.
5.
6.
7.
8.
9.
10.
11.
Put on disposable gloves
Pour the urine into a measuring graduate
Set the graduate on a flat surface at eye level to read amount
Observe for any signs of blood, dark color, mucus, sediment, and/or change in odor
Empty urine into the toilet and flush
Rinse container used for urination (bedpan, urinal, etc.) and store appropriately
Remove gloves
Record immediately on appropriate document, reporting any abnormalities to registered nurse
Output with a catheter
1.
2.
3.
4.
5.
6.
Put on disposable gloves
Place the graduate container below the collection container
Carefully open the drain outlet from the collection container, making sure the drain outlet does not touch
the container or the floor
Allow the container to drain completely
Reattach the drainage outlet to the collection container
Follow steps 3 – 8 as above
Perform completion steps
Skill 34: Empty Urinary Drainage Bag
Perform initial steps
54
1. Put on disposable gloves
2. Place the graduate container below the collection container
3. Open the drain outlet from the collection container, maintaining sterility
4. Allow the container to drain completely
5. Reattach the drainage outlet to the collection container
6. Dispose of urine and rinse container
Perform completion steps
Skill 35: Assist Resident Bedpan/Fracture Pan
Perform initial steps
1.
2.
3.
4.
5.
Raise the side rails, raise the bed to a correct working height, and lock the brakes. Adjust bed to as flat a
position as possible
Lower the side rail on the side nearer you
Assist the resident to a supine position (on the back) moving the top linens aside
Put on gloves
Position the resident on the bedpan, using one of these two methods:
Method 1:
a. Ask the resident to raise the hips (bending at the knees and pushing with the feet may make this
easier)
b. Slide the bedpan under the resident’s buttocks
Method 2:
a. Turn the resident onto the side facing away from you
b. Place the bedpan against the resident’s buttocks
c. Roll the resident back onto the bedpan
6. Adjust the head of the bed so that the resident is in a sitting position and cover for privacy
7. Place toilet tissue and the call signal within the resident’s reach
8. Raise the side rail and tell the resident to signal when finished
9. Remove gloves and wash hands
10. Leave the room only if the resident can be left alone. Lower the bed if you leave
11. If you leave, check back frequently and answer the call signal promptly
12. To remove the bedpan, lower the side rail and head of the bed
13. Put on gloves and ask the resident to raise the hips or turn the resident onto the side facing away from
you. Cover the bedpan immediately
14. Assist as needed to clean the perineal area
15. Raise the side rail and dispose of the bedpan contents according to facility policy
16. Measure input and output or obtain stool sample if needed. Observe contents for abnormalities
17. Remove gloves and wash your hands
18. Assist resident to wash his/her hands
Perform completion steps
Skill 36: Demonstrate Proper Use of a Gait Belt
Perform initial steps
1.
2.
Place the belt around the resident’s waist, over clothing
Fasten buckle snug, leaving enough room for your fingers to slip under the belt, and leaving the buckle
slightly off-center, in the front
3. Remove immediately after activity is complete
Perform completion steps
55
Skill 37: Change Gown
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
Untie soiled gown
Draw top sheet over resident’s chest
Remove resident’s arms from gown, unaffected arm first
Roll soiled gown from neck down and remove from beneath sheet
Slide resident’s arms into clean gown, affected arm first
Tie gown
Remove top sheet from beneath clean gown and cover resident
Perform completion steps
Skill 38: Supine Position
Perform initial steps
1.
2.
3.
4.
5.
Lower head of bed
Move resident to head of bed if necessary
Position resident flat on back with legs slightly apart
Align resident’s shoulders and hips
Use supportive padding if necessary
Perform completion steps
Skill 39: Fowler's Position
Perform initial steps
1. Move resident to supine position (Skill 38)
2. Elevate bed 45 to 60 degrees
3. Use supportive padding if necessary
Perform completion steps
Skill 40: Lateral Position
Perform initial steps
1. Place resident in supine position (Skill 38)
2. Move resident to side of bed closest to you
3. Cross resident’s arms over chest
4. Slightly bend knee of the leg nearest to you or cross nearest leg over farthest leg at ankle
5. Place your hands under resident’s shoulder blade and buttock. Turn resident away from you onto side
6. Place supportive padding behind back, between knees and ankles, and under top arm
Perform completion steps
Skill 41: Semi-Fowler's Position
Perform initial steps
1.
2.
3.
Move resident to supine position (Skill 38)
Elevate head of bed 30 to 45 degrees
Use supportive padding if necessary
Perform completion steps
56
Skill 42: Assist to Bathroom
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Walk with resident into bathroom
Assist resident to lower garments and sit
Give resident call light and toilet paper
If resident is able to be left alone, step out of bathroom and return when called
Put on gloves
Assist resident to wipe from front to back
Remove gloves and wash hands
Assist resident to raise garments
Assist resident to wash hands
Walk with resident back to bed or chair
Perform completion steps
Skill 43: Bedside Commode
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Place commode next to bed on resident’s unaffected side
Assist resident to commode
Give resident call light and toilet paper
If resident is able to be left alone, step behind curtain and return when called
Put on gloves
Assist resident to wipe from front to back
Help resident into bed
Remove and cover pan and take to restroom
Check urine and/or feces for color, odor, amount and character and report unusual findings to nurse
Dispose of urine and/or feces, sanitize pan and return pan according to current nursing practices
Remove gloves and wash hands
Assist resident to wash hands
Perform completion steps
Skill 44: Ambulation with a Walker
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
8.
Assist resident to sit on edge of bed
Place walker in front of resident
Assist resident to standing position
Have resident grasp both arms of walker
Brace leg of walker with your foot and place your hand on top of walker
Assist resident to stand on count of three
Stand to side and slightly behind resident
Have resident move walker ahead six to 10 inches, then step up to walker
Perform completion steps
Skill 45: Ambulation with a Cane
Perform initial steps
1.
Instruct the resident to hold the cane close to his or her body on the unaffected side
57
2.
3.
4.
5.
Have the resident move the cane and the involved leg at the same time, and then move the uninvolved
leg
Encourage the resident to keep the stride length of each leg and the timing of each step equal
Demonstrate correct technique if necessary
Observe carefully and assist resident to learn the technique
Perform completion steps
Skill 46: Sitting in a Chair Using a Cane
Perform initial steps
1.
Have resident sit by placing backs of his or her legs against the edge of the chair seat, moving the cane out
from his or her side, and reaching back with both hands to grasp the chair’s armrests
2. Have the resident get up by unhooking the cane, holding it in his or her stronger hand while grasping the
armrests, and pushing against the armrests while raising himself or herself upright
3. Demonstrate the technique if necessary
4. Observe the resident’s technique and assist him/her in learning the technique
Perform completion steps
Skill 47: Providing Foot Care
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
8.
9.
Test water temperature and ensure it is safe and comfortable before placing resident’s foot in water, and
adjust if necessary
Completely submerge foot in water
Remove foot from water, washing entire foot, including between toes, with soapy washcloth
Rinse entire foot, including between toes
Dry entire foot, including between toes
Put lotion in hand and warm lotion by rubbing hands together
Massage lotion into entire foot (top and bottom), removing excess (if any) with towel
Assist resident to replace sock
Support foot and ankle properly throughout procedure
Perform completion steps
Skill 48: Put One Knee-High Elastic Stocking on Resident
Perform initial steps
1. Turn stocking inside-out at least to heel area
2. While supporting the heel, bring the stocking over the toes, then foot and ankle. The opening in the
stocking should be either on top or bottom of the toe area depending upon the manufacturer
3. Slowly bring the stocking up the leg of the resident, smoothing out any wrinkles. This should be done
gently and naturally, avoiding force and overextension of limb and joints throughout the procedure
4. Straighten all of the lines and make sure resident is comfortable
Perform completion steps
Skill 49: Give Partial Bed Bath (Face, one arm, hand and underarm)
Perform initial steps
1.
2.
3.
4.
5.
Remove or fold back top bedding keeping resident covered with bath blanket (or top sheet)
Remove resident’s gown
Test water temperature and adjust if necessary
Wash face with wet washcloth (no soap) beginning with the eyes, using a different area of the washcloth
for each eye, washing inner aspect to outer aspect
Dry face with towel, using a blotting motion
58
6.
7.
8.
9.
10.
Expose one arm
Place towel underneath arm
Using washcloth and towel, wash with soap, rinse and dry arm, hand, and underarm
Put clean gown on resident (will verbalize for testing procedure)
Remove bath blanket and pull up bedcovers
Perform completion steps
Skill 50: Changing Adult Incontinent Brief or Pad
Perform initial steps
1. Apply gloves
2. Ensure privacy, remove bed linen, lift gown or pull down pajamas
3. Turn resident to side, place bed protector under the resident
4. Undo incontinent brief , carefully remove it by turning the resident from side to side
5. Place in disposable bag
6. Clean resident with disposable wipe or washcloth. Place disposable wipe in disposable bag or return
washcloth to collection container
7. Replace with fresh brief by turning resident side to side. Take care not to pull so hard that the brief is torn
8. Replace adhesive protector from back of brief and attach to strips on the front of brief. Do not wrap too
tightly
9. Replace pajamas or gown and secure resident
10. Remove gloves, wash hands
Perform completion steps
Skill 51: Measure and Record Weight of Ambulatory Resident
Perform initial steps
1. Start with scale balanced at zero before weighing resident
2. Assist resident to step up onto center of the scale
3. Determine resident’s weight
4. Assist resident off scale before recording weight
5. Report weight within plus or minus two pounds of evaluator’s reading
Perform completion steps
Skill 52: Measuring Height of a Bedridden Resident
Perform initial steps
1.
2.
3.
4.
5.
6.
7.
Turn linen down so it is off the resident
Position resident comfortably in the supine (back) position
Using a pencil, make a small mark on the bottom sheet at the top of the resident's head
Go to the foot of the bed and make another small pencil mark at the resident's heels
Using a tape measure, measure the area between the pencil marks. This is the height of the resident
Note the number on your paper to report to the nurse and/or document
Position resident comfortably and replace linen over resident
Perform completion steps
Skill 53: Measuring Abdominal Girth
Perform initial steps
1.
2.
3.
Turn linen down and raise resident gown or pajamas just enough that abdomen can be measured. Keep
all areas covered that do not need to be exposed
Carefully wrap measuring tape around the resident's abdomen at the level of the navel (umbilicus)
Read the number where the ends of the tape meet
59
4. Carefully remove the tape measure. Write down the abdominal girth measurement on your paper
5. Replace resident clothing and position comfortably
Perform completion steps
Skill 54: Care of the Artificial Eye
Perform initial steps
1.
2.
3.
Position resident in the supine position with a towel over the chest
Position eyecup on flat surface
Ask resident to close both eyes and cleanse eyes with moistened cotton balls. Wipe gently from inner
corner (canthus) of each eye outward. Use clean cotton ball for each eye
4. Remove eye:
a. Hold hand under eye area so that the eye will move out into your hand
b. Pull lower eyelid down with the thumb and lift the upper lid gently with the first finger
c. Eye should come out into the hand
5. Place eye carefully in eye cup on gauze
6. Secure the resident
7. Bring the eye cup to the sink and place on flat surface
8. Line the sink with towel
9. Empty and rinse eye cup, place new gauze inside of it and replace cup on a flat surface
10. Wash eye in lukewarm water, rinse and place on clean gauze inside eye cup. Do not dry the eye (Eye may
be washed in other solution, such as antibacterial soap if ordered by physician or recommended by the
manufacturer)
11. Store eye in water or soft contact saline solution or prepare to replace inside the socket
12. Replace eye:
a. Return to bedside
b. Clean the eye socket, if needed with moistened cotton balls and dry (or as ordered by physician)
c. Hold the notched edge of eye toward the nose
d. Lift upper lid with first finger and using other hand, gently insert the eye
e. Press down on the lower lid until the eye slips into its place. It is held in place by suction
Perform completion steps
Skill 55: Stump Prosthesis Care and Application
Perform initial steps
1.
2.
To care for the plastic prosthesis:
a. Wipe the plastic socket of the prosthesis with a damp cloth and mild soap or alcohol
b. Wipe the insert with a dry cloth
c. Dry the prosthesis thoroughly
d. Maintain and lubricate the prosthesis as advised by the manufacturer
e. Check for malfunctions and adjust or repair if necessary
f. Check the condition of the shoe on the foot prosthesis
To apply the prosthesis:
a. Apply the stump sock
b. Remove the insert from the prosthesis and place it over the stump
c. Insert the stump into the prosthesis
d. Secure the prosthesis onto the stump according to the manufacturer’s instructions
Perform completion steps
60
Skill 56: Care of the Limb After Amputation
Perform initial steps
1.
Wash limb at least once daily, preferably in the evening as the limb should always be dry when putting on
the prosthesis
2. Prepare basin with water at proper temperature for bathing
3. Wash limb using mild soap, rinse and pat dry
4. If ordered by physician, the limb should be massaged to decrease discomfort and increase circulation.
Always observe for any changes or problems with the stump, such as open wounds, redness, signs of
injury or infection
5. Never use lotion or hand cream on a residual limb. The lotion will soften the skin and the goal is to have
the skin toughened so it will not break down inside the prosthesis
6. The stump shrinker or ace wrap should be replaced if the resident has one. This will be done by the nurse
7. Empty basin
Perform completion steps
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