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PAMELA K. RANDOLPH, RN, MS SHEILA A. SORRENTINO, P H D, RN JUNE 2010 Inconsistencies Between Nurse Aide Programs and the Need for Uniformity in Education,

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Presentation on theme: "PAMELA K. RANDOLPH, RN, MS SHEILA A. SORRENTINO, P H D, RN JUNE 2010 Inconsistencies Between Nurse Aide Programs and the Need for Uniformity in Education,"— Presentation transcript:

1 PAMELA K. RANDOLPH, RN, MS SHEILA A. SORRENTINO, P H D, RN JUNE 2010 Inconsistencies Between Nurse Aide Programs and the Need for Uniformity in Education, Evaluation, and Endorsement

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 states approach to nursing assistant endorsement (Implementation and Evaluation).


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 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 AlabamaMontana CaliforniaNebraska ConnecticutNew Jersey DelawareNew Mexico FloridaNew York IdahoNorth Carolina IllinoisNorth Dakota IndianaOhio KansasOklahoma MainePennsylvania MassachusettsSouth Carolina MichiganTennessee MontanaWest Virginia MinnesotaWisconsin Mississippi Missouri Responsible Agency

6 Responsible Agency (cont.) Other Arkansas Dept of Human ServicesDiv. of Long-term Care Georgia Health Partnership-GMCF Hawaii Dept of Commerce & Consumer Affairs Iowa Dept. of Inspections & AppealsHealth 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 Hours120+ Hours StateRequired HoursClinical Hours Maine18070 Missouri California Delaware15075 Oregon15075 Alaska14080 Arizona12040 District of Columbia12045 Florida12040 Illinois12040 Virginia12040 West Virginia12055 Wisconsin12032

8 Program Hours76 to 119 Hours StateRequired HoursClinical Hours Indiana10575 Connecticut10050 Hawaii10070 Maryland10040 New Hampshire10060 New York10030 Rhode Island10020 Arkansas9016 Kansas9045 New Jersey9040 Georgia8524 Washington8550

9 Program Hours76 to 119 Hours (cont.) Louisiana8040 Pennsylvania South Carolina8040 Utah8016 Vermont8030

10 Program Hours75 Hours StateRequired HoursClinical Hours Alabama7516 Colorado7516 Iowa7530 Kentucky7516 Massachusetts7516 Michigan7516 Minnesota7516 Mississippi7516 Montana7525 Nebraska7516 Nevada7516 New Mexico7516

11 Program Hours75 Hours StateRequired HoursClinical Hours North Carolina7516 North Dakota7516 Ohio7516 Oklahoma7516 South Dakota7516 Tennessee7535 Texas7524 Wyoming7548

12 Testing Services Pearson Vue21 states ProMetric10 states Diversified13 states Other Illinois Indiana Iowa Kansas Kentucky Maine Massachusetts Missouri Nebraska

13 Competency Evaluation: Written Test Written test: required passing score Low65% Mid75% High80% 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 (Fowlers, 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 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 signsTPR

19 Skills ComparisonHandwashing 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 ComparisonFeeding 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.

21 Skills ComparisonPerineal 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

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

23 Legal Titles for Nursing Assistants CNAcertified nursing assistant; certified nurse aide LNA licensed nursing assistant RNAregistered nurse aide STNAstate tested nurse aide Nurse aide Nursing assistant Geriatric nursing assistant Nursing home nurse aide


25 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


27 Minimum requirements-quickest way to uniformity is to seek the lowest common denominatorlowers all standards Increasing requirementshow much? Differing ideas among states Grandfatheringalways neededacross state lines? Other Minimum requirementswhat about other settingsacute 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 actionlobbyists for LTC may oppose Availability of clinical sites for more hours Labor market needs States rights

30 One states response to varying standards Endorsement in Arizona Implementation and Evaluation

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 cardneed 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 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, McKnights Long Term Care News, December 01, 2008

39 PAMELA RANDOLPH Arizona State Board of Nursing SHEILA A. SORRENTINO Contact Information

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