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PAMELA K. RANDOLPH, RN, MSSHEILA A. SORRENTINO, PHD, RN
JUNE 2010
Inconsistencies Between Nurse Aide Programs and the Need for
Uniformity in Education, Evaluation, and Endorsement
Objectives
Assess similarities and differences between state requirements (Assessment and Nursing Diagnoses).
Discuss approaches to mitigating mobility issues for nursing assistants (Planning).
Describe and evaluate one state’s approach to nursing assistant endorsement (Implementation and Evaluation).
HISTORICAL OVERVIEW:
ILLINOIS AND OTHER STATESOMNIBUS BUDGET RECONCILIATION ACT OF 1987
Assessment
Nursing Assistant Profile
Average hourly rate $11.46 Lowest 10%—less than $8.34 per hour (less than $19,000
annual full-time) Middle 50%—between $9.71 and $13.76 per hour Highest 10%—more than $15.97 per hour
Many work and average of 30 hours/week Reduces annualized earning to below $15,000
28% live in poverty and rely on public benefits30 to 35% of single-parents receive food stamps
Many rely on publicly funded health careOver 90% are female
12 to 23% are foreign-born; about 1/3 are naturalized citizens28 to 35% have some college educationOver 40 titles used in the industry
State Board of NursingState Board of Nursing Dept. of Health, Public Health, or SimilarDept. of Health, Public Health, or Similar
Arizona Colorado District of Columbia Kentucky Maryland Nevada New Hampshire Oregon South Dakota Vermont Virgin Islands Virginia Wyoming
Alabama Montana California Nebraska Connecticut New Jersey Delaware New Mexico Florida New York Idaho North Carolina Illinois North Dakota Indiana Ohio Kansas Oklahoma
Maine Pennsylvania Massachusetts South Carolina Michigan Tennessee Montana West Virginia Minnesota Wisconsin Mississippi Missouri
Responsible Agency
Responsible Agency (cont.)
Other Arkansas Dept of Human Services—Div. of Long-term Care Georgia Health Partnership-GMCF Hawaii Dept of Commerce & Consumer Affairs Iowa Dept. of Inspections & Appeals—Health Facilities
Division Louisiana State Board of Examiners for Nursing Facility
Administrators or Louisiana Dept. of Health and Hospitals Rhode Island Dept. of Health Professionals Texas Dept. of Aging & Disability Services Utah Health Technology Certification Center Washington Aging & Adult Services Administration
Residential Care Services Division
Program Hours—120+ Hours
State Required Hours Clinical Hours
Maine 180 70
Missouri 175 100
California 150 100
Delaware 150 75
Oregon 150 75
Alaska 140 80
Arizona 120 40
District of Columbia 120 45
Florida 120 40
Illinois 120 40
Virginia 120 40
West Virginia 120 55
Wisconsin 120 32
Program Hours—76 to 119 Hours
State Required Hours Clinical Hours
Indiana 105 75
Connecticut 100 50
Hawaii 100 70
Maryland 100 40
New Hampshire 100 60
New York 100 30
Rhode Island 100 20
Arkansas 90 16
Kansas 90 45
New Jersey 90 40
Georgia 85 24
Washington 85 50
Program Hours—76 to 119 Hours (cont.)
Louisiana 80 40
Pennsylvania 80 37.5
South Carolina 80 40
Utah 80 16
Vermont 80 30
Program Hours—75 Hours
State Required Hours Clinical Hours
Alabama 75 16
Colorado 75 16
Iowa 75 30
Kentucky 75 16
Massachusetts 75 16
Michigan 75 16
Minnesota 75 16
Mississippi 75 16
Montana 75 25
Nebraska 75 16
Nevada 75 16
New Mexico 75 16
Program Hours—75 Hours
State Required Hours Clinical Hours
North Carolina 75 16
North Dakota 75 16
Ohio 75 16
Oklahoma 75 16
South Dakota 75 16
Tennessee 75 35
Texas 75 24
Wyoming 75 48
Testing Services
Pearson Vue—21 statesProMetric—10 statesDiversified—13 statesOther
Illinois Indiana Iowa Kansas Kentucky Maine Massachusetts Missouri Nebraska
Competency Evaluation: Written Test
Written test: required passing score Low—65% Mid—75% High—80% Pass/fail
Competency Evaluation: Written Test (cont.)
Test questions (some states do not specify a time) 55 with 2 hours for completion 60 with 2 hours for completion 70 with 90 minutes for completion 72 with 90 minutes for completion 75 with 90 minutes for completion 77 with 90 minutes for completion 79 with 90 minutes for completion 85 with 90 minutes for completion 100 with no time specified
Competency Evaluation: Skills Tested
Abdominal thrust Ambulation Ambulation with gait belt Ambulation with walker (or
cane) Antiembolic stockings Apply warm or cold compress Assist with bedpan Back rub Bedpan Bedpan and output Bedpan/fracture pan and
output Bed bath (face, arm, hand, and
underarm) Bed bath (partial) Bed bath (full) Blood pressure Brief application
Catheter care for indwelling urinary catheter
Catheter care for female Change of position Change of position with
backrub Convert ounces to mLs Denture care Dressing Dressing/undressing Dress a resident who has a
weak arm Dressing bedridden resident Feeding Feeding a dependent resident Fingernail care Fluid intake
Competency Evaluation: Skills Tested (cont.)
Foot care Gown and gloves Hair and nail care Handwashing Height and weight Making an occupied bed Making an unoccupied
bed/closed Measure and record
contents of urinary drainage bag
Measure and record weight Measure and record urinary
output Mechanical lift
Mouth care (brushing teeth) Mouth care to a resident
who has dentures Mouth care of comatose
resident Moving and positioning a
resident Nail care (one hand) Obstructed airway Oxygen Passing fresh water Passive range-of-motion
exercises to lower extremity (hip, knee, ankle)
Passive range-of-motion exercises to upper extremity (shoulder, elbow, wrist, and fingers)
Competency Evaluation: Skills Tested (cont.)
Perineal care (female) Perineal care (female who is
incontinent of urine) Perineal care (male) Perineal care for
uncircumcised male Position Foley
catheter/bag/tubingPosition for an enema
Position resident for meals Position resident on side Positioning and alignment
(Fowler’s, lateral, supine) Pressure ulcer prevention
Range-of-motion elbow Range-of-motion hip and knee Range-of-motion hip Range-of-motion shoulder Range-of-motion wrist Restraints Shaving Transfer Transfer from bed to
wheelchair using transfer belt and pivot transfer technique
Transferring from bed to wheelchair/one man pivot
Vital signs (TPR) Vital signs (T (oral/axillary)PR
Common Skills
BathingBedmaking
Occupied/UnoccupiedDressingHandwashing (may be pre- and post-procedure steps)Mouth care
Brushing teeth Comatose person Person with denture
Range-of-motionPositioningTransferVital signs—TPR
Skills Comparison—Handwashing
Pearson Vue 10 steps 15 seconds
ProMetric 7 to 9 steps 15 seconds; 10 seconds for Michigan
Diversified 12 steps No time specified for some states; 15 seconds for
others
Skills Comparison—Feeding
Pearson Vue 14 steps 1 key step
Client is in upright sitting position (45-90 degrees)
ProMetric 19 steps
Diversified 19 steps 2 key steps
Positioning upright at least a 45 degree angle. Candidate within 25% of solids; within 30 mL of fluids
consumed.
Skills Comparison—Perineal Care (Female)
Pearson Vue 18 steps 2 key steps
Washes from front to back with clean area of washcloth for each stroke
Rinses from front to back with clean area of a clean washcloth for each stroke
ProMetric (to incontinent female) 23 steps No key steps
Diversified 31 steps No key steps
Competency Evaluation Costs
Written and skills: $59 to $176.50Re-test written: $19 to $45.50Re-test skills: $55 to $119
Legal Titles for Nursing Assistants
CNA—certified nursing assistant; certified nurse aide
LNA— licensed nursing assistantRNA—registered nurse aideSTNA—state tested nurse aideNurse aideNursing assistantGeriatric nursing assistantNursing home nurse aide
STUDENTSINSTRUCTORSEMPLOYERS
GENERAL PUBLICCANDIDATES SEEKING ENDORSEMENT
Nursing Diagnoses
Nursing Diagnoses
Anxiety Comfort, Impaired Confusion, Acute Confusion, Chronic Confusion, Risk for Acute Coping, Defensive Coping, Ineffective Decisional Conflict Human Dignity, Risk for
Compromised Fatigue Fear Hopelessness Insomnia
Knowledge, Deficient Knowledge, Readiness for
Enhanced Powerlessness Powerlessness, Risk For Self-Esteem, Chronic Low Self-Esteem, Situational
Low Self-Esteem, Situational
Low, Risk for Sleep Deprivation Sleep Pattern, Disturbed Sleep, Readiness for
Enhanced Stress Overload
IS IT NECESSARY OR DESIRABLE TO HAVE UNIFORMITY IN NURSING ASSISTANT EDUCATION,
EVALUATION, AND ENDORSEMENT?
Planning
Planning
Minimum requirements-quickest way to uniformity is to seek the lowest common denominator—lowers all standards
Increasing requirements—how much? Differing ideas among states
Grandfathering—always needed—across state lines?
Other Minimum requirements—what about other settings—acute care, assisted living
Positive Aspects
Resolves endorsement issues, time, and costsIncreases interstate mobilityResolves range of function issuesLessens confusion Increases respect
Negative Aspects
CHANGE!Agreement on what/how to standardize will
take effort an planningIncrease costs to facilitiesMajor curricular revisionsMay require legislative action—lobbyists for
LTC may opposeAvailability of clinical sites for more hoursLabor market needsStates’ rights
One state’s response to varying standardsEndorsement in Arizona
Implementation and Evaluation
Arizona Variances
Title is CNARequire 120 hour programTesting by D and S TechnologiesRenewal on birthday month every 2 yearsRequire practice of 160 hours of nursing
assistant practice hours within the past 2 years to renew
Endorsement Process
Complete ApplicationSubmit fingerprint card—need our ownFeesDocumentation of legal presence in USVerification of current inclusion in the
registry Provide address/contact of all registries in US Provide form to send to the state registry to verify
status
Education Options
Board approved CNA programProof of a 120 hour CNA programProof of a 75-119 hour CNA program plus working as
a nursing assistant for an additional 45 hoursProof of graduation from RN/LPN program (foreign
or domestic) or Proof of completion of a part of a nursing program that
contained didactic content relating to LTC clients and 40 hours of LTC clinical
Proof of 100 hours military health care training
Practice Requirement Options
Currently working doing nursing assistant activities even if title is different
Has worked performing nursing assistant activities for 160 hours in past two years even if title is different
Or completed a NA program in the past 2 years
Challenges
Lapsed NA certificate/registry If has continuously worked performing NA tasks, we
will endorse (at least 160 hours every 2 years) If never worked needs to retake course
Challenges
Recently completed a 75 hour course in another jurisdiction and never worked Can enroll as an Advanced Placement Student in an
approved course Can accumulate work hours doing CNA duties in a
non-CNA position Can ask the original course to allow him/her to
complete additional long term care clinical to make up to 120 hours
Can ask the Board to make an exception
Uniformity
From a State Board of Nursing Perspective, uniformity is desired if: Education is appropriate to job duties and evidence-
based Endorsement/Renewal requirements ensure
competency Protection of the public is ensured Preserves state authority over discipline
Bibliography
An introduction to the national nursing assistant survey, U.S. Department of Health and Human Services, series 1, number 44, March 2007.
Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2010-2011.
Nursing Aides, Home Health Aides, and Related Health Care occupations—national and local workforce shortages and associated data needs, February 2004, National Center for Health Workforce Analyses, Bureau of health professions, Health resources and services administration.
Rosen J: Getting to the bottom of CNA turnover, McKnight’s Long Term Care News, December 01, 2008
PAMELA RANDOLPH
Arizona State Board of Nursing602-771-7800
[email protected] A. SORRENTINO
Contact Information