Pandemic (Temporary) Nurse Aide To Nurse Aide Transition Program

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Pandemic (Temporary) Nurse Aideto Nurse AideTransition Programfacility manual

Pandemic (Temporary) Nurse Aideto Nurse AideTransition ProgramNebraska Health Care Association, Inc.Lincoln, NebraskaCopyright 2021All rights reservedNo part of this publication may be reproduced, stored in a retrieval system, ortransmitted, in any form or by any means, electronic, mechanical, photocopying,recording, or otherwise, without the prior permission of the Nebraska Health CareAssociation, Inc.1

AcknowledgmentsCreated ByConnie Knorr, RN, BSNDirector of Professional DevelopmentNebraska Health Care AssociationResourcesAmerican Health Care Association. Temporary Nurse ry-nurse-aide#tabproduct tab course overviewTruscott, Pamela (2019). Basic Nursing Assistant Training: Instructor manual, sixth edition.Nebraska Health Care Association2

Program Overviewwith Federal and Nebraska State RequirementsOn March 31, 2020, Governor Pete Ricketts announced Executive Order No. 20-12Coronavirus – Relief for Hospitals and Care Facilities and Expanded Use of TelehealthServices. This executive order, in combination with the Centers for Medicare andMedicaid Services’ blanket waiver of the federal nurse aide training and certificationrequirements found in 42 CFR 483.35(d), allowed for the use of pandemic (temporary)nurse aides during the declared federal and state public health emergencies (PHEs).Pandemic nurse aides are not required to have a minimum number of training hours butare required to have sufficient training to be competent to furnish the care they areexpected to provide. Pandemic nurse aides are also allowed to work without being onthe Nebraska Nurse Aide Registry.Once the PHEs are lifted, all state and federal regulations will be back in effect. At thatpoint, to be added to Nebraska’s Nurse Aide Registry, pandemic nurse aides will beexpected to meet the relevant state and federal requirements within four months.Nebraska Health Care Association’s Pandemic (Temporary) Nurse Aide Program (PNAT)is designed to meet the federal and state requirements necessary to be eligible forstate testing, and once testing is successfully completed, to be eligible for placementon to the Nebraska Nurse Aide Registry. The PNAT program includes eight hours ofonline education combined with an additional 68 hours of on-the-job training under theoversight of a registered nurse who is responsible for assessing competency.Specific Regulations:[172 NAC 108-005.01] In order for an individual to be eligible for employment as anursing assistant in a nursing home, the individual:1. Must be at least 16 years of age;2. Cannot have been convicted of a crime involving moral turpitude rationallyrelated to his/her practice;3. Must be able to speak and understand the English language or a languageunderstood by a substantial portion of the facility’s residents; and4. Must successfully complete, within 120 days of employment, a nursing assistanttraining course approved by the Department.[172 NAC 108-003.01] Courses of training for all nursing homes except ICF/MR’s must begiven by a single sponsor or organization and include, at a minimum, 75 clock hours ofinstruction including at least 16 hours of supervised practical training. In addition, thecourse must include at least one hour of instruction on the responsibility of each nursingassistant to report suspected abuse or neglect pursuant to Neb. Rev. Stat. §§ 28-372and 28-711.[42 CFR 483.152(a)] For a nurse aide training and competency evaluation program tobe approved by the State, it must, at a minimum—3

(1) Consist of no less than 75 clock hours of training;(2) Include at least the subjects specified in paragraph (b) of this section;(3) Include at least 16 hours of supervised practical training. Supervised practicaltraining means training in a laboratory or other setting in which the traineedemonstrates knowledge while performing tasks on an individual under the directsupervision of a registered nurse or a licensed practical nurse;(4) Ensure that—(i) Students do not perform any services for which they have not trained andbeen found proficient by the instructor; and(ii) Students who are providing services to residents are under the generalsupervision of a licensed nurse or a registered nurse;(5) Meet the following requirements for instructors who train nurse aides;(i) The training of nurse aides must be performed by or under the generalsupervision of a registered nurse who possesses a minimum of 2 years of nursingexperience, at least 1 year of which must be in the provision of long-term carefacility services;(ii) Instructors must have completed a course in teaching adults or haveexperience in teaching adults or supervising nurse aides;(iii) In a facility-based program, the training of nurse aides may be performedunder the general supervision of the director of nursing for the facility who isprohibited from performing the actual training; and(iv) Other personnel from the health professions may supplement the instructor,including, but not limited to, registered nurses, licensed practical/vocationalnurses, pharmacists, dietitians, social workers, sanitarians, fire safety experts,nursing home administrators, gerontologists, psychologists, physical andoccupational therapists, activities specialists, speech/language/hearingtherapists, and resident rights experts. Supplemental personnel must have at least1 year of experience in their fields;(6) Contain competency evaluation procedures specified in §483.154.[172 NAC 108-003.06] Courses must be administered by registered nurses who hold acurrent license to practice as a registered nurse in this state or have the authority topractice in this state as a registered nurse under the provisions of the Nurse LicensureCompact.[172 NAC 108-003.07] The registered nurse administering the nursing assistant coursemust document an individual's successful completion of the course in a certificate orletter, the original of which must be given to the individual, containing the followinginformation:1. The individual's name;2. The individual's date of birth;3. The date of successful completion of the course;4. The course sponsor; and5. The course instructor.[172 NAC 108-003.08] The information required by 108-003.07 must also be submitted tothe Department in form or letter signed by the administrator and must also include theindividual’s Social Security Number.4

[172 NAC 108-003.01 and 42 CFR 483.152(b)] The curriculum for a nursing assistanttraining course must include, at a minimum, the following:1. At least 16 hours of training in the following areas prior to any direct contact withresidents:a. Communication and interpersonal skills;b. Infection control;c. Safety/emergency procedures, including emergency measures forchoking;d. Promoting residents’ independence; ande. Respecting resident rights.2. Basic nursing skills:a. Taking and recording vital signs;b. Measuring and recording height and weight;c. Caring for the resident’s environment;d. Recognizing abnormal changes in body functioning and the importanceof reporting such changes to a supervisor; ande. Caring for residents when death is imminent.3. Personal care skills including, but not limited to,:a. Bathing;b. Grooming, including mouth care;c. Dressing;d. Toileting;e. Assisting with eating and hydration;f. Proper feeding techniques;g. Skin care; andh. Transfers, positioning, and turning.4. Mental health and social service needs:a. Modifying nursing assistant’s behavior in response to residents’ behavior;b. Awareness of developmental tasks associated with aging;c. How to respond to a resident’s behavior;d. Allowing the resident to make personal choices, providing, andreinforcing other behavior consistent with the resident’s dignity; ande. Using the resident’s family as a source of emotional support.5. Care of cognitively impaired residents:a. Techniques for addressing the unique needs and behaviors of individualswith dementia (Alzheimer’s and others);b. Communicating with cognitively impaired residents;c. Understanding the behavior of cognitively impaired residents;d. Appropriate responses to the behavior of cognitively impaired residents;ande. Methods of reducing the effects of cognitive impairments.6. Basic restorative services:a. Training the resident in self-care according to the resident’s abilities;b. Use of assistive devices in transferring, ambulation, eating, and dressing;c. Maintenance of range of motion;d. Proper turning and positioning in bed and chair;e. Bowel and bladder training; and5

f. Care and use of prosthetic and orthotic devices.7. Resident rights:a. Providing privacy and maintenance of confidentiality;b. Promoting the resident’s right to make personal choices to accommodatetheir needs;c. Giving assistance in resolving grievances and disputes;d. Providing needed assistance to residents in getting to and participating inresident and family groups and other activities;e. Maintaining care and security of residents’ personal possessions;f. Promoting the resident’s right to be free from abuse, mistreatment, andneglect and the need to report any instances of such treatment toappropriate facility staff; andg. Avoiding the need for restraints in accordance with current professionalstandards.The Pandemic Nurse Aide to Nurse Aide Transition program includes at least therequired 16 hours of supervised practical training in a laboratory, nursing facility, or othersetting in which the student demonstrates knowledge while performing tasks on anindividual, who does not have to be a resident, under the direct supervision of aregistered nurse (or licensed practical nurse under the supervision of a registered nurse).Federal regulations [42 CFR 483.156] require that states establish a nurse aide registry,which includes a listing of individuals who have successfully completed a training andcompetency evaluation program and a listing of nurse aides who have findings ofabuse, neglect, or misappropriation of property.Information related to the successful completion of an approved training must beentered into the registry within 30 days of the date the student is found competent [42CFR 483.154(e)(2)]; and information related to findings of abuse, neglect, ormisappropriation of resident property must be included in the registry within 10 workingdays of the findings [42 CFR 483.156(c)(iv)(D)].[471 NAC 12-014-02(A)] Before allowing an individual to serve as a nurse aide, a facilitymust contact the State nurse aide registry and verify that the individual has metcompetency evaluation requirements unless:(i) The individual is a full-time employee currently participating in a training andcompetency evaluation program approved by the State; or(ii) The individual can prove that he or she has recently successfully completed atraining and competency evaluation program or competency evaluationprogram approved by the State and has not yet been included in the registry.Facilities must follow up to ensure that the individual actually becomesregistered.[172 NAC 108-003.03] Individuals completing a nursing assistant training course mustdemonstrate at least the minimum acceptable proficiency in tasks or duties connectedwith each unit of the components set forth in 172 NAC 108-003. This minimumacceptable proficiency must be determined by the registered nurse administering thecourse and the instructor for the course.6

[172 NAC 108-003.04] Individuals completing a 75-hour nursing assistant training coursemust successfully complete an approved competency evaluation program consistingof a written or oral examination and a demonstration of skills. The competencyevaluation program will be administered by the Department or a Departmentapproved entity that is not a nursing home that participates in Medicare or Medicaid.Notification must be provided to the state testing agency (i.e., Nebraska Health CareAssociation) that the student has satisfied the following requirements to be eligible totake the state test:1. The student must have successfully completed the eight-hour American HealthCare Association’s Temporary Nurse Aide course written competency exam witha minimum score of 80%2. The student must have completed at least 68 hours of on-the-job training (172NAC 108-003.01), working as a temporary nurse aide in the facility under thesupervision of a registered nurse (or a licensed practical nurse under thesupervision of a registered nurse).3. The student must have completed at least one hour of instruction on theresponsibility of each nurse aide to report suspected abuse or neglect pursuantto Neb. Rev. Stat. §§ 28-372 and 28-711.4. The student must have successfully demonstrated competency on the requiredskills by a registered nurse (or a licensed practical nurse under the supervision ofa registered nurse), as required in 172 NAC 108-003.01.The facility administrator or registered nurse must complete an attestation form verifyingthe student’s successful completion and competency on the above requirements andsubmit this documentation to the state testing agency (i.e., Nebraska Health CareAssociation).Once these requirements are fulfilled, the student is eligible to take the state writtenand clinical tests.If the student does not pass the state written and clinical tests within three attempts, thestudent must complete a traditional nurse aide training course.The Attestation Form and other documents can be found in the Appendix section ofthis manual.The completed and signed forms can be electronically submitted documents/; scanned and emailedto coursecomplete@nehca.org; or mailed to:Nebraska Health Care Association1200 Libra Drive, Suite 100Lincoln, NE 68512Program7

The Pandemic Nurse Aide to Nurse Aide Transition program is divided into threesections:Section A — Eight-Hour American Health Care Association’s Online Temporary NurseAide CourseIn this section, the student will be introduced to his/her work setting and jobresponsibilities. Important concepts such as psychosocial wellbeing, safety precautions,and emergency care are covered. The student must successfully complete theAmerican Health Care Association Temporary Nurse Aide course written competencyexam with a minimum score of 80%.Section B — Basic Resident Care SkillsIn this section, the student will learn the skills needed to meet the physical needs ofresidents. The student must demonstrate competence on a skill before performing it inthe work setting without supervision. These skills can count toward the 68 hours of onthe-job training described in Section C.Section C — On-the-Job TrainingIn this section, the student will learn and participate in caring for residents for at least 68hours, while working as a pandemic nurse aide in the facility under the supervision of aregistered nurse (or licensed practical nurse under the supervision of a registered nurse).Unit Format: The program’s three sections are divided into a total of 19 units.Content: The student must understand the content to meet the objectives of theprogram. The nurse may add other classroom activities relevant to the content tofacilitate learning. These activities may include videos, class discussion, role-play, skillspractice, and other teaching methods.Procedures: Procedures must be demonstrated and practiced, and the studentsuccessfully demonstrate competency before the procedure is performed on aresident. The student will need to demonstrate his/her competency on the procedureslisted on the Nurse Aide Skills Sheet. These are also the skills the student may be testedon for placement on the Nurse Aide Registry.Skills Packet: Each individual skill is included in the Skills Packet. To be consideredcompetent, the student must demonstrate at least 70 percent of the skill’s step correctlyand 100% of the critical steps. The nurse may use the Skills Packet to check off andassess competency for the student as he/she performs each skill’s steps. The Nurse AideSkills Sheet should not be signed unless the nurse has observed the student successfullyperform the skill.Final Exam: The eight-hour American Health Care Association Temporary Nurse Aidecourse includes a final exam that is used to assess learning. This exam can becompleted by the student online. The student must score a minimum of 80 to pass theexam, which will generate a certificate. If a student requires an oral exam, this can beadministered by a registered nurse. This exam will give the student more practice inpreparing for state testing.8

Program Grading (Pass/Fail): The student’s overall program grade is based on the finalexam score and successful competency demonstration of all skills. The overall grade willbe either pass or fail.On-the-Job Training: Students will utilize learned theory and skill content to care forresidents under the supervision of a registered nurse (or licensed practical nurse underthe supervision of a registered nurse). Students will provide hands-on care to residents,learning valuable knowledge from other applicable staff.General InformationCertificate: Nebraska regulations (172 NAC 108-003.07) requires the student be given adocumentation indicating completion of the training requirements. The certificate,included in this manual’s appendix, should be completed by the registered nurse oradministrator, which includes all of the information required by the state.Equipment: To provide students with the best opportunity for developing skillscompetency, it is recommended that a facility have a mannequin on which topractice that allows for the demonstration of both male and female perineal care. It isalso recommended that the students have the opportunity to practice packageopening and equipment manipulation prior to performing the actual skill in a clinicalsetting or during their state competency testing.Completion of Program Requirements: The student must complete all the programrequirements in order to be eligible to take the state test.Materials: This packet includes several forms, including the Attestation Form, which mustbe completed and signed by the registered nurse or administrator. Instructions forcompleting the Attestation Form are also included. These records must be kept on filefor a minimum of two years from the date of completion (172 NAC 108-004.06).Employer: It is important that the employer have a thorough understanding of the roleand scope of work of the nurse aide. The employer should also recognize that evenafter completion of this course, the student will have only a beginning knowledge ofnurse aide skills and will require further orientation and supervision by other facility staff.The student’s competency demonstration should be repeated regularly, anddocumentation of the demonstration maintained. Continuing education of the nurseaide will also be necessary to maintain and enhance clinical skills and knowledge. Toutilize nurse aides, the employer should also ensure specific policies and procedures areestablished.NoticeThe author and publisher of this manual have taken great care to include informationthat reflects standards of practice at the time of publication. However, health care is arapidly changing art and science; and other information and procedures may alsomeet current standards of practice. It is the employer’s responsibility to stay informed ofany changes in federal or state policy, as well as the facility’s own policies andprocedures. The Nebraska Health Care Association disclaims any responsibility for9

adverse effects resulting from the use of the information and suggested procedures,from any undetected errors, or from misunderstanding of the content.Additionally, ensure safety precautions recommended by equipment manufacturersand product representatives are reviewed and adopted into practice. The NebraskaHealth Care Association does not endorse or recommend any specific equipment orproducts discussed in this manual.Our CustomersThere are many terms used to describe the individuals who are cared for by nurseaides, including customer, resident, patient, client, and consumer. For simplicity’s sake,the term “resident” will be used throughout this manual. It is understood that you will usethe term that best suits your particular work situation.10

Pandemic Nurse Aide to Nurse Aide Transition ProgramSuggested Teaching ScheduleSection AUnit 1: Psychosocial Well-beingUnit 2: Preventing Infection while Providing Personal CareUnit 3: Personal Safety and Emergency CareUnit 4: Documentation and Core Nursing SkillsUnit 5: Positioning, Moving, and Restorative CareUnit 6: Nutrition and EliminationUnit 7: Advanced and Specialty Care EnvironmentsUnit 8: Comfort Care and End of LifeUnit 9: Ethics and the Law in Long-Term CareSubtotal: 8Section BUnit 10: Basic Nursing SkillsUnit 12: Personal Care SkillsUnit 13: Basic Restorative ServicesSubtotal: 14Section CUnit 14: Resident CareUnit 15: Abuse and NeglectUnit 16: Communication and Interpersonal SkillsUnit 17: Mental Health and Social Service NeedsUnit 18: Care of Cognitively Impaired ResidentsUnit 19: Resident RightsSubtotal: 54Total Training Hours: 76DidacticPractical.51.51111116621946222167Please note that this is only a suggested timetable. Time needed to teach the requiredcontent may vary according to number of students;student experience and abilities;available resources; access to clinical experience; and many other factors. Thisschedule is not to be used by the survey agency, training instructors, health careadministrators, or any other entity as a required class schedule.11

Table of ContentsSection A – American Health Care Association Temporary Nurse Aide CourseUnit 1: Psychosocial Well-being1. Honoring Resident’s Life2. Resident RightsUnit 2: Preventing Infection while Providing Personal Care1. Chain of Infection2. Standard Precautions3. Handwashing4. Handwashing Video5. Using Barriers – Personal Protective Equipment (PPE)6. Isolation Precautions/Transmission-Based Precautions7. Psychosocial Needs or Resident-on-Isolation Precautions8. Cleaning, Disinfection, and Sterilization9. Personal Care Routines10. Skills Video11. Bathing12. Whirlpool13. Shampooing14. Oral Hygiene15. Denture Care Video16. Grooming17. Shaving a Male Resident Video18. Care of Fingernails Video19. Assisting with Dressing and UndressingUnit 3: Personal Safety and Emergency Care1.2.3.4.Bloodborne PathogensBody MechanicsChokingInjury PreventionUnit 4: Documentation and Core Nursing Skills1.2.3.4.5.6.7.Resident Care PlanYour Role in DocumentationBedmakingMaking an Occupied Bed VideoRespecting Residents’ PrivacyTransferring a ResidentDischarging a Resident12

Unit 5: Positioning, Moving, and Restorative Care1.2.3.4.5.6.7.PositioningMoving Up in Bed When Your Resident is Unable VideoMoving a ResidentStand, Pivot, and Transfer VideoAssisting with Walking VideoStopping a FallCueing, Promoting, and EncouragingUnit 6: Nutrition and Elimination1.2.3.4.5.6.Assisting with MealsAssisting with Meals VideoFeeding Your Residents VideoAssisting with EliminationCollecting a SpecimenHelping with OstomyUnit 7: Advanced and Specialty Care Environments1.2.3.4.Oxygen TherapyMotivate the Resident and Stop When Resident Resists CareSpecific Behavioral SymptomsSpecific Techniques for Activities of Daily LivingUnit 8: Comfort Care and End of Life1.2.3.4.5.6.Pain ManagementPromoting Comfort and Sleep and Stages of GriefEnd-of-Life CareHospiceYour Role Through the Dying ProcessSigns of Approaching DeathUnit 9: Ethics and the Law in Long-Term Care1.2.3.4.Physical Care of the Body After DeathWhat is a Survey?Types of SurveysYour Role in SurveysSection B – Basic Resident Care Skills (Attachment A)Unit 10: Basic Nursing Skills13

Unit 12: Personal Care SkillsUnit 13: Basic Restorative ServicesSection C – On-the-Job Training (Attachment B)Unit 14: Resident CareUnit 15: Abuse and NeglectUnit 16: Communication and Interpersonal SkillsUnit 17: Mental Health and Social Service NeedsUnit 18: Care of Cognitively Impaired ResidentsUnit 19: Resident Rights14

Pandemic Nurse Aide to Nurse Aide Transition Program Skills CompetencyChecklist“Competency” is a measurable pattern of knowledge, skills, abilities, behaviors, andother characteristics that an individual needs to perform work roles or occupationalfunctions successfully.Demonstration of Competency: Competency may not be demonstrated simply bydocumenting that a student attended a training, listened to a lecture, or watched avideo. A student’s ability to use and integrate the knowledge and skills that were thesubject of the training, lecture, or video must be assessed and evaluated by individualsalready determined to be competent in these skill areas.Examples for evaluating competencies may include but are not limited to: Lecture with return demonstration for physical activities; A pre- and post-test for documentation errors; Demonstrated ability to use tools, devices, or equipment that were the subject oftraining and used to care for residents; Reviewing adverse events that occurred as an indication of gaps incompetency; or Demonstrated ability to perform activities that are in the scope of practice anindividual is licensed, certified, or registered to perform.15

Attachment A: Nurse Aide Skills SheetAttachment B: Nurse Aide Competency SheetAttachment C: Nurse Aide Attestation FormAttachment D: Nurse Aide CertificateAttachment E: Nurse Aide Skills Packet16

Attachment A: Nurse Aide Skills Sheet17

STUDENT NAME:Nurse Aide Skills SheetPROCEDUREHandwashingGlove RemovalHandling Soiled EquipmentHandling WastesHandling Soiled Bed LinensAbdominal ThrustsChanging an Unoccupied BedChanging an Occupied BedRoutine Oral HygieneCare of DenturesOral Hygiene for Unresponsive ResidentAssisting with Undressing and DressingNail CareShaving with an Electric RazorMale Perineal CareFemale Perineal CareShowerTub BathBed BathPartial BathTurning Resident to a Lateral PositionMoving Resident up in Bed: One AssistMoving Resident up in Bed: Two AssistTransfer Gait BeltTransferring from Bed to ChairTransferring from Wheelchair to ToiletAssisting to AmbulateAssisting to Ambulate with CaneAssisting to Ambulate with WalkerRange of Motion ExercisesAssisting Dependent Resident with DiningMeasuring Electronic Oral TemperatureMeasuring a Radial PulseApical PulseMeasuring RespirationsMeasuring Blood PressureHeight and Weight Standing ScaleApplication of Elastic Support StockingsMeasuring Fluid IntakeMeasuring Fluid OutputUse of a UrinalBedpan – Dependent & IndependentChanging Incontinent BriefsEmptying the Urinary Drainage BagCatheter CareBackrubDEMONSTRATES COMPETENCY(Y/N)NURSE INITIALSDemo by NurseDemo by NurseN/AN/ADemo by NurseN/ANURSE SIGNATURE:DATE:18

Attachment B: Nurse Aide CompetencyChecklist19

Nurse Aide Competency ChecklistStudentTopicSectionCommunication and interpersonal skillsInfection controlSafety/emergency procedures, includingemergency measures for chokingPromoting residents’ independenceRespecting residents’ rightsTaking and recording vital signsMeasuring and recording height and weightCaring for the residents’ environmentRecognizing abnormal changes in bodyfunctioning and the importance of reportingsuch changes to a supervisorCaring for residents when death is imminentBathingGrooming, including mouth careDressingToiletingAssisting with eating and hydrationProper feeding techniquesSkin careTransfers, positioning, and turningModifying nursing assistant’s behavior inresponse to resident’s behaviorAwareness of developmental tasksassociated with the aging processHow to respond to resident behaviorAllowing the resident to make personalchoices, providing, and reinforcing otherbehavior consistent with the resident’s dignityUsing the resident’s family as a source ofemotional supportTechniques for addressing the unique needsand behaviors of individuals with dementia(Alzheimer’s and others)Communicating with cognitively impairedresidentsUnderstanding the behavior of cognitivelyimpaired residents20A, B, CA, B, CA, B, CA, B, CA, B, CB, CB, CB, CCA, CA, B, CA, B, CA, B, CA, B, CA, B, CA, B, CA, B, CA, B, CA, CCA, CA, B, CCA, CA, CA, CDemonstratesCompetency(Y/N)NurseInitials

TopicSectionAppropriate responses to behavior ofcognitively impaired residentsMethods of reducing the effects of cognitiveimpairmentsTraining the resident in self-care according tothe resident’s abilitiesUse of assistive devices in transferring,ambulation, eating, and dressingMaintenance of range of motionProper turning and positioning in bed andchairBowel and bladder trainingCare and use of prosthetic and orthoticdevicesProviding privacy and maintenance ofconfidentialityPromoting the resident’s right to makepersonal choices to accommodate his or herneedsGiving assistance in resolving grievances anddisputesProviding needed assistance in getting toand participating in resident and familygroups and other activitiesMaintaining care and security of residentpersonal possessionsPromoting the resident’s right to be free fromabuse, mistreatment, and neglect and theneed to report any instances of suchtreatment to appropriate facility staffAvoiding the need for restraints inaccordance with current urseInitialsCB, CB, CB, CA, B, CA, B, CCA, B, CA, B, CA, CB, CCCCNurse Name:Completion Date for Demonstration of Competency on Above Tasks:21

Attachment C: Nurse Aide CompetencyAttestation22

Nurse Aide Competency Attestation FormThis form is to be completed by the facility administrator or the registered nurse. Initial toattest that each requirement is completed and sign below.Student Name Student DOBTraining LocationI, , attest that has(Please print nurse or administrator name)(Student name) Successfully completed the eight-hour American Health Care

Care Association's Temporary Nurse Aide course written competency exam with a minimum score of 80% 2. The student must have completed at least 68 hours of on-the-job training (172 NAC 108-003.01), working as a temporary nurse aide in the facility under the supervision of a registered nurse) . Association). Program

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