Nurse Aide I Training Program - Module A

Module A: The Nurse Aide I Training Program - Comprehensive Notes

Glossary of Key Terms

• AM Care: Personal activities performed in the morning, encompassing toileting, face/hand washing, and mouth care both before and after breakfast.

• Activities of Daily Living (ADL): A healthcare term describing routine everyday tasks a resident performs, such as hygiene, grooming, dressing, eating, toileting, and transferring.

• Basic Nursing Skills: Essential skills nurse aides must possess to deliver competent care to residents in diverse healthcare settings.

• Cognition: The process by which sensory messages are collected, stored, retrieved from memory, and subsequently used to answer questions, fulfill requests, and execute tasks. It refers to the ability to think logically and clearly.

• Delegation: The act of assigning a portion of one's responsibility to another qualified individual in a specific situation. It involves transferring responsibility for task performance while the delegating person retains accountability for the outcome.

• Grooming: Tasks undertaken to maintain a person's appearance, including caring for fingernails and hair, which foster dignity and choice.

• Health Care Personnel Registry (NCDHHS/DHSR/HCPEC): A listing of unlicensed healthcare personnel who are either under investigation for or have a substantiated finding of neglect, abuse, misappropriation of resident or facility property, diversion of drugs, or fraud against a resident or healthcare facility.

• Hygiene: Tasks performed to keep bodies clean and healthy, such as bathing and brushing teeth.

• Interpersonal Skills: In a healthcare context, these skills generally refer to a healthcare provider's capacity to collaborate effectively with others while completing tasks.

• North Carolina Board of Nursing (NCBON): The regulatory body responsible for issuing the list of approved tasks included in a Nurse Aide I training program, defining the scope of practice for nurse aides in North Carolina.

• North Carolina Board of Nursing Administrative Code: The legal framework that explicitly defines the range of functions for nurse aides in North Carolina.

• North Carolina Health Care Personnel Education and Credentialing Section (NC HCPEC): A state section providing services for unlicensed healthcare workers, their employers, and instructors, and maintaining the NC Nurse Aide I Registry.

• North Carolina Nurse Aide I Registry: A comprehensive registry of all individuals who meet both state and federal training and testing requirements to perform Nurse Aide I tasks within North Carolina.

• Nurse Aide I in the State of North Carolina: A valuable, unlicensed member of the healthcare team, tasked with providing delegated nursing tasks within a defined range of function for residents (patients/clients) across various settings. Inclusion on the NC Nurse Aide I Registry is mandatory.

• OBRA (Omnibus Budget Reconciliation Act) of 1987: A federal law enacted by Congress in 1987, with significant updates in 2016, aimed at enhancing the quality of life for residents in nursing home environments.

• PM Care: Personal activities conducted in the evening, including toileting, face/hand washing, a snack, mouth care, and a backrub.

• Personal Care Skills: Tasks related to a person's body, appearance, and hygiene, typically performed daily.

• Team: A group of individuals united by a common purpose, assigned specific tasks, and coordinating their efforts to achieve a collective goal.

• Work Ethic: Behavior exhibited in the workplace that encompasses appearance, communication skills, treatment of others, decision-making, judgment, and teamwork.

The North Carolina Nurse Aide I (NA I)

• Definition: The Nurse Aide I in North Carolina is an essential, unlicensed member of the healthcare team. They are responsible for delivering delegated nursing tasks within a specific range of functions to residents (patients/clients) in various settings.

• Registry Requirement: Listing on the N.C. Nurse Aide I Registry is mandatory.

• Alternative Titles: Nurse Aide I is also commonly referred to as a nurse aide or nursing assistant. The term "Certified Nursing Assistant" or "CNA" is frequently used by the public and employers, signifying successful completion of a state-approved training program, passing the state competency test, and being listed on the Nurse Aide I Registry.

Regulatory Framework and Registries

OBRA (Omnibus Budget Reconciliation Act) of 1987

• Origin: A Federal Law passed by Congress in 1987, with updates implemented in 2016.

• Purpose: Its primary objective is to enhance the quality of life for residents residing in nursing homes.

• Impact on Training: A crucial component of OBRA defines the requirements for nurse aide training and competency evaluation, as well as the nurse aide registry, directly mandating the existence of this course and its instructors.

Range of Function for Nurse Aides

• Defining Body: The North Carolina Board of Nursing (NCBON) holds the responsibility for defining the allowed range of functions for nurse aides in North Carolina.

• Core Task List: The NCBON issues a specific list of core tasks that must be incorporated into Nurse Aide I training programs, accessible online.

• Delegation of Other Tasks: Nurses are permitted to delegate additional tasks that fall within the nurse aide's range of functions, provided these tasks meet specific criteria prior to delegation.

North Carolina Nurse Aide I Registry

• Purpose: A registry containing all individuals who have met state and federal training and testing requirements to perform Nurse Aide I tasks in North Carolina.

• Administering Body: The North Carolina Health Care Personnel Education and Credentialing (NC HCPEC) section of the state government:

  • Provides services for unlicensed healthcare workers, their employers, and instructors.

  • Maintains the N.C. Nurse Aide I Registry.

  • Approves Nurse Aide Training Programs.

NC Health Care Personnel Registry (NCHCPR)

• Purpose: A registry for unlicensed healthcare personnel who have substantiated findings or are under investigation for serious offenses.

• Offenses Listed: These include resident neglect, resident abuse, misappropriation of resident or healthcare facility property, diversion of drugs belonging to a resident or facility, or fraud against a resident or healthcare facility.

• Interlink with NA I Registry: Specific offenses (resident neglect, abuse, and misappropriation of resident property by nurse aides in nursing homes) are also listed on the N.C. Nurse Aide I Registry.

• Employer Requirement: Many healthcare settings mandate checking the Health Care Personnel Registry for allegations or substantiated findings before hiring employees.

• Employment Restriction: Federal regulations prohibit a nurse aide listed on the Nurse Aide I Registry with a substantiated finding of resident abuse, neglect, and misappropriation of resident property in a nursing home from being employed in a nursing home.

• Nurse Aide's Goal: A Nurse Aide I must strive to avoid being listed on the NCHCPR.

Nurse Aide I Listing and Renewal Requirements

Initial Registry Listing

• Requirements: An individual is listed on the Nurse Aide I Registry upon successfully completing a State-approved Nurse Aide I Training Program and passing the National Nurse Aide Assessment Program (NNAAP).

• NNAAP Test Components: The NNAAP test comprises:

  • Computer-based testing (CBT) with multiple-choice questions.

  • A demonstration of five (5) randomly selected skills.

• Test Attempts: An individual may attempt the NNAAP test up to three (3) times after completing a State-approved training program before retraining becomes necessary.

• Initial Listing Period: This period begins on the day of successful completion of the North Carolina state-approved Nurse Aide I competency test and concludes on the last day of the 24^{th} consecutive month.

  • For example, if the initial listing date is 10/22/2024, the renewal date is 10/30/2026.

Listing Renewals

• Renewal Method: Renewal is achieved through qualified work experience completed every 24 months.

• Qualified Work Experience Criteria:

  • Working a minimum of eight (8) hours during the 24-month listing period.

  • Receiving payment for the work experience.

  • Performing nursing or nursing-related services.

  • Being supervised by a Registered Nurse (RN).

• Expiration without Qualified Work: If a nurse aide fails to meet the 8-hour paid work experience under RN supervision within the 24-month period, their Registry listing will expire.

• Re-listing After Expiration: To continue working as a Nurse Aide I after expiration, the individual must retake and pass a state-approved Nurse Aide I training program and then retake and pass the state competency test before re-listing.

• New Listing Period at Renewal: The new listing period commences on the last date worked as a Nurse Aide performing nursing or nursing-related duties, as reported by an RN on the Online Employment Verification Form. It then expires on the last day of the 24^{th} consecutive month.

Online Renewal Process and Responsibilities

• Form Access: The renewal form is exclusively online at the Nurse Aide I Online Renewal Form; paper forms are not accepted.

• Nurse Aide Responsibility: It is the Nurse Aide I's responsibility to know their listing expiration date and how to renew it. Expiration dates can be verified online at https://ncnar.ncdhhs.gov.

• Required Forms: Both the nurse aide and their RN supervisor must complete and sign their respective online forms:

  • Nurse Aide I Online Renewal Form (completed by the nurse aide).

  • Nurse Aide I Online Employment Verification Form (completed by the RN).

• Submission Timing: Nurse aides should submit their renewal listing form approximately three (3) months before the expiration date.

• Cessation of Work: A nurse aide cannot legally work as a Nurse Aide I once their listing on the Nurse Aide I Registry expires.

• Reporting Changes: Promptly report any changes in name, address, or email to the registry.

Delegation and Job Responsibilities

Delegation Explained

• Definition: Delegation occurs when a licensed nurse formally requests a nurse aide to assume responsibility for performing a task. The nurse aide must be capable of performing the task both safely and accurately.

• Purpose: Nurses utilize delegation and legal regulations to assign duties and tasks to other members of the healthcare team.

• Benefits: Delegation enhances efficiency and signifies trust in team members.

• Accountability: Crucially, the delegating nurse retains ultimate accountability for the outcome of the delegated task.

General Job Responsibilities of a Nurse Aide

• Competently and caringly perform delegated basic nursing skills.

• Competently and caringly perform delegated personal care skills.

• Utilize appropriate interpersonal skills for understanding, communication, interaction, and relating with others.

• Support the NCDHHS mission and vision by working to improve the health, safety, and well-being of individuals under their care.

• Understand and maintain current listing requirements on the Nurse Aide I Registry.

• Be aware of legally permissible tasks.

• Show concern for others, helping to make their lives happier and more complete, and encouraging residents' independence.

• Maintain excellent appearance, grooming, and hygiene at work.

Types of Tasks Performed by Nurse Aides

1. Basic Nursing Skills

• Definition: Essential skills required for a nurse aide to provide competent care in healthcare settings.

• Examples:

  • Taking and accurately recording vital signs.

  • Caring for the resident's immediate environment.

  • Recognizing and reporting abnormal changes in a resident's condition to the nurse.

  • Providing care for residents during end-of-life (when death is imminent).

• Importance: Performing these skills is a critical duty. Following the resident's interdisciplinary care plan, adhering to supervisor directives, and reporting significant findings are all vital for resident well-being.

• Key Aspect: Privacy is paramount when providing basic nursing skills.

2. Personal Care Skills

• Definition: Tasks that focus on a person’s body, appearance, and hygiene.

• Frequency: Typically performed daily; in the AM, PM, or at the resident's preferred time.

• Individualization: Care should respect individual preferences regarding bath times, specific soaps, or hairstyles.

• Key Aspect: Privacy is essential when providing personal care skills.

Hygiene and Grooming

• Hygiene: Tasks executed to maintain bodily cleanliness and health (e.g., bathing, brushing teeth).

• Grooming: Tasks performed to uphold a person's appearance while fostering dignity and choice (e.g., caring for fingernails, hair styling).

Concept of Activities of Daily Living (ADLs)

• Definition: ADLs encompass hygiene, grooming, dressing, eating, transferring, and toileting.

• Nurse Aide Role: Assisting assigned residents with their ADLs is a significant duty.

Providing Personal Care

• Promoting Independence: Encourage residents to be as independent as possible, allowing them to perform as much self-care as they can.

• Professionalism and Privacy: Understand that residents may feel embarrassed; maintain professionalism and ensure privacy during care.

• Observation Opportunity: While assisting with personal care, nurse aides have the opportunity to observe the resident's skin, mobility, comfort level, and cognitive status.

3. Interpersonal Skills

• Definition: Essential skills used when interacting and collaborating with others.

• Influences: Shaped by standards and values, cultural context, environment, heredity, personal interests, expectations from others, and past experiences.

• Healthcare Context: In healthcare, it refers to a provider's ability to get along with others while efficiently accomplishing tasks.

• Importance: Nurse aides interact with a diverse group (residents, families, co-workers). Understanding the impact of one's actions and attitudes is crucial for success.

Nurse Aide's Role in Interpersonal Skills

• Caring for Residents:

  • Empathize: View situations from the resident's perspective.

  • Anticipate Needs: Proactively identify and address residents' needs.

  • Individualized Care: Treat each resident as a unique individual, honoring requests when feasible.

  • Patience and Tolerance: Display patience and tolerance, striving to understand residents' behavior.

  • Mood Sensitivity: Be sensitive to residents' moods and mindful of reactions.

• Relationships in Healthcare:

  • Family Respect: Be respectful to families, listening attentively to understand their concerns.

  • Team Collaboration: Maintain an open, positive, and professional relationship with every healthcare team member.

  • Effective Communication: Communicate effectively and work collaboratively with others.

Qualities of a Competent, Caring Nurse Aide

• Professional Demeanor: Act, behave, and function professionally at all times.

• Excellent Work Ethic: Demonstrate high personal values that dictate one's approach to work (behavior in the workplace).

  • Components of Work Ethic: Appearance, communication skills, treatment of others, attitude, and teamwork.

Professional Appearance

• Adhere to facility dress codes for uniforms and jewelry.

• Dress neatly in a modest, clean uniform (no tears/wrinkles), with a visible facility name badge.

• Wear clean, non-skid, closed-toed, comfortable, supportive shoes.

• Wear clean undergarments of appropriate color and style to prevent showing through outer clothing.

Personal Hygiene

• Maintain neatly trimmed, short, natural, clean nails without polish.

• Maintain a simple, attractive hairstyle; pull long hair back from the face.

• Practice excellent personal hygiene (daily bathing, no offensive odors, no perfume/cologne/after-shave).

• Wear clean, well-fitting stockings or socks.

• Avoid face jewelry (eyebrows, nose, lips, tongue); at most, a single pair of stud earrings.

• Wear no heavy make-up.

• Offer a warm and friendly smile.

Importance of Appearance - "15 Seconds"

• First impressions are formed within approximately 15 seconds.

• These first impressions are critical, whether meeting a resident or interviewing for a job.

• Looking and feeling good boosts self-confidence, which, in turn, increases residents' confidence in the healthcare provider.

Nurse Aide Attitude at Work

• Patient and understanding.

• Honest and trustworthy.

• Conscientious and strives for their absolute best.

• Enthusiastic and enjoys the job.

• Courteous, considerate, and respectful.

• Cheerful.

Caring for Others

• Dependable and responsible.

• Accountable and willing to admit mistakes.

• Tolerant of others and keeps opinions to self.

• Self-aware.

• Cares for all people equally, regardless of race, age, sex, religion, or sexual orientation.

• Cares about others and what they are experiencing.

NCDHHS Mission and Vision and the Nurse Aide I

• NCDHHS Mission: To collaborate with partners to provide essential services that improve the health, safety, and well-being of all North Carolinians.

• NCDHHS Vision: To advance innovative solutions that foster independence, improve health, and promote well-being for all North Carolinians.

• Nurse Aide I Role: The nurse aide's role is to embody this mission and vision by improving health and promoting the safety and well-being of individuals in their care.

Being a Nurse Aide

• Be gentle and kind to residents, families, and co-workers.

• Practice empathy.

• Maintain a pleasant disposition, avoiding moodiness, bad temper, or sadness at work.

• Respect others and their possessions.

• Always strive to do your best.

• Never hesitate to ask questions when unsure of an answer or how to perform a task.

• Treat residents, families, and co-workers with dignity.

• Be a team player, offering help when asked and during downtime.

• Be careful and alert to surroundings and resident cues.

• Be eager and excited about going to work.

Ethical Conduct - "Do Not Gossip"

• Be trustworthy in your speech.

• Speak honestly and with kindness.

• Say only what you mean.

• Avoid speaking against yourself or gossiping about others.

• Use the power of your word truthfully and caringly (Paraphrased from The Four Agreements by Don Miguel Ruiz).

• Do not lie, cheat, or steal (even minor items).

• Always seek the good in others and praise them when opportunities arise.

• Avoid using profanity or telling offensive jokes.

• Listen to Your Conscience: If unsure if an action is right, do not proceed; this is your conscience guiding you.

The Workday

• Report to work on time and as scheduled.

• Use sick time only for illness.

• Perform an honest day's work for an honest day's pay.

• Show respect to bosses and supervisors; avoid criticizing management.

• Perform tasks delegated by the nurse.

Teamwork in Healthcare

Definition of a Team

• A group of people sharing a common purpose, with assigned tasks and coordinated effort to achieve a goal.

• Key Characteristics:

  • Work together and function as a whole.

  • Communicate with each other.

  • Coordinate work activities and share responsibilities.

  • Receive assignments clearly to ensure everyone knows their roles, expectations, and how to plan schedules.

• The nurse aide is an integral member of the healthcare team.

Qualities of an Effective Team

• Climate: Informal, comfortable, and relaxed, with members actively interested and involved.

• Communication: Open and two-way, encouraging the sharing of ideas and feelings.

• Interactions: Inclusive and trusting; members enjoy and like working together.

• Goals and Tasks: Appropriate, well-understood, and modifiable to ensure work completion.

• Leadership and Participation: Leaders lead effectively, and members participate respectfully and cooperatively.

• Cohesion: High levels of inclusion, trust, liking, and mutual support mean everyone works together.

• Problem-Solving: High emphasis on problem-solving; issues are resolved by consulting appropriate resources and working collaboratively.

Qualities of an Ineffective Team

• Climate: Tense.

• Communication: Closed and one-way, discouraging ideas and feelings; members are hesitant to speak.

• Interactions: Based solely on authority; individuals with more power dominate and dismiss those perceived as unequal or undeserving.

• Goals: Unclear, misunderstood, or forced, often leading to uncompleted tasks.

• Decision-Making: The highest authority makes decisions with minimal group involvement.

• Trust: Distrust among members; members are coerced into conformity.

• Conflict Resolution: Disagreements or conflicts are ignored, denied, or suppressed, preventing healthy interaction.

• Problem-Solving: Low; criticism is destructive, members are attacked, and tasks are not completed.

Group Commitment

• Members feel a strong sense of belonging.

• Enjoy each other's company.

• Seek advice from one another.

• Provide and receive support during difficulties.

• Value each other and their contributions.

• Are motivated and committed to doing a good job.

• Share positive feelings openly.

• Believe the group's goals are important and achievable.

Activities

Activity #A2: Go Team Worksheet

This activity involves evaluating overheard conversations in healthcare settings to determine if they reflect effective or ineffective team behavior.

Activity #A3: First NC Nurse Aide I Renewal Date

This activity prompts students to record their initial NC Nurse Aide I Registry listing date and calculate their first renewal date.

• Initial Listing Date: (Date of successful completion of the NC state-approved Nurse Aide I competency test)

• First Renewal Date: (Last day of the 24^{th} consecutive month following the initial listing date. E.g., if initial is 10/22/2024, renewal is 10/30/2026)