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Pamela K. Randolph, RN, MS Sheila A. Sorrentino, PHd, rn June 2010

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Presentation on theme: "Pamela K. Randolph, RN, MS Sheila A. Sorrentino, PHd, rn June 2010"— Presentation transcript:

1 Pamela K. Randolph, RN, MS Sheila A. Sorrentino, PHd, rn June 2010
Inconsistencies Between Nurse Aide Programs and the Need for Uniformity in Education, Evaluation, and Endorsement Pamela K. Randolph, RN, MS Sheila A. Sorrentino, PHd, rn June 2010

2 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).

3 Illinois and other states Omnibus Budget Reconciliation Act of 1987
Assessment Historical overview: Illinois and other states Omnibus Budget Reconciliation Act of 1987

4 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 benefits 30 to 35% of single-parents receive food stamps Many rely on publicly funded health care Over 90% are female 12 to 23% are foreign-born; about 1/3 are naturalized citizens 28 to 35% have some college education Over 40 titles used in the industry

5 Responsible Agency Dept. of Health, Public Health, or Similar
State Board of Nursing Dept. 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

6 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

7 Program Hours—120+ Hours State Required Hours Clinical Hours Maine 180
70 Missouri 175 100 California 150 Delaware 75 Oregon Alaska 140 80 Arizona 120 40 District of Columbia 45 Florida Illinois Virginia West Virginia 55 Wisconsin 32

8 Program Hours—76 to 119 Hours
State Required Hours Clinical Hours Indiana 105 75 Connecticut 100 50 Hawaii 70 Maryland 40 New Hampshire 60 New York 30 Rhode Island 20 Arkansas 90 16 Kansas 45 New Jersey Georgia 85 24 Washington

9 Program Hours—76 to 119 Hours (cont.)
Louisiana 80 40 Pennsylvania 37.5 South Carolina Utah 16 Vermont 30

10 Program Hours—75 Hours State Required Hours Clinical Hours Alabama 75
16 Colorado Iowa 30 Kentucky Massachusetts Michigan Minnesota Mississippi Montana 25 Nebraska Nevada New Mexico

11 Program Hours—75 Hours State Required Hours Clinical Hours
North Carolina 75 16 North Dakota Ohio Oklahoma South Dakota Tennessee 35 Texas 24 Wyoming 48

12 Testing Services Pearson Vue—21 states ProMetric—10 states
Diversified—13 states Other Illinois Indiana Iowa Kansas Kentucky Maine Massachusetts Missouri Nebraska

13 Competency Evaluation: Written Test
Written test: required passing score Low—65% Mid—75% High—80% Pass/fail

14 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

15 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

16 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)

17 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

18 Common Skills Bathing Bedmaking Dressing
Occupied/Unoccupied Dressing Handwashing (may be pre- and post-procedure steps) Mouth care Brushing teeth Comatose person Person with denture Range-of-motion Positioning Transfer Vital signs—TPR

19 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

20 Skills Comparison—Feeding
Pearson Vue 14 steps 1 key step Client is in upright sitting position (45-90 degrees) ProMetric 19 steps Diversified 2 key steps Positioning upright at least a 45 degree angle. Candidate within 25% of solids; within 30 mL of fluids consumed.

21 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

22 Competency Evaluation Costs
Written and skills: $59 to $176.50 Re-test written: $19 to $45.50 Re-test skills: $55 to $119

23 Legal Titles for Nursing Assistants
CNA—certified nursing assistant; certified nurse aide LNA— licensed nursing assistant RNA—registered nurse aide STNA—state tested nurse aide Nurse aide Nursing assistant Geriatric nursing assistant Nursing home nurse aide

24 Candidates seeking endorsement
Nursing Diagnoses Students Instructors Employers General public Candidates seeking endorsement

25 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

26 Planning Is it necessary or desirable to have uniformity in Nursing assistant education, evaluation, and endorsement?

27 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

28 Positive Aspects Resolves endorsement issues, time, and costs
Increases interstate mobility Resolves range of function issues Lessens confusion Increases respect

29 Negative Aspects CHANGE!
Agreement on what/how to standardize will take effort an planning Increase costs to facilities Major curricular revisions May require legislative action—lobbyists for LTC may oppose Availability of clinical sites for more hours Labor market needs States’ rights

30 Implementation and Evaluation
One state’s response to varying standards Endorsement in Arizona

31 Arizona Variances Title is CNA Require 120 hour program
Testing by D and S Technologies Renewal on birthday month every 2 years Require practice of 160 hours of nursing assistant practice hours within the past 2 years to renew

32 Endorsement Process Complete Application
Submit fingerprint card—need our own Fees Documentation of legal presence in US Verification 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

33 Education Options Board approved CNA program
Proof of a 120 hour CNA program Proof of a hour CNA program plus working as a nursing assistant for an additional 45 hours Proof 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

34 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

35 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

36 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

37 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

38 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, 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

39 Arizona State Board of Nursing
Contact Information Pamela Randolph Arizona State Board of Nursing SHEILA A. SORRENTINO

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