5NNAAP® Registrationbut I think I spoke with and apologized personally to all but 6 of you at sometime since the beginning of on-line registrationAll got apology letter…to use Gary Esquerre’s line… we are sorry, we are sorry, we are sorryBUT 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/PULSE5
6On-Line Registration and Scheduling ImprovementsLessons LearnedChallengesReduced # of steps to complete registration and schedulingKeep process simpleIs it a registration or a scheduling issue?Clarified instructions for In-facility candidatesObtain client input prior to implementationPerception/confidence in systemImproved website navigationDeploy usability testing/or training prior to implementationReview of system procedures prior to registrationReduce # of days between scheduling & testing (effective 8/24/13)Allow correction of errors when registering/Prevent errors in the first place6
7BI PORTAL Training Program Performance Report Generated monthlyReports summary pass/fail performance for written & skillsReports individual candidate performanceLists skills7
9Training Program Reports Generated quarterlyReports summary pass/fail performance for written & skillsYour studentsOverall candidates within the stateReports candidate performance byIndividual content categoryIndividual skill9
112012 Highest to Lowest Skills for NC CC Pass %Pass%Washes handsMakes occupied bed99%98%Feeds client who cannot feed selfMeasures and records weightProvides mouth care92%Assists to ambulate using transfer beltCleans upper or lower dentureDonning and removing PPEPerforms passive ROM knee & anklePositions on side97%Dresses client with weak right armProvides catheter care90%Performs passive ROM shoulderProvides fingernail careProvides foot careTransfers from bed to wheelchair96%Assists with the use of bedpanMeasures and records blood pressureGives modified bed bath89%88%Applies knee-high stockingCounts and records respirationsMeasures and records urinary output95%94%93%Provides perineal care for femaleCounts and records radial pulse86%85%11
12Why 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 yearsMost recent JA conducted in 2009 with results published in 2010Two examination components: Written & SkillsDeveloped by the NCSBN, and includes participation of subject-matter experts (SMEs) from across the country (2011)Developed according to the Standards for Educational & Psychological Testing12
13Job 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 settingsDirectors of nursingTraining program instructorsExperienced nurse aidesIdentify knowledge, skills and activities (KSAs) required for competent performanceRequired knowledge, skills, and abilities (KSAs) linked with tasksSkills weighted for each KSA13
14Standards for Educational & Psychological Testing Use standards developed by American Psychological Association, American Educational Research Association, and National Council on Measurement in ResearchNationally recognized standards for assessmentConcerned with:ValidityAre you measuring what you intend to measure?ReliabilityHow accurate is your measurementTest developmentAdministration, scoring, equating, and reporting of scores14
152012 Skill Changes Minor changes effective July 1, 2013 Skills EliminatedMakes an Occupied BedProvides Fingernail CareTwo-Step Blood Pressure (was only in PA)Skill Name ChangesWashes 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 AnklePerforms Passive Range of Motion (PROM) for One Shoulder Performs Modified Passive Range of Motion (PROM) for One Shoulder15
162012 Skill Changes More significant changes Revised passing standard (not percentage based)Increased minimal competency levelIncreased the cut scoresSome skills now require additional steps to be performed correctlySome skills now have/additional critical elements (7 skills)Revised skills stepsClarity, Consistency, Infection Control, Order dependencyCombining of stepsClarityThis 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
17July 1 – September 15, 2013 North Carolina CC SkillPass %Hand Hygiene (hand washing)Cleans upper or lower denture98% (-1)+1Assists with the use of bedpanFeeds client who cannot feed selfMeasures and records urinary output89% n/c(-3)(-4)Counts and records respirationsProvides foot careApplies knee-high stockingDonning and removing PPEPerforms passive ROM knee & ankle96% (-2)95% (-1)93% (-2)Dresses client with weak right armPerforms passive ROM shoulderPositions on sideCounts and records radial pulse88% (-2)(-8)(-9)87% +2Measures and records weightAssists to ambulate using transfer belt92% n/c91% (-6)Gives modified bed bathProvides catheter care84% (-4)(-6)Measures and records blood pressureTransfers from bed to wheelchair90% +1Provides perineal care for femaleProvides mouth care83% (- 3) 81% (-11)17
19Tips for Programs & Instructors (NACES) Review Candidate Handbook!Cut Score – each step weighteddifferentlyCandidates are allowed to correct steps before they finish with skillException is GlovingPrior to skills exam candidate are allowed to try equipment and look at supplies/stations – highly encouraged
20Scoring of Skills Exam Scored Objectively Be aware of over exposure YES or NOMultiple component stepsOrder dependent stepsBe aware of over exposureHand HygieneWill be scored YES if introduces self in next skill20 seconds by clockHands lower than elbows, fingertips downCleans fingernails (step 6) not part of Step 5
21Scoring of Skills Exam Applies One Knee-High Elastic Stocking Mannequin or clientHeel is on heel, no twists or wrinklesAssists to Ambulate Using Transfer BeltClient must have shoes onCandidate or ClientWatch for order dependent steps “Before”Steps 2 – 7Step 5 – Client “assisted”Candidate must be touching client“Feet flat on the floor”“Maintain stability of client’s legs”
22Scoring of Skills Exam Assists with Use of Bedpan Counts Radial Pulse Standard bedpanProper placement!Often forget gloving as applied and removed twiceCounts Radial PulseAny wristIf recorded measurement not within 4 +/-, evaluator will ask if candidate is finished with skill, stop clock, and retake pulse on same wrist as candidate
23Scoring of Skills Exam Feeds Client who Cannot Feed Self Safety Stop! Step 3, client seated at degreesGives Modified Bed BathStep 3 – removes gown and places in soiled linen containerWill miss Steps 3, 13, 16, and 18Measures and Records Blood PressureCandidate can try two times on each armStep 7 – inflating cuffSafety Stop! If inflates over 200 mm Hg
24Scoring 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 diastolicIf recorded measurement not within 8 +/-, evaluator will ask if candidate is finished with skill, stop clock, and retake B/P on same arm as candidateMeasures and Records Urinary OutputCan record in cc / ml, not in ounces!
25Scoring of Skills Exam Measures and Records Weight Step 2, client must have shoes onCandidate can put on or ask client to put onSteps 3 & 4, candidate must set scale to ZERO before client steps onto scaleIf scale not set to ZERO will miss Steps 3 & 4Performs PROM for 1 Knee and 1 AnkleStep 4, supports leg and anklePerforms PROM for 1 ShoulderStep 5, raises to ear level
26Scoring 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.
27Scoring 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 strokesStep 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 CareCandidates must use water with this skill.Foot must be washed, rinsed and dried including between the toes.Step 11 – The candidate must apply lotion.
28Scoring of Skills Exam Provides Mouth Care Provides Perineal Care Safety Stop! Step 3, client seated at degreesStep 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 CareSteps 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.
29Scoring 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.
30New In-Facility Testing Process 5 Skills candidates required prior to scheduling test date with the assigned evaluator.Evaluator may test up to 10 candidatesSome 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.
31New In-Facility Testing Process If the designated evaluator not available please contactIn-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.
32New 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.
33New In-Facility Testing Process To apply to become an In-facility test site, please contact Cheryl ator ext 187.Test DateRoster due to Naces(15 days prior)Last Date Candidate May Register(12 days prior)10/7/139/23/139/25/13
34Aging 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 millionBy 2025, 86 of the NC’s 100 counties are projected to have more people over age 60 than age 17 and underOver the next two decades, the age group will be the fastest growing of those ages 65 and older
35Program Statistics 2010-11 2011-12 2012-13 New CC programs added 11 14 18Program renewals617571# clinical sites475597608CC program300296324Total programs646674693Number Active Aides121,233123,822124,323
36Preparing for the Challenge Revised NA I curriculum - to meet learning needs of students and care needs of citizensIdentify 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)
37Active Nurse Aides Employment Breakdown – 9/17/13 Employment TypeNumber of Aides reportingPercentage of TotalNursing Homes23,26319%Home Health/Care/Hospice28,31223%Hospital17,21714%Mental Health278---Clinic32433%Adult Care Home836834%Other42,1547%Not employed in healthcare399TOTAL123,234100%
38Changes 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.
39Refresher Program – application A 4-page application consists of:Basic program informationClinical site information (if used – not mandated)Required signaturesStatement of understandingPolicy statements such as:40 clock hoursMust have offered full NAT program during 2-year cycleOther “NAT-type” policies
40NAT Refresher Program – student requirements This course is designed for individuals:whose listing has expired orfor individuals with a state recognized or military health care credential who wish to be listed on the NC Nurse Aide I Registry.
41Refresher Program – content topics At minimum programs MUST teach:Basic nursing skillsPersonal care skillsRecognition of mental health and social service needsCare of cognitively impaired residentsBasic restorative servicesResident’s rights
42Medication Aides in Adult Care Homes Session Law 2011, House Bill 474An Act to Protect Adult Care Home ResidentsAmong other requirements, this law:Increases minimum continuing education, training and competency evaluation requirements for Adult Care Home Medication AidesStrengthens Adult Care Home Infection Control RequirementsAs a result, the following curricula will be posted to the Adult Care Home web pages:Infection Control Course Instructor Manual – 2013Medication Aide Training Courses for Adult Care Homes--5 hour--10/15 hour
43Oral Health ProjectNew, improved method of oral hygiene for persons with cognitive and physical impairmentNew DVD “Mouth Care Without a Battle”, developed by UNCBest practices will be implemented in nurse aide trainingFunding - approved to purchase one per school via PHCASTFor more info: