1. State Nurse Aide and NNAAP 2013
Kathy Turner – DHSR
Diana Brosko-Carelli – Pearson VUE
Susan Worthington –
NACES
September 26, 2013

2. Overview of Session
Updates from Pearson VUE – registration issues, improvements, standardized testing, reports, scores
Updates from NACES – clarifications, skill areas needing attention, testing tips, in-facility
Updates from DHSR – projects & initiatives, consultant activity for , refresher programs, statistics

3. Copyright © 2012 Pearson Education, Inc. or its affiliate(s)
Copyright © 2012 Pearson Education, Inc. or its affiliate(s). All rights reserved 3

4. Testing Topics On-Line Registration Reports 2012 Skills Results
Standardized Testing
2013 Skills Changes
New Skills Results 4

5. NNAAP® Registration
but I think I spoke with and apologized personally to all but 6 of you at sometime since the beginning of on-line registration
All got apology letter…to use Gary Esquerre’s line… we are sorry, we are sorry, we are sorry
BUT with all the issues that we encountered, you all still managed to register more candidates (708 to be exact) than the same time period w/PULSE 5

6. On-Line Registration and Scheduling
Improvements
Lessons Learned
Challenges
Reduced # of steps to complete registration and scheduling
Keep process simple
Is it a registration or a scheduling issue?
Clarified instructions for In-facility candidates
Obtain client input prior to implementation
Perception/confidence in system
Improved website navigation
Deploy usability testing/or training prior to implementation
Review of system procedures prior to registration
Reduce # of days between scheduling & testing (effective 8/24/13)
Allow correction of errors when registering/Prevent errors in the first place 6

7. BI PORTAL Training Program Performance Report
Generated monthly
Reports summary pass/fail performance for written & skills
Reports individual candidate performance
Lists skills 7

8. Sample BI PORTAL Pass/Fail Roster8

9. Training Program Reports
Generated quarterly
Reports summary pass/fail performance for written & skills
Your students
Overall candidates within the state
Reports candidate performance by
Individual content category
Individual skill 9

10. Sample Training Program Reports10

11. 2012 Highest to Lowest Skills for NC CC
Pass %
Pass %
Washes hands
Makes occupied bed
99%
98%
Feeds client who cannot feed self
Measures and records weight
Provides mouth care
92%
Assists to ambulate using transfer belt
Cleans upper or lower denture
Donning and removing PPE
Performs passive ROM knee & ankle
Positions on side
97%
Dresses client with weak right arm
Provides catheter care
90%
Performs passive ROM shoulder
Provides fingernail care
Provides foot care
Transfers from bed to wheelchair
96%
Assists with the use of bedpan
Measures and records blood pressure
Gives modified bed bath
89%
88%
Applies knee-high stocking
Counts and records respirations
Measures and records urinary output
95%
94%
93%
Provides perineal care for female
Counts and records radial pulse
86%
85% 11

12. Why Is NNAAP A Quality Examination?
Examinations are based on a job analysis regularly conducted by National Council of State Boards of Nursing (NCSBN)
Conducted every 5 years
Most recent JA conducted in 2009 with results published in 2010
Two examination components: Written & Skills
Developed by the NCSBN, and includes participation of subject-matter experts (SMEs) from across the country (2011)
Developed according to the Standards for Educational & Psychological Testing 12

13. Job Analysis Content Outline
Periodic Job Task Analysis:
What does a nurse aide do?
Has the job changed?
How is this determined?
Conduct a national survey of:
Multiple job settings: Long-term care, acute care, and home care settings
Directors of nursing
Training program instructors
Experienced nurse aides
Identify knowledge, skills and activities (KSAs) required for competent performance
Required knowledge, skills, and abilities (KSAs) linked with tasks
Skills weighted for each KSA 13

14. Standards for Educational & Psychological Testing
Use standards developed by American Psychological Association, American Educational Research Association, and National Council on Measurement in Research
Nationally recognized standards for assessment
Concerned with:
Validity
Are you measuring what you intend to measure?
Reliability
How accurate is your measurement
Test development
Administration, scoring, equating, and reporting of scores 14

15. 2012 Skill Changes Minor changes effective July 1, 2013
Skills Eliminated
Makes an Occupied Bed
Provides Fingernail Care
Two-Step Blood Pressure (was only in PA)
Skill Name Changes
Washes Hands  Hand Hygiene (Hand Washing)
Performs Passive Range of Motion (PROM) for One Knee an One Ankle  Performs Modified Passive Range of Motion (PROM) for One Knee an One Ankle
Performs Passive Range of Motion (PROM) for One Shoulder  Performs Modified Passive Range of Motion (PROM) for One Shoulder 15

16. 2012 Skill Changes More significant changes
Revised passing standard (not percentage based)
Increased minimal competency level
Increased the cut scores
Some skills now require additional steps to be performed correctly
Some skills now have/additional critical elements (7 skills)
Revised skills steps
Clarity, Consistency, Infection Control, Order dependency
Combining of steps
Clarity
This change in the certification standard addresses the evolving role of the CNAs in caring for the elderly and chronically ill by ensuring a level of minimal competency and preparedness. 16

17. July 1 – September 15, 2013 North Carolina CC
Skill
Pass %
Hand Hygiene (hand washing)
Cleans upper or lower denture
98% (-1) +1
Assists with the use of bedpan
Feeds client who cannot feed self
Measures and records urinary output
89% n/c
(-3)
(-4)
Counts and records respirations
Provides foot care
Applies knee-high stocking
Donning and removing PPE
Performs passive ROM knee & ankle
96% (-2)
95% (-1)
93% (-2)
Dresses client with weak right arm
Performs passive ROM shoulder
Positions on side
Counts and records radial pulse
88% (-2)
(-8)
(-9)
87% +2
Measures and records weight
Assists to ambulate using transfer belt
92% n/c
91% (-6)
Gives modified bed bath
Provides catheter care
84% (-4)
(-6)
Measures and records blood pressure
Transfers from bed to wheelchair
90% +1
Provides perineal care for female
Provides mouth care
83% (- 3) 81% (-11) 17

18. Questions

19. Tips for Programs & Instructors (NACES)
Review Candidate Handbook!
Cut Score – each step weighted
differently
Candidates are allowed to correct steps before they finish with skill
Exception is Gloving
Prior to skills exam candidate are allowed to try equipment and look at supplies/stations – highly encouraged

20. Scoring of Skills Exam Scored Objectively Be aware of over exposure
YES or NO
Multiple component steps
Order dependent steps
Be aware of over exposure
Hand Hygiene
Will be scored YES if introduces self in next skill
20 seconds by clock
Hands lower than elbows, fingertips down
Cleans fingernails (step 6) not part of Step 5

21. Scoring of Skills Exam Applies One Knee-High Elastic Stocking
Mannequin or client
Heel is on heel, no twists or wrinkles
Assists to Ambulate Using Transfer Belt
Client must have shoes on
Candidate or Client
Watch for order dependent steps “Before”
Steps 2 – 7
Step 5 – Client “assisted”
Candidate must be touching client
“Feet flat on the floor”
“Maintain stability of client’s legs”

22. Scoring of Skills Exam Assists with Use of Bedpan Counts Radial Pulse
Standard bedpan
Proper placement!
Often forget gloving as applied and removed twice
Counts Radial Pulse
Any wrist
If recorded measurement not within 4 +/-, evaluator will ask if candidate is finished with skill, stop clock, and retake pulse on same wrist as candidate

23. Scoring of Skills Exam Feeds Client who Cannot Feed Self
Safety Stop! Step 3, client seated at degrees
Gives Modified Bed Bath
Step 3 – removes gown and places in soiled linen container
Will miss Steps 3, 13, 16, and 18
Measures and Records Blood Pressure
Candidate can try two times on each arm
Step 7 – inflating cuff
Safety Stop! If inflates over 200 mm Hg

24. Scoring of Skills Exam Measures and Records Blood Pressure
If candidate hears systolic again at 200 mm Hg, use that as the systolic reading and listen and record diastolic
If recorded measurement not within 8 +/-, evaluator will ask if candidate is finished with skill, stop clock, and retake B/P on same arm as candidate
Measures and Records Urinary Output
Can record in cc / ml, not in ounces!

25. Scoring of Skills Exam Measures and Records Weight
Step 2, client must have shoes on
Candidate can put on or ask client to put on
Steps 3 & 4, candidate must set scale to ZERO before client steps onto scale
If scale not set to ZERO will miss Steps 3 & 4
Performs PROM for 1 Knee and 1 Ankle
Step 4, supports leg and ankle
Performs PROM for 1 Shoulder
Step 5, raises to ear level

26. Scoring of Skills Exam Positions on Side
Step 5 – Candidate must roll client, not just ask client to roll onto side.
Step 6 – In order to receive credit the candidate must touch the pillow.
Step 7 – In order to receive credit must touch the arm.
Step 10 – Support the ankle as well as the knee.

27. Scoring of Skills Exam Provides Catheter Care for Female
Must hold the catheter AT THE MEATUS.
Frequently missed step.
Steps 8, 9 & 10 do NOT specify how many strokes
Step 5 – If the candidate does not place the linen protector under the client, then they will be scored “NO” for Steps 5, 13 & 15.
Provides Foot Care
Candidates must use water with this skill.
Foot must be washed, rinsed and dried including between the toes.
Step 11 – The candidate must apply lotion.

28. Scoring of Skills Exam Provides Mouth Care Provides Perineal Care
Safety Stop! Step 3, client seated at degrees
Step 6 & 7 – Both relate to the toothbrush needing to be moistened. If not done in step 6, then step 7 will be scored as a “NO” also.
Provides Perineal Care
Steps 8, 9 & 11 do NOT specify how many strokes they must do.
Suggestion….candidate gather 4 washcloths for the peri care. One for washing, one for rinsing, one for drying (or use towel) and one for the rectal area.

29. Scoring of Skills Exam Transfer from Bed to Wheelchair
Steps 2 – 11, order dependent, all need to be done BEFORE assisting to stand.
Client “assisted” -candidate must be touching client
“Feet flat on the floor”
“Maintain stability of client’s legs”
After Step 19 (last step), candidates does not need to put the client back in bed. If they have another skill following this skill, then they should continue on and the evaluator will tell the client to get back in bed.

30. New In-Facility Testing Process
5 Skills candidates required prior to scheduling test date with the assigned evaluator.
Evaluator may test up to 10 candidates
Some evaluators are willing to test up to candidates per test date, must be pre-approved with evaluator.
Be flexible with the test dates when arranging mutually agreeable test date and time.

31. New In-Facility Testing Process
If the designated evaluator not available please contact
In-facility test sites are required to submit a roster students testing to Cheryl NACES no later than 15 calendar days prior to the scheduled test date. 
Roster can be ed faxed to Cheryl’s attention at  
Please note: NACES will not verify if all your students sign up for INF testing.

32. New In-Facility Testing Process
Students may now register for a test date 12 calendar days out (weekends and holidays DO count towards calendar days), instead of the original 16.  
If testing at an In-facility testing site, must have correct test site code.
Students who miss the deadline to register must test at a regional test site.  
If less than 5 students registered for an In-facility test date for skills exam, exam will be cancelled and students rescheduled into a regional test site/date.

33. New In-Facility Testing Process
To apply to become an In-facility test site, please contact Cheryl at
or ext 187.
Test Date
Roster due to Naces
(15 days prior)
Last Date Candidate May Register
(12 days prior)
10/7/13
9/23/13
9/25/13

34. Aging Trends to Consider
In the next 20 years the number of persons 65 and older will almost double from 1.3 million to 2.3 million
By 2025, 86 of the NC’s 100 counties are projected to have more people over age 60 than age 17 and under
Over the next two decades, the age group will be the fastest growing of those ages 65 and older

35. Program Statistics 2010-11 2011-12 2012-13 New CC programs added 11 1418
Program renewals 61 75 71
# clinical sites
475
597
608
CC program
300
296
324
Total programs
646
674
693
Number Active Aides
121,233
123,822
124,323

36. Preparing for the Challenge
Revised NA I curriculum - to meet learning needs of students and care needs of citizens
Identify additional training opportunities to educate caregivers (examples PHCAST, Med Aide, Oral Care project, refresher programs)
Identify recruitment and retention activities to ensure competent and well-qualified workers (examples PHCAST and building linkages)

37. Active Nurse Aides Employment Breakdown – 9/17/13
Employment Type
Number of Aides reporting
Percentage of Total
Nursing Homes
23,263
19%
Home Health/Care/Hospice
28,312
23%
Hospital
17,217
14%
Mental Health
278
---
Clinic
3243 3%
Adult Care Home
8368
34%
Other
42,154 7%
Not employed in healthcare
399
TOTAL
123,234
100%

38. Changes to the Nurse Aide Refresher Program Requirements
All NAI Refresher programs will be approved.
Proprietary programs may offer, however they must be approved.
As community college NAT programs are reviewed, associated Refresher programs will also be reviewed.
Applications for state-approved refresher programs are available through DHSR.

39. Refresher Program – application
A 4-page application consists of:
Basic program information
Clinical site information (if used – not mandated)
Required signatures
Statement of understanding
Policy statements such as:
40 clock hours
Must have offered full NAT program during 2-year cycle
Other “NAT-type” policies

40. NAT Refresher Program – student requirements
This course is designed for individuals:
whose listing has expired or
for individuals with a state recognized or military health care credential who wish to be listed on the NC Nurse Aide I Registry.

41. Refresher Program – content topics
At minimum programs MUST teach:
Basic nursing skills
Personal care skills
Recognition of mental health and social service needs
Care of cognitively impaired residents
Basic restorative services
Resident’s rights

42. Medication Aides in Adult Care Homes
Session Law 2011, House Bill 474
An Act to Protect Adult Care Home Residents
Among other requirements, this law:
Increases minimum continuing education, training and competency evaluation requirements for Adult Care Home Medication Aides
Strengthens Adult Care Home Infection Control Requirements
As a result, the following curricula will be posted to the Adult Care Home web pages:
Infection Control Course Instructor Manual – 2013
Medication Aide Training Courses for Adult Care Homes
--5 hour
--10/15 hour

43. Oral Health Project
New, improved method of oral hygiene for persons with cognitive and physical impairment
New DVD “Mouth Care Without a Battle”, developed by UNC
Best practices will be implemented in nurse aide training
Funding - approved to purchase one per school via PHCAST
For more info:

44. Contact Information
Kathy Turner
Fax