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

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 2013-14, refresher programs, statistics

Copyright © 2012 Pearson Education, Inc. or its affiliate(s) Copyright © 2012 Pearson Education, Inc. or its affiliate(s). All rights reserved. 800 837 8969 3

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

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

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

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

Sample BI PORTAL Pass/Fail Roster 8

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

Sample Training Program Reports 10

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

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

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

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

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

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

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

Questions

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

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

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”

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

Scoring of Skills Exam Feeds Client who Cannot Feed Self Safety Stop! Step 3, client seated at 75-90 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

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!

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

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.

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.

Scoring of Skills Exam Provides Mouth Care Provides Perineal Care Safety Stop! Step 3, client seated at 75-90 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.

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.

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 11-12 candidates per test date, must be pre-approved with evaluator. Be flexible with the test dates when arranging mutually agreeable test date and time.

New In-Facility Testing Process If the designated evaluator not available please contact NACES @ 1-888-282-6904. In-facility test sites are required to submit a roster students testing to Cheryl Anderson @ NACES no later than 15 calendar days prior to the scheduled test date.  Roster can be emailed to canderson@texasnurses.org or faxed to Cheryl’s attention at 1-877-696-2237.   Please note: NACES will not verify if all your students sign up for INF testing.

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.

New In-Facility Testing Process To apply to become an In-facility test site, please contact Cheryl at canderson@texasnurses.org or 1-888-282-6904 ext 187. Test Date Roster due to Cheryl @ Naces (15 days prior) Last Date Candidate May Register (12 days prior) 10/7/13 9/23/13 9/25/13

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 75-84 age group will be the fastest growing of those ages 65 and older

Program Statistics 2010-11 2011-12 2012-13 New CC programs added 11 14 18 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

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)

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%

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.

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

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.

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

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 http://www.ncdhhs.gov/dhsr/acls/

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: www.mouthcarewithoutabattle.unc.edu

Contact Information Kathy Turner Kathy.turner@dhhs.nc.gov 919-855-3972 Fax 919-733-9764