NA-Policy_Manual.pdf

Effective Date: May 2016

Office of Health Facility Licensure & Certification

Nurse Aide Program Policy Manual

Contents How to Use this Manual

Purpose

Administration

Requirements

Instructional Program

Program Approval

Application

Action by the OHFLAC-NAP

Program Identifier

Post-Approval Review and Monitoring

Enforcement

Federal Prohibition of Program Approval

Federal Waiver of Prohibition of Nurse Aide Training Program

Withdrawal of Approval

Program Monitoring

On-Site Reviews and Surveys

Suspension and Revocation

Program Operation

Class Setting and Size

Clinical Setting

Clock Hour Requirements

Expectations for Record Retention

Skills Performance Record

Student Absenteeism

Instructor Absenteeism

Textbooks

Grades

Classroom Laboratory Requirements

Documentation

Clinical Requirements

Complaint File

Instructor Availability and Accessibility

Facility-Based Programs

Notification of Substantial Changes in the Program

Student Clinical Orientation

Class Orientation

Charging For Nurse Aide Education and Testing

Program Faculty

Program Director

Primary or Program Instructor

Coordinator Instructor

Resource Instructors

Clinical Instructor

Refresher Instructor

Faculty Active Status

Application Requirements for Faculty

Educate-the-Educator Workshop

Reporting Program Changes

Student Nurses

Eligibility Requirements

Nurse Aide Registry

Establishment of the Registry

Registry Content

Inclusion on the Registry

Transfer to Other States

Reporting a Change

Reportable Nurse Aide Employment

Renewal or Reregistration Application Requirements

Competency Examination (Testing)

Refresher Course

Alternative Sanction

Facility Employment Requirements

Nurse Aide Retraining

Facility In-Service Requirement

West Virginia Clearance for Access: Registry and Employment Screening (WV CARES)

What is WV CARES?

Nurse Aide Competency Evaluation

Testing Vendor

Demonstration of Skills

Administration of the Competency Evaluation

Oral Competency Evaluation

Successful Completion of the Competency Evaluation Program

Unsuccessful Completion of the Competency Evaluation Program

Evaluator Qualifications

Testing Site Criteria

Regional Test Site

In-Facility Test Site

Appendix A: Commonly Used Acronyms

Appendix B: Glossary of Terms

Appendix D: Contact

Appendix E: Minimum Curriculum Requirements

Orientation

Communication and Social Interaction

Basic Nursing Skills

Personal Care Skills

Basic Restorative Services

Rights of Residents

Dementia

Appendix F: Skills Performance Tasks

How to Use this Manual

This manual incorporates and replaces all manuals, program instructions, memorandums, and other printed materials about the Nurse Aide Program previously issued by the Office of Health Facility Licensure and Certification.

Appendix A contains a list of frequently used acronyms.

Appendix B contains a glossary of terms.

Appendix C contains a list of resources.

Appendix D contains specific contact information for the West Virginia Nurse Aide Program.

Please refer to this to direct your questions and general inquiries.

Appendix E contains the minimum curriculum requirements for a nurse aide training and competency program.

Appendix F contains the skills performance list.

Forms referenced in this manual can be found at: ohflac.wv.gov

Purpose

The purpose of this manual is to provide detailed information about the nurse aide training and competency evaluation program (NATCEP) regulations, and the Nurse Aide Abuse and Neglect Registry in

West Virginia. This manual is intended to assist nurse aide training program instructors, competency evaluation program examiners, and nurse aides in understanding their roles and responsibilities.

Administration

The NATCEP was established under the federal Omnibus Reconciliation Act (OBRA) of 1987, 1990, and

1999. This Act requires states to establish a NATCEP and maintain a long-term care nurse aide registry by coordinating the following activities:

1. Approve and monitor the nurse aide training programs;

2. Oversee the nurse aide competency evaluation program;

3. Manage the Nurse Aide Abuse and Neglect Registry; and

4. Authorize the renewal process for nurse aides.

The NATCEP is managed by the Office of Health Facility Licensure and Certification (OHFLAC) Nurse Aide

Program (NAP) within the West Virginia Department of Health and Human Resources (WVDHHR).

Requirements

1. All providers conducting nurse aide training programs must be approved by the OHFLAC-NAP;

2. All Medicare and/or Medicaid certified nursing facilities have the potential to serve as clinical sites and/or offer the instructional training program. Nursing homes that are not Medicare/Medicaid certified are not eligible.

http://ohflac.wv.gov/

3. Each area vocational center, community college, or nursing facility conducting nurse aide training programs must designate a qualified registered professional nurse (RN) to oversee training and instruction and a program director.

4. Each program must have a primary instructor and clinical instructor. The program director and the primary instructor cannot be the same person. The responsibilities related to the program are distinctively different.

5. There must be valid contact phone number, mailing address, email and fax number for the program director and instructors provided.

Instructional Program

An instructional program is a training program for nurse aides approved by the OHFLAC-NAP. The purpose of an instructional program is to provide a basic level of both knowledge and demonstrable skills for individuals who provide nursing-related services to residents in the nursing home setting, and who are not licensed health professionals or volunteers who provide services without monetary compensation.

Each nurse aide training program must be competency based. The program must contain behavioral objectives for each unit of instruction. Each objective must state performance criteria which are measureable and which will serve as the basis for the competency evaluation. The objectives must be reviewed at the beginning of each unit so the students have an understanding of what is expected.

The goal of each educational program must be to prepare an entry-level nurse aide who will provide quality care to the residents of nursing facilities.

In West Virginia, the OHFLAC-NAP approves nurse aide training programs that satisfy standards outlined in federal and state laws and regulations.

The OHFLAC-NAP reviews the curriculum of each approved training program sporadically following the initial approval date to determine whether the program continues to satisfy the required standards.

The OHFLAC-NAP may suspend, revoke, or impose a plan of correction (POC) on a training program that does not meet the required state and federal standards or does not operate under the conditions of the approved application.

Program Approval

Application

In order for a facility-based or non-facility based program to be approved, the following documents must be completed and submitted.

1. The OHFLAC-NATCEP Microsoft Excel Calendar Workbook;

2. A faculty data and/or resource instructor form; and

3. For non-facility based programs, copies of the contracts with the nursing facilities where the clinical experience requirement will be met.

The program shall provide any additional information requested by the OHFLAC-NAP during the review of the application. The program shall designate a director who will be responsible for the operation and compliance of the program. All aspects of the program shall be in compliance with all applicable federal, state and local laws.

Action by the OHFLAC-NAP

1. Upon receiving a training program application, the OHFLAC-NAP will determine whether it meets federal and state compliance requirements, including the following:

a. Program content, length and ratio of classroom instruction to skills training;

b. Qualifications of instructors;

c. Clinical setting and type of clinical supervision;

d. Provision for written evaluation of the program;

e. Reasonable accommodations for prospective students with disabilities;

f. Criteria for successful completion; and

g. Appropriate furnishing of physical facilities to meet classroom instruction and skills training needs.

2. Within 30 days after receiving a training program application, the OHFLAC-NAP shall either issue a preliminary approval or deny the application. Preliminary approval is only granted for a period of six months to allow the qualified RN to attend the educate-the-educator session. If the application is denied, the OHFLAC-NAP shall provide the applicant written notice detailing the reasons for the denial.

Program Identifier

At start-up, each training program will be issued a program identification number. The program number and the program’s full name shall be placed on each correspondence submitted into the OHFLAC-NAP for review, including emails. The NATCEP faculty staff members will be assigned or linked to their approved training program.

Post-Approval Review and Monitoring

1. The OHFLAC-NAP shall conduct a review of the program every two years after the date of the initial program approval. The department may conduct an announced or an unannounced on-site review of the program at any time to verify that the program remains in compliance with the requirements.

2. If the program is found out of compliance with the requirements, the program director shall submit a POC to the OHFLAC-NAP. The POC shall be submitted on the form provided by the

OHFLAC-NAP, and shall include any additional information requested during the review of the program. The primary instructor shall provide reasonable means for the OHFLAC-NAP to examine records and gather requested information.

3. The primary instructor or program coordinator shall submit for approval any substantial change in the program to the OHFLAC-NAP in writing. A program may not implement the proposed change without written approval of the OHFLAC-NAP. "Substantial change" means a change in the program’s faculty staff members, including the director, curriculum, course hours, or program site.

4. If training has not been conducted within 24 consecutive months, the approved program may be deemed “inactive status.”

5. If at any time the OHFLAC-NAP determines a program has failed to comply with the requirements, written notice will be provided to impose a POC on the program, or suspend or revoke approval of the program.

Enforcement

The department may deny or withdraw approval of a training program for one or more of the following reasons:

1. The program cannot provide evidence they meet the program standards and requirements as outlined in the approval;

2. The program did not conduct any training classes within the previous 24 consecutive months; and

3. The program fails to allow the department to conduct an on-site visit of the training program.

The OHFLAC-NAP may withdraw program approval immediately or prescribe the timeframe the deficiencies identified during an onsite review shall be corrected. All written notices of deficient practices shall be provided to the Program Director. With the assistance of the primary instructor, the program director shall submit a POC to the OHFLAC-NAP. If the program fails to correct the deficient practice within the specified time, the approval may be withdrawn.

When a program is withdrawn for any reason, the program shall submit a plan to allow for the enrolled students to continue the training and competency program through another approved NATCEP program.

Federal Prohibition of Program Approval

The OHFLAC-NAP shall not approve a NATCEP offered by or in a facility, if in the prior two years the facility was:

1. Operated under a waiver because the facility was unable to provide nursing care for a period in excess of 48 hours per week;

2. Subjected to an extended (or partial extended) health recertification or complaint investigation survey;

3. Terminated as a provider under Medicare or Medicaid;

4. Subjected to the penalty of denial of payment under Medicare or Medicaid;

5. Assessed a civil money penalty of more than $5,000;

6. Subjected to penalty of an appointment of a temporary manager to oversee operations;

7. Operated under a waiver of the requirement of a registered nurse for at least eight consecutive hours, seven days a week; and

8. Closed or had its residents transferred due to state action.

Federal Waiver of Prohibition of Nurse Aide Training Program

Pursuant to 42 USC 1396r(f)(2), a facility-based program (nursing home) may request a waiver of the two

(2) year prohibition when the facility has been assessed a civil money penalty of less than $5000, and the deficiency was not related to the “quality of care furnished to residents.” To request a waiver, the facility must make the request in writing to the Long-Term Care Program at OHFLAC. Requests will only be considered if:

1. There is no such program offered in that area or region;

2. Assures, through an oversight effort, that an adequate environment exists for operating the program in the facility, and

3. Provides notice of such determination and assurances to the state long-term care ombudsman.

The Long-Term Care (LTC) Program within OHFLAC will review each waiver request and make a recommendation to the Centers for Medicare and Medicaid Services (CMS). The CMS will make the final determination whether to approve or deny the waiver request. Each determination will be made on a case by case basis.

A federal waiver of disapproval may not exceed two (2) years, but will be withdrawn earlier if the facility is subsequently found to no longer meet the waiver criteria. When two (2) periods of program disapproval overlap, the programs will not be restored until the second two year disapproval period has been completed.

If a federal waiver of disapproval is requested and granted by the OHFLAC Long-Term Care Program and/or

CMS, the program must re-apply as a new program with the OHFLAC-NAP.

Withdrawal of Approval

The OHFLAC-NAP shall withdraw approval of any program if any of the following identified requirements are not met:

1. Refusing to permit visits, investigations, or inspections by state survey agency officials;

2. Operating outside the minimum standards as identified in the approval;

3. Operating without an approved POC following an on-site review;

4. Using faculty who do not meet the required qualifications;

5. Failing to submit required documents in a timely manner; and/or

6. Failing to have a pass rate in any class of 40 percent or higher and/or a pattern of frequent failures.

When withdrawing approval from a NATCEP, the OHFLAC-NAP will:

1. Notify the program in writing, indicating the reason(s) for withdrawal of approval; and

2. Permit students who have already started a program to finish. (However, these students are not eligible to take the competency evaluation, unless they transfer and complete the program with an approved NATCEP.)

Program Monitoring

On-Site Reviews and Surveys

Federal regulations require on-site reviews of all approved programs be conducted by the NATCEP office.

These reviews will be unannounced.

The OHFLAC-NAP will conduct a review of the program within one (1) year of the date of the initial approval of the program. One year after the initial approval, the training program will be scheduled for a survey; subsequently ever two years thereafter.

Surveyors may conduct an on-site review of the program at any time to verify compliance. The on-site survey will include a visit to the clinical site, as well as the classroom site. During the review the surveyor may request time during the pre- and post- conference to interact with the students to educate the students about their role in the evaluation process and the purpose for the nurse aide registry.

Surveyors will conduct observation of the program implementation, including student performance and the expected outcomes of the curriculum. As part of the survey, the surveyor will review program records to ensure documents are maintained within the guidelines. The surveyor also has the authority to remove the students from the clinical setting if the safety of the residents is jeopardized.

The program shall provide any additional information requested by the surveyor during its review of the program. If documents related to the program are kept electronically, the instructor must have the ability to print the documents immediately upon requests.

Suspension and Revocation

The OHFLAC may suspend or revoke approval of a NATCEP when the program:

1. Fails to comply with any of the nurse aide training program requirements;

2. Violates federal or state requirements;

3. Refuses to permit an on-site visit by surveyors; and

4. Obstructs or interferes with the survey process during the on-site visit.

The OHFLAC will notify the program in writing of the reasons for suspending or revoking approval of the nurse aide training program. Students enrolled in a course that began before the date of the suspension or revocation will be permitted to finish the session; however, they will not be eligible to take the competency examination as long as the program remains in noncompliance.

Program Operation

To meet the federal and state approval requirements, a training program must provide all of the following:

1. Access to an approved clinical setting;

2. Qualified faculty members for both the classroom and skills portions of the training;

3. An adequate number of clinical instructors in the clinical session to provide safe and effective supervision and assistance; and

4. Classroom space that is adequate to meet the needs of the program.

The training program must present their policies and class syllabus for review to OHFLAC-NAP regarding class attendance, grades, uniform and badges, confidentiality, how complaints will be handled, and other pertinent topic areas.

Students, who are also employees of the certified Medicare/Medicaid nursing homes, are not responsible for any costs associated with this training, including deposits for textbooks, supplies or testing. The instructor shall communicate this clearly to the students.

Class Setting and Size

If residents are doing activities in an area, it cannot be designated as a classroom or laboratory in a program.

The size of the classroom is not specified; however, the instructor must ensure that the classroom and lab facilities are adequate to meet the needs of the program based on the number of students enrolled and how the space is utilized.

The instructor must ensure the classroom and skills labs have adequate temperature controls, clean and safe conditions, adequate space and lighting, and all the required training equipment.

The program shall make reasonable accommodations for students and prospective students with disabilities.

Clinical Setting

Supervised practical training is defined as training in a laboratory or other setting in which the student demonstrates knowledge while performing tasks for individuals under the direct supervision of a qualified registered professional nurse (RN). Before a student performs any resident-related services, the RN primary instructor shall determine that the student has been trained and found proficient in providing the services listed on the skills performance record.

The training program shall ensure all of the following are included:

1. Access to a clinical setting approved by the department that is adequate to meet the needs of the program.

2. Clinical settings shall be in compliance with state and federal law. The program director or primary instructor and the health care provider with whom the program has contracted are responsible for verifying that the clinical facility is in compliance with state and federal law. Compliance is based on the most recent nursing home survey. This nursing home’s verification of compliance shall be documented in the training program's files and shall be available during the evaluation process.

3. Any contractual agreement between the program and the clinical setting shall be renewed annually and upon any change of facility or administration change. A copy of the agreement and any amendments shall be submitted to the OHFLAC.

4. During classroom and lab instructions, students shall be oriented to the various forms used to document resident information. Instructors shall supervise documentation on the appropriate flow sheets and forms during the clinical rotation.

5. Before a student begins a clinical rotation, the primary and clinical instructor shall evaluate and document that the student successfully demonstrated the ability to perform a skill.

6. The hours allotted for orientation and pre- and post- conference are not included in the total hours approved for the training program.

7. Within the minimum 120 hours of training, at least 55 hours must be devoted to supervise practical training in the clinical setting where the student demonstrates knowledge while performing tasks on an individual under the direct supervision of an RN.

8. At least a total of 55 hours of training of the minimum required curriculum must be completed prior to any direct contact with the resident.

9. Students may not give hands-on care to a resident who is not assigned to the student unless the student is under the direct supervision of the clinical instructor.

10. Students who are under the general supervision of the clinical instructor may not be paired, during the student's clinical rotation, with nurse aides who are employed by the health care provider.

11. Students shall maintain safe practices, infection control precautions and respect resident rights at all times.

12. Student shall not be assigned to perform a task independently until he or she has received instruction and has been determined capable of performing the task without direct supervision.

13. Students shall demonstrate knowledge regarding their assigned residents' diagnoses and identified needs.

14. Students and instructors shall wear clothing that is in compliance with program policy and that is appropriate for performing resident care. The clothing shall include a nametag that designates the name of the nurse aide training program and the person's status as a student or instructor.

The name tag must also list individual’s legal first and last name. Nick names or initials are prohibited.

15. The scheduled clinical hours shall provide experiences that meet expected outcomes outlined in the program curriculum.

16. The length of the clinical day may not exceed 10 hours. Clinical hours of eight (8) hours or greater must allow the students break periods.

17. A nursing home may serve as the site of clinical instruction for up to two nurse aide training programs at the same time. This decision shall be made by the OHFLAC-NAP in conjunction with the facility’s administrative staff on a case-by-case basis.

18. The training program shall not be used as a substitute for staff orientation or staff education programs.

19. There must be an adequate number of instructors in the clinical setting to provide safe and effective supervision and assistance to students.

20. Clinical or the primary instructor shall not function in any other role while supervising students in the clinical or classroom setting.

21. A ratio of 20 students per one instructor (20:1) in the classroom and 10 students per one instructor

(10:1) in the clinical setting is considered to be adequate in most circumstances.

22. The primary instructor shall evaluate and document a student has demonstrated the ability to correctly perform a skill before the student begins a clinical rotation.

23. The instructor shall make all student clinical assignments with the approval of the director of nursing. The instructor shall complete a review of each resident's chart to retrieve pertinent information needed by the students to provide the required care. Care plan information shall be reviewed at the beginning of each clinical experience, including new orders or changes in each resident’s status.

24. A student's assignment shall be shared with the clinical setting to which the student is assigned before the student arrives at the clinical setting.

25. Each student shall be given an individual assignment. More than two students shall not be assigned to the same resident at the same time.

26. Clinical assignments shall include the care of residents with varied levels of care needs, and the opportunity to be evaluated on organizational skills and time management.

27. The primary instructor is responsible for supervising the clinical performance of each clinical instructor and resource staff.

28. The class training calendar must be sent to the OHFLAC-NAP at least two weeks before the beginning of each new class.

29. The calendar must show dates and times the students will be in class and clinical, the program name, program number and list the names of all of the instructors that will be involved with training that class.

30. At the end of the first day of class, the initial class roster with all of the student signatures must be submitted to OHFLAC-NAP.

31. The instructor must provide each student with a copy of the class syllabus and lesson plans. In the syllabus the instructor shall discuss classroom conduct, learning objectives, activities and outcomes, student/teacher ratio, dress code and badge, minimum passing score for classroom and clinical performance, method used for evaluation of skills lab practice and clinical performance, the nurse aide’s role as a caregiver and what part they play in the health care team, their responsibilities, and why they are a mandatory reporter.

Clock Hour Requirements

The minimum time required for a nurse aide training program is 120 clock hours. At least 55 of the 120 hours must be instructor supervised clinical practice. The remaining hours must be classroom instruction and skills development in the classroom laboratory. The length of a training course must be, at a minimum, four weeks.

Expectations for Record Retention

A training program must maintain a master copy of the Skills Performance Record and summary of the knowledge that a student is expected to have upon completion of the training program.

The primary instructor must individually record when a student satisfactorily performs each required task or skill and provide a copy of the student’s performance record to the student. The instructor will document this with the date of completion and place his or her initial in the appropriate box. When a student has satisfactorily completed all required skills and competencies, attained the necessary knowledge, and achieved the stated course completion criteria, the student qualifies to take the state competency test.

The training program must retain all required records for at least three years, including the student’s:

1. Legal name;

2. Social Security Number;

3. Attendance record (dates and hours);

4. Skills checklist;

5. Course evaluations; and

6. All documents related to training.

The program must provide all students who successfully complete the training course with a certificate of completion. The certificate must have the student’s full name, name of the program and program identification number, instructor’s name and title, number of hours completed and the completion date.

Skills Performance Record

The training program shall maintain a skills performance record, or a list of competency skills a student must demonstrate.

The primary instructor shall verify the student has satisfactorily performed each skill by placing his or her initials and date on the skills performance record. Upon the satisfactory completion of all the required skills and competencies in the course completion criteria, the trainee qualifies to enter a competency evaluation program.

The primary instructor shall provide a copy of the skills performance record to the student at the conclusion of the training.

Student Absenteeism

Student absences shall be monitored by the instructor. At the instructor’s discretion, a student may be given the opportunity to make up missed assignments and clinical rotations. The number of absences allowed and how to make up days of missed instruction must be clearly outlined in the program’s policy.

If students are allowed to miss clinical or classroom days, there must be enough makeup days scheduled on the calendar for both clinical and classroom for the same amount of days missed. Individuals that miss greater than one week of class must be dis-enrolled and encouraged to join the next scheduled training class session.

Instructor Absenteeism

If a primary or clinical instructor becomes ill during a session and is unable to continue instruction, another approved NATCEP instructor may substitute and complete the assignment. In order for the substitute

NATCEP instructor to fulfill this obligation, the prospective NATCEP instructor/coordinator will need to notify the OHFLAC-NAP office of this faculty change, unless the prospective instructor’s name was already listed on the calendar when the initial approval was issued.

Textbooks

The use of up‐to‐date textbooks is an important learning resource for students and it is important that the faculty staff select the most appropriate textbook to meet their students learning needs.

Supplemental reference tools are permitted; for example, videos and printed materials. Textbooks shall be replaced five (5) years after the publishing date.

Grades

Each training program must decide the grading scale method used for its nurse aide training and competency program (NATCEP). This information is to be included in the class syllabus.

Grading may be based on a combination of the following components: quizzes, tests, projects, homework assignments, worksheets, and/or a final examination.

Competency education is based on the concept of mastery of behavioral objectives with sufficient time allotted for the individual to achieve mastery. To pass the practical (laboratory and clinical) portion of the

NATCEP, the individual must be proficient in demonstrating all skills.

Proficiency is defined as the ability to perform a skill in a competent and safe manner. Students must be evaluated and deemed proficient in a skill prior to performing that skill in the clinical setting for a resident.

Pursuant to the child labor laws issued by the Department of Labor, individuals under 18 years of age cannot operate mechanical lifts/hoists in the long-term care setting. These individuals must have clear identification of their age limitations in their documentation and record. When the students go to clinical, the students who are younger than 18 will observe the other students perform this particular skill(s).

Classroom Laboratory Requirements

The laboratory portion of the training is completed in the classroom setting where the student is able to practice the skills demonstrated and taught by the primary instructor. Guided student practice is best performed right after skill demonstration. During this type of student practice, the educator observes the practice sessions and provides descriptive feedback. The educator must be astute and correct errors during guided practice to prevent the repetition of errors.

Proficiency check‐offs, also known as skills check‐offs, are held after demonstration and student practice has taken place. At a minimum, students must be evaluated and deemed by the instructor to be proficient in each of the skills listed on the Skills Performance Record in order to pass the laboratory requirement, as well as clinical. At this time, the instructor’s role changes and the instructor becomes an evaluator. The evaluator observes a student’s performance of the skill, and then actively checks‐off each skill step on the sheet. The evaluator does not prompt, cue, or assist the student.

Based on the instructor’s definition of proficiency, the student either passes the skill and is evaluated as proficient, or does not pass the skill. Students who pass the skill must continue to independently practice the skill correctly in order to achieve long‐term retention of skill performance. Students who fail proficiency check‐offs should repeat guided practice and independent practice, and then be checked‐off again. Per federal regulations, students may not perform a skill with a resident in the clinical setting until the student is deemed proficient by the RN instructor in that specific skill.

Documentation

Calendar and Roster Submission

Each approved NATCEP is required to submit a calendar to OHFLAC-NAP for review two (2) weeks prior to actually starting its class session, except for the High School Career Technical Schools (HS-CTC). High

School Career Technical Schools may submit their calendars two weeks prior to the start of their clinical rotation.

Class rosters are due at the end of the first day of class (orientation day), except for the HS-CTC. The HS-

CTC initial class roster is due prior to the class going to clinical or nursing home rotation. Adult Career and Technical Programs (A-CTC) calendars and rosters are to follow the same guidelines as the facility-based programs when it comes to calendar and roster submission.

Skills Performance Record Documentation

The instructor is responsible for maintaining the Skills Performance Record. A copy may be given to the student, but the instructor is responsible for maintaining the master copy.

The instructor completes this document for each student, as directed, and maintains the completed document in the student’s record for a minimum of three years. A completed Skills Performance Record documents proficiency of skills demonstration both, in the laboratory and in the clinical settings.

The instructor shall keep the master copy updated and current at all times. All skills must be checked off at the time the student demonstrates the task and not at the end of the day.

When a skill is introduced in class and/or laboratory, then demonstrated in laboratory by the instructor, the skills check sheet will serve as a valuable resource for the student. The skills check sheet also serves as a reference for the student during practice.

The instructor must use the skills sheet to evaluate proficiency of skills demonstration by the student.

When the instructor evaluates a student as proficient in a particular skill using the skill check sheet, they date and initial the Skills Performance Record. The skills performance record must be maintained in the student’s individual file.

Each student must receive copies of all course documents at the beginning of the course.

Rosters

There are three types of rosters:

1. Class roster, often referred to as the initial class roster;

2. Completion roster; and

3. Refresher roster.

All rosters must be typed. The initial class roster must be submitted to the OHFLAC-NAP office by the end of the first day of class (orientation day) or within 24 hours after the first day of class. Orientation day is considered the first day of class for both the facility-based and the non-facility programs. The completion roster and refresher roster must be submitted to OHFLAC-NAP no more than 30 days following the last day of class. Program completion roster will not be accepted if a calendar has not been submitted for that class. This means that the students will not be eligible to take the state test.

Clinical Requirements

In order to successfully complete the classroom requirement, the primary instructor first must document on the skills performance list that the skill was demonstrated and taught in the classroom setting, and that the student performed all skills listed on the Skills Performance Record in a proficient manner, while under the RN’s supervision prior to clinical rotation.

Then, in the clinical setting the clinical instructor will allow the student first to practice their skills independently without coming into contact with the residents. Once proficient, students may be issued an assignment and allow them to deliver care to the resident.

Complaint File

Each training program is responsible for developing its own process in which the student have the opportunity to communicate anonymously any concerns or complaints they might have related to the

NATCEP. Documentation of complaint resolution must be part of the file. The location of the complaint file or box must be accessible to all during the entire class and clinical session.

Instructor Availability and Accessibility

While students are in the clinical setting, the instructor must be easily accessible and within visual range.

Students cannot provide care in different parts of a facility without an instructor. For example, if the students are assisting resident with eating in the dining room, the instructor should be physically present in the dining room or have the student within his or her visual range. Students should not be in a separate wing, floor or part of the building or out of the view of the instructor. There are times when the building floor plan will hinder the “visual range” requirement, in that case the instructor must still be accessible to the student.

If for any reason the instructor must leave the clinical area, the students must also leave the clinical area.

The instructor is responsible and accountable for his or her students behavior while in the nursing home setting.

Facility-Based Programs

Training of nurse aides may be performed under the general supervision of the director of nursing (DON) for a facility; however, the DON is prohibited from acting as the primary instructor or as a clinical instructor.

Notification of Substantial Changes in the Program

An approved nurse aide training program must report all substantial changes within 24 hours to the

OHFLAC-NAP prior to implementation. A substantial change means any changes in the program designee or faculty staff member, curriculum, clinical site, classroom and program site.

The program must report this change to the OHFLAC-NAP in writing prior to the implementation of the change. Failure to provide this notification of a substantial change may result in suspension or revocation of approval of the training program or faculty.

Student Clinical Orientation

The goal of the nurse aide student orientation at a clinical facility is to provide the student and faculty with important information about the facility and any other information related to the facility day- to- day functions prior to a student getting involved in resident care.

All students will receive an orientation program which includes, but is not limited to, an explanation of the organizational structure and policies and procedures of the facility.

The facility policies and procedures must include:

1. The philosophy of care of the facility;

2. Tour of the facility;

3. Fire and safety plan;

4. Daily routines and organizational structure;

5. The description of the resident populations and the general requirements of the facility; and

6. Employee rules and legal and ethical aspects.

All students must attend a two hour facility orientation prior to the clinical rotation. This two hour facility orientation is not included in the total hours for the program.

Class Orientation

Orientation day is considered the first day of class. On this day the instructor communicates the class introduction and expectations. The instructor will also:

1. Introduce textbooks, policy, copy of calendar, skills check list, course outline, lesson plans with goals and objectives;

2. Explain dress code for class and clinical instruction;

3. Discuss behavioral expectations, including absences and tardiness;

4. Explain the purpose and procedures for filing classroom and state-level complaints;

5. Discuss the student to instructor ratio, and that the students cannot be in the facility without an

RN Instructor;

6. Explain the nurse aide’s roles and the responsibilities;

7. Explain the reregistration every two years with the OHFLAC-NAP;

8. Explain the purpose for the Nurse Aide Abuse and Neglect Registry;

9. Explain how to report a change in the student’s contact information, such as, name, mailing address, and marital status.

10. Introduce the federal and state laws and regulations related to abuse, mistreatment, neglect and misappropriation of property;

11. Facility in-service requirements (12 hours); and

12. State testing requirements.

Charging For Nurse Aide Education and Testing

According to federal regulation, “No nurse aide who is employed by, or who has an offer of employment from a facility on the date the nurse aide begins a NATCEP may be charged for any portion of the program

(including any fees for textbooks or other required course materials).

Facility-based programs cannot charge their employees, or those individuals offered employment, prior to the beginning of the NATCEP. Nor can the facility offer contingency plans prior to the start of the

NATCEP class where the applicant must work for the company for a specified number of days, or enforce a stipulation where the applicant must pass the test in order to get a refund.

If an employee is attending class at a non-facility-based program which charges a fee, the facility, not the employee, must pay that fee.

At the discretion of the nursing home sponsor, if an employee is classified as a “no show” by the vendor for testing, the facility may elect not to pay for any future testing for that individual.

If an individual becomes employed by, or receives an offer of employment from, a facility within 12 months after completing a NATCEP, Medicaid will reimburse the first facility that employs the nurse aide on a pro rata basis during the period in which the individual is employed as a nurse aide.

Program Faculty

Only approved NATCEP instructors assigned to the training program can teach the minimum curriculum requirements. If an organization has multiple programs or satellite offices, an instructor cannot switch between those programs without first being assigned to the program. In the technical career center, a substitute teacher within the school system cannot teach the nurse aide class.

Program Director

The program director shall be an individual who is responsible for the operation and compliance of the program and is generally not involved in the day-to-day function of the program. During the application process the program shall note the director on the application for approval.

The director may be the principal or vice principal of a school, the administrator or assistant administrator, or the DON or assistant DON of the nursing facility. Only one program director is allowed per program.

This person cannot share the role of instructor or coordinator, unless this person is also a registered nurse.

Primary or Program Instructor

The primary instructor for a training program shall be a registered nurse licensed to practice in West

Virginia, who has at least two years of continuous or equivalent experience working as a registered nurse.

At least one year of full time status or equivalent (2080 hours) experience shall be actual work experience in a certified nursing home, or distinct part of a hospital that meets the requirements of Sections 1919(a), (b), (c) and (d) of the Social Security Act. The program shall maintain documented evidence of the instructor’s education, license, and work requirements in their files.

The primary instructor, sometimes referred to as the program instructor, must have completed a course in teaching adults or completed the “Educate-the-Educator” training course for instructors approved by the OHFLAC-NAP, or must have a vocational certificate from the West Virginia Department of Education.

The department may waive this requirement for an instructor who has at least one year of experience as an instructor in a college or university nursing program accredited by the West Virginia Board of Nursing or any other state and has had clinical teaching experience of at least six months in a nursing home setting.

The number of primary instructors required is determined by the needs of the program.

Instructors must not be involved in more than one role while supervising students in the classroom or clinical area.

The primary instructor is responsible for:

1. Maintaining the day-to-day class and clinical activities related to the program;

2. Supervising all faculty staff, except the program director;

3. Planning and evaluation of each segment of the curriculum;

4. Monitoring the resource instructor(s) during initial job duties;

5. Maintaining his or her availability to the clinical instructor during the entire clinical teaching time;

6. Teaching the theory portion of the class; and

7. Demonstrating the skills listed on the performance skills record and evaluating the return demonstration.

Coordinator Instructor

The program coordinator, under the general supervision of the primary instructor, shall assist with all planning and coordination activities for the NATCEP. This individual may also share roles with the primary instructor and clinical instructor.

The coordinator’s responsibilities are:

1. Plan and coordinate the class and clinical portion of the course;

2. Complete all of the required paperwork needed for the program and submit to OHFLAC for review;

3. Report program changes; and

4. Submit the rosters to the OHFLAC office.

Resource Instructors

Resource instructors are persons with specialized knowledge and information in a specific area who provide expertise to enhance learning. Resources instructors may be, but are not limited to: licensed registered nurses, licensed practical nurses, pharmacists, dietitians, social workers, registered sanitarians, fire safety experts, health care administrators, gerontologists, psychologists, physical and occupational therapists, activity therapists, speech and language pathologists, audiologists, and ombudsmen.

A resource instructor shall have at least one year of work experience in the area of training he or she will provide.

A resource instructor shall work under the general supervision of the primary instructor. The resource instructor shall not be used as a substitute instructor.

The resource instructor may not verify demonstrated competency in a task/skill through the Skills

Performance Record.

Clinical Instructor

The clinical instructor qualifications are the same as those for the primary instructor. However, he or she is exempt from the Educate the Educator requirement. This individual is under the general supervision of the primary instructor.

Clinical Instructor Duties

The clinical instructor is responsible for supervising the performance of the students while in the clinical environment.

The clinical instructor is responsible for providing communication between the facility staff and the students. At no time shall a student receive instruction from the facility staff. The clinical instructor can only be involved in one role at a time while supervising students in the clinical area. The ratio of instructors to students in skills training must be adequate to ensure that each student receives safe and effective assistance and supervision. A ratio of 10 students per one instructor is required in the clinical setting.

The clinical instructor makes all student clinical assignments with the approval of the DON or assistant

DON of the facility. The instructor must complete a review of the resident’s medical record to retrieve pertinent information needed by the student to provide the required care. The instructor should provide the information on a worksheet for each student. Care plan information is to be reviewed at the beginning of each clinical experience and should include new orders or changes in resident status.

Student assignments should be shared with the appropriate professional clinical staff prior to the students arrival at the clinical setting. During at least one clinical experience, it is recommended that each student care for a minimum of two, but not more than four, residents during a specified clinical day. Students should be given individual assignments. More than two students should not be assigned to the same resident at the same time.

Clinical assignments shall include the following:

1. Care of residents with special care needs, such as aphasia or dementia;

2. The opportunity to practice organizational and time management skills; and

3. The opportunity to demonstrate skills, safety and infection control precautions.

Refresher Instructor

Instructors affiliated with an approved NATCEP shall have the privilege to teach the refresher course.

Once an instructor disassociates himself/herself from an approved program, he or she is no longer eligible to teach the class.

Faculty Active Status

The status of a faculty member is considered active as long as the member remains affiliated with an approved program. If the faculty member leaves the program, that individual's status will be deactivated.

The coordinator shall complete the bottom of the Faculty Data form, with the deactivation date and submit to the OHFLAC-NAP. This form shall be submitted within one week after the date of deactivation.

Application Requirements for Faculty

To be approved as instructor or director an individual must submit the Faculty Data or Resource form, and include all of the following:

1. WV RN license number;

2. Copy of train-the-trainer certificate or equivalent; and

3. Work experience as an RN in the long-term care setting, listing start and end dates formatted month/date/year.

Educate-the-Educator Workshop

The primary instructor, sometimes referred to as the program instructor, must have completed a course in teaching adults or completed the “Educate-the-Educator” training course for instructors approved by the OHFLAC-NAP; or must have a vocational certificate from the West Virginia Department of Education.

The department may waive this requirement for an instructor who has at least one year of experience as an instructor in a college or university nursing program accredited by the West Virginia Board of Nursing or any other state and has had clinical teaching experience of at least six months in a nursing home setting.

This is a three day course, and shall include the following areas:

1. Principles in adult learning and training techniques;

2. Formulating training objectives, including behavioral objectives which state measurable performance criteria for competency evaluation;

3. Designing the curriculum to provide a logical organization of the material;

4.…