North Carolina NURSE AIDE I

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North CarolinaNURSEAIDE IWritten (or Oral) Examination& Skills EvaluationCandidate HandbookFebruary 2022verNCNA1.0

QUICK REFERENCENORTH CAROLINA DEPARTMENT OF HEALTHAND HUMAN SERVICESHealth Care Personnel Educationand Credentialing Section2709 Mail Service CenterRaleigh, NC 27699-27091-919-855-3969Fax: 1-919-733-9764Hours of Operation: 8:00 a.m. – 5:00 p.m.(Eastern Time Zone, Weekdays)The phone lines will be open between8:00 am - 12:00 p.m. and 1:00pm - 3:00pmGo to NC DHHS website https://ncnar.ncdhhs.gov/for additional informationREGISTRATION AND SCHEDULING SERVICESNorth Carolina NNAAP 1-888-723-6773Hours of Operation: 8 a.m. – 11 p.m.(Eastern Time Zone, Weekdays)Saturday 8 a.m. – 5 p.m. & Sunday 10 a.m. – 4 p.m.Call to: Schedule, reschedule or cancel an examination Request an excused absence Ask questions about On-Line Registration Obtain information regarding your Score Report Obtain information regarding your examinationGo to Credentia’s website atwww.credentia.com/test-takers/ncna to: Access your CNA365 account to register to take anexam. To view most current exam updates Download a Candidate Handbook View the Nurse Aide Practice Written Examination

Credentia does not discriminate on the basis of age, sex, race, creed,disabling condition, religion, national origin, or any other protected characteristics.Copyright 2021 Credentia Services LLC, or its affiliate(s). All Rights Reserved.NNAAP Written Exam Content Outline and Practical Skills ListingCopyright 2016–2018 National Council of State Boards of Nursing, Inc. (NCSBN ). All rights reserved.

TABLE OF CONTENTSQuick Reference. inside front coverIntroduction. 1National Nurse Aide Assessment Program. 1Exam Overview. 2Eligibility. 3North Carolina State-Approved Nurse Aide ITrained Candidates (E1). 3North Carolina State-Approved RefresherCourse Trained Candidates (E3). 3North Carolina State-Approved Student .NurseTraining Candidates (E5). 4Other Trained (E8). 4Trained Out of State (E9). 4NC Registry Candidates (E10). 5Out-of-state Registry Candidates (E11). 5Regristration and Scheduling. 6Exam Fees. 7Exam Scheduling. 7Accommodations. 8Testing Locations. 8Cancellation and Rescheduling. 9Refunds. 9Absence Policy. 9Weather Emergencies. 10Exam Day (Online Exam). 10What You'll Need. 10Before Exam Day. 11On Exam Day. 11Exam Day (Test Center Exam). 12Proper Identification. 12Security . 14Testing Policies. 14Lateness. 14Electronic Devices. 15Study Aids. 15Eating/Drinking/Smoking. 15Misconduct. 15Guests/Visitors. 15continued on next page

The Written (or Oral) Exam. 16Written Exam. 16English or Spanish Oral Exam. 16Written (or Oral) Exam Content Outline. 17Sample Questions. 18Self-Assessment Reading Test. 19-22The Skills Evaluation.23What to Expect. 23Who Will Act As a Client?. 23Candidate Volunteer Requirements. 23Candidate Dress Requirements. 23The Tasks. 24Recording a Measurement. 25Sample Recording Sheet for MeasurementSkills. 26Tips for the Skills Evaluation. 27Skills Listing . 28-43Score Reporting. 44Exam Results. 44Score Reporting. 44Failing. 44Reading a Failing Score Report. 45Grievance Process. 45The Registry. 45Initial Listing. 45Change of Address or Name. 46Online Listing Renewal. 46How to Read A Failing Score Report. 47

INTRODUCTIONThis handbook is designed for Candidates seeking NurseAide I listing on the North Carolina Nurse Aide I Registry.It describes the process of applying for and taking theNational Nurse Aide Assessment Program (NNAAP )Examination.The North Carolina Department of Health and HumanServices (DHHS) has contracted with Credentia, a nationally recognized leading provider of assessment services toregulatory agencies and national associations. Credentiawill develop, score, and report the results of the NNAAP Examination for the North Carolina Nurse Aide I Registry.Credentia also manages scheduling and administers theexamination to qualified individuals.NATIONAL NURSE AIDE ASSESSMENTPROGRAM (NNAAP )The Nursing Home Reform Act, adopted by Congress aspart of the Omnibus Budget Reconciliation Act of 1987(OBRA ’87), was designed to improve the quality of carein long-term health care facilities and to define trainingand evaluation standards for nurse aides who work in suchfacilities. Each state is responsible for following the termsof this federal law.The National Nurse Aide Assessment Program (NNAAP )is an examination program designed to determine minimalcompetency to become listed as a nurse aide in NorthCarolina on the North Carolina Nurse Aide I Registry.The NNAAP was developed by the National Council ofState Boards of Nursing, Inc. (NCSBN), to meet the nurseaide evaluation requirement of federal and state laws andregulations. Credentia is the authorized administrator ofthe NNAAP in your state.The NNAAP Examination is an evaluation of nurseaide-related knowledge, skills, and abilities. The NNAAPExamination is made up of both a written (or oral)examination and a Skills Evaluation. The purpose of theNNAAP Examination is to test that you understand andcan safely perform the job of a Nurse Aide I.1

EXAM OVERVIEWThe two parts of the examination process, the written(or oral) examination and the skills evaluation, will beadministered separately. You must pass both parts inorder to become listed on the North Carolina Nurse AideI Registry.The written examination consists of seventy (70) multiplechoice questions written in English. Sample examinationquestions are provided in this handbook.An oral examination, available in English or in Spanish,may be taken in place of the written examination may betaken in place of the written examination. The oral examination consists of sixty (60) multiple-choice questions andten (10) m ultiple-choice reading comprehension questions. If you want to take the oral examination, youmust request it when you submit your application.At the skills evaluation you will be asked to perform five(5) randomly selected nurse aide skills. You will be giventhirty (30) minutes to complete the five (5) skills. You willbe rated on these skills by a Nurse Aide Evaluator. Youmust successfully demonstrate all five (5) skills to pass theskills evaluation. A complete listing of the skills is shownon pages 28 to 42.See The written (or oral) exam and the skills evaluation for moredetails about the NNAAP Examination.2

ELIGIBILITYAll Candidates applying to take the NNAAP Examinationin North Carolina MUST complete an Applicationfor Registration by Competency Examination on-line atwww.credentia.com/test-takers/ncna. Select yourstate and go to the test taker link for additional information. You must pass both portions of the examinationwithin the designated time period to be eligible for listingon the North Carolina Nurse Aide I Registry.LIGHT DUTYIndividuals are prohibited from taking the Skills Evaluationif on restricted activity or light duty due to medical reasons. Candidates must be able to complete all requiredskills included in the Skills Evaluation. Candidates whoare on light duty are not permitted to take the SkillsEvaluation; however, they can take the written/oral exam.Appropriate medical documentation stating return to full,unrestricted duty is required to take the skills evaluation.NORTH CAROLINA STATE-APPROVEDNURSE AIDE I TRAINED CANDIDATES(E1)All applicants who have successfully completed a NorthCarolina state-approved Nurse Aide I training program.Candidates must pass both the written examination and theskills examination within two (2) years from the successfulcompletion date of a state-approved training program orwithin three (3) attempts, whichever comes first, to be placedon the North Carolina Nurse Aide I Registry. Failure to doso will require Candidates to complete state-approvednurse aide training and competency testing again.In addition, a change in the eligibility route may requireCandidates to complete state-approved nurse aide trainingand competency testing.NORTH CAROLINA STATE-APPROVEDREFRESHER COURSE TRAINED CANDIDATES (E3)All applicants who have successfully completed a NorthCarolina state-approved Nurse Aide I refresher course ata North Carolina state-approved Community College orProprietary School.Candidates must pass both the written examination and theskills examination within two (2) years from the successful3

completion date of a state-approved training program orwithin three (3) attempts, whichever comes first, to be placedon the North Carolina Nurse Aide I Registry. Failure to do sowill require Candidates to complete state-approved nurseaide training and competency testing again. In addition,a change in the eligibility route may require Candidates tocomplete state-approved nurse aide training and competencytesting.NORTH CAROLINA STATE-APPROVEDSTUDENT NURSE TRAINING CANDIDATES (E5)All applicants who are currently enrolled in a North Carolinastate-approved nursing education program preparing forregistered nurse or practical nurse licensure.Candidates must pass both the written examination andthe skills examination within two (2) years from successfulcompletion date of coursework equivalent to state-approvednurse aide training or within three (3) attempts, whichevercomes first, to be placed on the North Carolina Nurse AideI Registry. Failure to do so will require Candidates tocomplete state-approved nurse aide training and competency testing again. In addition, a change in the eligibility route may require Candidates to complete state-approvednurse aide training and competency testing.OTHER TRAINED (E8)All applicants that are either an emergency medicaltechnician (EMT), an out of state licensed nurse, an unlicensed nursing graduate, an unlicensed nursing student,or a military veteran who received nursing/medical training credentials while in the United States Armed Forces.Candidates must pass both the written examinationand the skills examination within two (2) years of theapplication approval date or within three (3) attempts,whichever comes first, to be placed on the North CarolinaNurse Aide I Registry. Failure to do so will requireCandidates to complete state-approved nurse aidetraining and competency testing. In addition, a changein the eligibility route may require Candidates to completestate-approved nurse aide training and competency testing.OUT OF STATE TRAINED (E9)All applicants who successfully completed a state-approvedNurse Aide I training program in another state, excluding4

North Carolina, within the previous 24 consecutive monthsand are not listed on any state’s registry of nurse aides.Candidates must pass both the written examination andthe skills examination within two (2) years from the successful completion date of a state-approved training program date or within three (3) attempts, whichever comesfirst, to be placed on the North Carolina Nurse Aide IRegistry. Failure to do so will require Candidates tocomplete state-approved nurse aide training andcompetency testing again. In addition, a change in theeligibility route may require Candidates to complete stateapproved nurse aide training and competency testingNC REGISTRY CANDIDATES (E10)For all nurse aides listed as active and in good standingstatus on the North Carolina Nurse Aide I Registry butdo not meet the requirements for registry listing renewal.Candidates may apply to take the state-approved nurseaide competency examination no more than 90 days priorto their North Carolina Nurse Aide I Registry listingexpiration date. Candidates must successfully completethe competency examination before their listing expiration date. Candidates have three (3) attempts to pass boththe written examination and the skills examination tobe placed on the North Carolina Nurse Aide I Registry.Failure to do so will require Candidates to completestate-approved nurse aide training and competencytesting. In addition, a change in the eligibility route mayrequire Candidates to complete state-approved nurse aidetraining and competency testing.OUT-OF-STATE REGISTRY CANDIDATES(E11)For all out-of-state Candidates who are in active and goodstanding status on another state's registry of nurse aides.Eligible Candidates must complete and submit aReciprocity application (found at https://ncnar.ncdhhs.gov/) to NC DHHS for review and approval in orderto be listed on the North Carolina Nurse Aide I Registrywithout additional training or testing. In addition, achange in the eligibility route may require Candidates tocomplete state-approved nurse aide training and competency testing.5

REGISTRATIONAND SCHEDULINGONLINE REGISTRATION ANDSCHEDULINGWith the Credentia CNA365 system, online registrationis quick, convenient and an environmentally responsibleway to register for your examination. A detailed step-bystep reference guide on how to create a CNA365 accountand register for exams can be found at www.credentia.com/test-takers/ncna.After completing a North Carolina state-approved training course, you will create an online account withCredentia’s CNA365 system. To create a CNA365account, click the “CNA365 Login” button on the topof the North Carolina nurse aide website page at www.credentia.com/test-takers/ncna. Payment is in the form of a credit card or pre-paidcredit card (American Express, MasterCard, Visa,or electronic voucher). Fees are non-refundable andnon-transferable once submitted. For exams at test center locations, you must makean online reservation via a PC (smart phones andtablets are not recommended) at least ten (10)Calender days prior to test date For Written (or Oral) online exams, you may schedule an exam as early as the following day dependingon exam availability. You are responsible for completing an online application in CNA365. You may ask someone from yournurse aide training program or facility employer forassistance in completing the application. If you need help or have any questions about theapplication process, contact a support representative at 1-888-723-6773 between 8:00 a.m. and11:00 p.m. (Eastern Time Zone, Weekdays). Fees are non-refundable and non-transferable.6

EXAM FEESThe fees listed below have been established for the NNAAPExamination in North Carolina.examination typeWritten Examination & SkillsEvaluationOral (English or Spanish)Examination & SkillsEvaluationWritten Examination ONLY(re-test)fees 140 140 40Oral (English or Spanish)Examination ONLY (re-test) 40Skills Evaluation ONLY (re-test) 100Under federal and North Carolina state laws, Candidatesemployed as nurse aides in nursing homes that participatein Medicaid/Medicare programs are prohibited frompaying their examination fees. Employers must pay theexamination fee and any re-test fee for those Candidatesthey employ as nurse aides or Candidates who have a written commitment or signed acceptance of employment onfile in a Medicaid-certified nursing home. Candidates whobecome employed as a nurse aide by a Medicare/Medicaidskilled nursing facility within 12 months of successful completion of the competency evaluation may be reimbursedby the facility for training and competency testing costs.Therefore, Candidates should save all receipts to submit tothe skilled nursing employer.EXAM SCHEDULINGOnce your online application has been approved, you willbe able to schedule the exams in CNA365. A detailedstep-by-step reference guide on how to schedule exams canbe found at www.credentia.com/test-takers/ncna. Whencompleted, you will receive a Confirmation Notice andReceipt of Payment via email.7

ACCOMMODATIONSCredentia complies with the provisions of the Americanswith Disabilities Act as amended. The purpose of accommodations is to provide Candidates with full access to thetest. Accommodations are not a guarantee of improvedperformance or test completion. Credentia provides reasonable and appropriate accommodations to individualswith documented disabilities who demonstrate a need foraccommodations. All accommodation requests must beapproved by Credentia before reserving an examinationdate.Test accommodations may include things such as: A separate testing room E xtra testing time A Reader or Recorder, for individuals with mobilityor vision impairments and cannot read or write ontheir ownTest accommodations are individualized and considered on acase-by-case basis. All Candidates who are requesting accommodations because of a disability must provide appropriatedocumentation of their condition and how it is expected toaffect their ability to take the test under standard conditions.This may include: S upporting documentation from the professional whodiagnosed the condition, including the credentials thatqualify the professional to make this diagnosis A description of past accommodations the candidate hasreceivedPlease visit www.credentia.com/accommodations to reviewthe accommodation process and required supporting documentation.TESTING LOCATIONSIn-Facility Testing (INF) is when arrangements have beenmade with Credentia to test at the state-approved trainingprogram location on a specific date. Please make certainyou know your INF code and test date when you are completing your registration.8

CANCELLATIONAND RESCHEDULINGYou may cancel or reschedule an examination online inyour CNA365 account. For details on how to cancel orreschedule an examination, visit www.credentia.com/testtakers/ncna and click on “How to Cancel or Reschedulean Exam” in the Resources section of the webpage.Online Written (or Oral) examinations must be canceledor rescheduled at least 48 hours before the scheduledexamination time.Test center examinations must be canceled or rescheduledat least nine (9) calender days before the scheduled examination date.If you do not cancel or reschedule your examinationwithin the required timeframes and do not show up foryour scheduled examination, you will be responsible forthe examination fee. Your fee will not be refunded andcannot be transferred to a new examination date, and youmay not give your examination date to another person.REFUNDSOnce payment of exam fees is received, NO REFUNDSWILL BE ISSUED.ABSENCE POLICYCandidates who are late or absent from an exam may call1-888-723-6773 within 14 days of the exam date to requestan excused absence for the following reasons: Illness of yourself or a member of your immediatefamily Death in the family Disabling traffic accident Court appearance or jury duty Military duty Weather emergencyA case number will be assigned, and instructions providedfor emailing supporting documentation.Your request must include documentation or verificationfor the cause of the absence. For example, if you are absentbecause of jury duty, you must supply a copy of the courtnotice. In the case of illness, a verification from your medical provider must be included in your request. Please note,9

a request takes approximately 3-5 business days to processand complete once documentation has been received.Candidates absent or late to an exam who have notchanged or canceled the reservation according tothe Change/Cancel Policy will not be admitted tothe exam and will forfeit the exam fee. The decisionof Credentia to approve or deny the excused absencewill be final.WEATHER EMERGENCIESA test center examination will be delayed or cancelledonly in emergencies. If severe weather or a natural disastermakes the test site inaccessible or unsafe, the examinationwill be delayed or cancelled. In the event of an examanation change due to a weather emergency, candidates will becontacted by phone and email with change detailsEXAM DAY (ONLINE EXAM)Take the written/oral exam conveniently from home usingthe online proctor option. A live proctor will monitor youthrough the webcam on your workstation to provide a secureexam experience. Online proctored exams offer more scheduling flexibility than test center exams.Please visit www.credentia.com/online-exams for informationon what to expect and how to best prepare for the onlineproctored exam. It is also recommended that you go to the“Policies & Procedures” link to review detailed exam rulesand procedures.WHAT YOU'LL NEED A properly equipped computer - a desktop, laptop, orChromebook with a single monitor (no smartphones ortablets). Visit www.credentia.com/online-exams to viewor download system requirements. A private room - if you don't have access to a privateroom, check with your training program or local libraryfor availability. A mobile device - to complete a 360 degree room scan,you'll need a smartphone or tablet (Apple or Android)that can download our free app.10

BEFORE EXAM DAY Perform a system test – make sure to do the requiredsystem test and exam simulation before exam day.Visit www.credentia.com/online-exams and select the“Run System Test” button. Find your testing space – Find a quiet, distractionfree area in your home or office to take the exam. Get your ID ready - You are required to bring two (2)forms of official, signature-bearing identification (oneof which must be a photo identification). Photocopiesof identification will NOT be accepted.The name on your identification must be the same asthe name you used on the application to register for theexamination. If you do not bring proper identification,you will not be allowed to test and your examination feewill not be refunded.ON EXAM DAYSTEP 1: Prepare your testing space Quiet: no background noise and inform membersof your household you are taking an exam. Proper Lighting: Online proctors must be able tosee you and your testing space. Privacy: no one else in the room. Remove Prohibited Items: clear workstation area toexpedite room scan. Restroom/Beverages: use restroom and preparebeverages before exam.STEP 2: Have your ID ready Have your government issued photo ID with you(see list or proper identification in section above).STEP 3: Prepare your computer Disconnect any additional monitors and close allother open applications. Have your chargers (laptop, smart phone or tablet)plugged in or nearby. Use a wired internet connection rather than WiFi,if possible. If using WiFi, we recommend at least 3Mbps andask that other household members do not use theinternet during your exam. Disconnect any VPNs or firewalls if you havethem.11

If taking an Oral Exam you must use a wiredheadset.STEP 4: Download the ExamRoom 360 app Download the ExamRoom 360 app to yoursmartphone or tablet and have your CNA365login credentials available (the user name andpassword for your Credentia CNA365 account).This app is required to complete a 360 degreeroom scan.STEP 5: Check-in for your exam When To Check-In: You can begin the check inprocess up to 30 minutes prior to your appointment. Your onboarding agent will make sureeverything is ready for your exam before introducing your proctor. Visit www.credentia.com/online-exams to view or download detailedcheck-in procedures. How To Check-In: Go to www.credentia.com/test-takers/nc and click the “CNA365 login”button. Once logged in, find your scheduledexam and select the "Start Exam" button.EXAM DAY (TEST CENTEREXAM)Please visit www.credentia.com/test-center-exams for information on what to expect and how to best prepare for yourtest center exam.WHAT TO BRINGYou must have the following items with you when youtake the examination: Two (2) forms of proper identification Three (3) No. 2 pencils (sharpened) Eraser Watch with a second handNo other materials will be allowed.PROPER IDENTIFICATIONCandidates are required to to bring two (2) forms of current, not expired official U.S. government-issued signaturebearing identification (one of which must be photo-bearing) to the test site. Photocopies of identifications will notbe accepted.12

One form of identification must be a U.S governmentissued Social Security (SS) card, signed and not laminated. Candidates who are in the armed services mayuse their current U.S. military identification inplace of a SS card. The Candidate’s SS numbermust be on the identification, if used. Sponsoror dependent military identifications will not beaccepted in place of a SS card. A second form of identification must be any of theitems listed below and must be photo-bearing. Current, non-expired driver’s license Candidates who do not have their new licenseby exam day must bring their expired driver'slicense and their temporary permit. Current, non-expired learner's permit Military Identification Candidate’s SS number must be on theidentification Sponsor military identification and adependent military identification may be usedwhen presented with a valid SS card. State- or federal-issued identification card Passport (US or foreign, current, non-expired) Alien registration card Employment authorization document (EAD)photo identification card (curent, non-expired,federal-issued)If a Candidate fails to present proper identification, thenhe or she will not be allowed to take the exam and the examfee will not be refunded.The name listed on the identifications must be the sameas the name used to register for the exam, including suffixes and hyphens. If your name has changed, then youmust complete the steps below at least nine (9) calendardays before your scheduled exam. Be prepared to provideofficial government documentation of your name change. Contact Credentia at 1-888-723-6773 if you are not onthe North Carolina Nurse Aide I Registry. Contact Credentia at 1-888-723-6773 if you havealready scheduled an exam. Contact the North Carolina Department of Healthand Human Services at 1-919-855-3969 if you are onthe North Carolina Nurse Aide I Registry.13

SECURITY AND CHEATINGIf you give help to or receive help from anyone during theexamination, the examination will be stopped. The incidentwill be reported to the North Carolina Department of Healthand Human Services (NC DHHS) for review, and your examination will not be scored (see Testing Policies).Please note that all examination questions, each form ofthe examination, and all other examination materials arecopyrighted by, the property of, or licensed by Credentia.Consequently, any distribution of the examination contentor materials through any form of reproduction, or throughoral or written communication, is strictly prohibited andpunishable by law. Anyone who removes or tries to removeexamination materials or information from the test site willbe prosecuted.TESTING POLICIESThe following policies are observed at each test center.LatenessYou must arrive thirty (30) minutes before the examinationstarts. If you are late for your scheduled examination, ordo not bring all of your required materials, you will NOTbe allowed to test, and your examination fee will NOT bereturned. If you are late for the written (or oral) examination, but arrive on time for the skills evaluation, you will beallowed to take the skills evaluation.If you are late for your skills evaluation or do not bringall your required materials, you will NOT be allowed totest and you will be required to re-apply and pay anotherexamination fee (Refer to page 9-10, Cancellation andRescheduling in this Handbook)Electronic DevicesCellular phone, beeper, or any other electronic device isnot permitted to be used and must be turned off duringthe exam.Study AidsYou are not permitted to take personal belongings suchas briefcases, large bags, study materials, extra books, orpapers into the examination room. Any such materialsbrought into the examination room will be collected andreturned to you when you have completed the examina14

tion. Credentia is not responsible for lost or misplaceditems.Eating/Drinking/SmokingYou are not permitted to eat, drink, or smoke during theexamination.MisconductIf you are discovered causing a disturbance or eng

The Nursing Home Reform Act, adopted by Congress as part of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87), was designed to improve the quality of care . nurse aide training or within three (3) attempts, whichever comes first, to be placed on the North Carolina Nurse Aide I Registry.

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