NYS DOH NATPJANUARY 2006NURSING HOME NURSE AIDE TRAINING PROGRAMA. INTRODUCTIONThis document contains the new Nursing Home Nurse Aide Training Program for NursingHome Nurse Aide Certification in New York State. Federal law and regulation requires thatevery individual used by a nursing home as a nurse aide must complete training in a stateapproved nurse aide training program and/or demonstrate competency to provide suchnursing related care and services. Those individuals successfully completing this processare deemed competent and are listed in the State Nursing Home Nurse Aide Registry(Registry). Nursing homes must verify the nurse aide's competency with the Registry priorto employment or use.Nurse aides provide more than 90% of the hands-on care received by nursing homeresidents. During the early 1980s, a study conducted by the Institute of Medicine found thatnationally, nurse aides receive none, or at most, inadequate training before actually providingcare for residents. As part of the national nursing home reform legislation, Omnibus BudgetReconciliation Acts (OBRA) of 1987 (OBRA '87), 1989 (OBRA '89) and 1990 (OBRA '90)mandated specific training and competency evaluation requirements for nurse aides andestablishment of a state nurse aide registry of such competent nurse aides.Effective October 1, 1990, nursing homes are precluded from employing or using anindividual as a nurse aide or nurse aide trainee unless that individual is listed, in goodstanding, in the State nursing home nurse aide registry or the person is concurrently enrolledin a state approved nursing home nurse aide training program [Section 1919(b)(5)]. TheState is required to include in the nurse aide registry information pertaining to sustained,after due process, administrative findings and/or criminal convictions for incidents of residentabuse, neglect or mistreatment or misappropriation of resident property. Individuals withsuch documentation are not permitted to work in any capacity in any nursing home.Federal statute requires each state to identify, approve and reapprove those nurse aidetraining programs and competency evaluation programs which meet the federalrequirements specified in law and regulation [Section 1919(e)(1) and (2)]. The statute furtherrequires nursing homes to use as nurse aides only individuals who are listed, in goodstanding, on the state’s nurse aide registry. To obtain state certification and listing in theRegistry, the individual must first complete a state approved nursing home nurse aidetraining program and then pass the state-authorized competency evaluation programcomprised of the clinical skills examination and the written or oral multiple choiceexamination.Nurse aide training programs offered in New York State may be approved by either the NewYork State Department of Health or the State Education Department. The Department ofHealth (DOH or Department) approves those programs provided by nursing homes as wellas training programs provided by other health care entities or community basedorganizations free of charge to the student or trainee. All nurse aide training programsPage 2 of 215

NYS DOH NATPJANUARY 2006provided by entities under the jurisdiction of the State Education Department (SED) such assecondary or vocational schools, community colleges, proprietary schools, post-secondaryschools, or any nurse aide training program that will charge the student or trainee tuition orfees must be approved by the SED.Each nursing home nurse aide training program taught in New York State, regardless ofsponsor, must include all DOH nursing home nurse aide training program curriculumrequirements to obtain state-approval. This is necessary to ensure that all New York Statenursing home nurse aides are instructed in and obtain the skills and knowledge necessaryto provide safe and effective care and services to the nursing home residents. Individualsthat successfully complete a state-approved nursing home nurse aide training program andpass the state-authorized nursing home nurse aide competency evaluation program shallbe certified by the Department as minimally competent and listed in the state’s nursing homenurse aide registry.Training programs approved by the State Education Department (SED) may have additionalrequirements beyond the DOH-state approved nursing home nurse aide training programrequirements that must be met for SED approval and/or licensure. Such programs shouldcontact the SED for additional information.The DOH-approved Nursing Home Nurse Aide Training Program (NATP) is comprised ofthe following components:1. Introduction and instructions for use of the mandated 100-hour minimumNursing Home Nurse Aide Training Program curriculum.2. Content outline for the minimum 100-hour Nursing Home Nurse Aide TrainingProgram. This program includes as part of the 100-hours, 30 hours ofsupervised clinical training in a New York State licensed nursing home.3. Nursing Home Nurse Aide Training Program Curriculum Manual. All nurseaide training programs within New York State must teach the content specifiedin this manual. Programs may add additional content or lessons but can notdelete or substitute any of the units, topics or lessons in this manual.4. Clinical skills checklist each containing the minimum set of clinical skills eachnurse aide trainee in the state must successfully demonstrate during thetraining program.The New York State nursing home nurse aide training program curriculum could not havebeen developed without the dedication and hard work put forth by nurses who either teachand/or supervise nursing home nurse aides. These nurses from throughout the statevolunteered to work with the department to develop a revised nurse aide training programcurriculum that would reflect current practice of today’s nursing homes. A group of nursesinvolved in the teaching and supervising of entry-level nursing home nurse aides began thiswork during 1997. It was completed during 2003 and 2005 by a second group of nurses alsoinvolved in teaching nursing home nurse aides in both nursing home and educationalsettings. The Department would like to thank each of the following individuals for theirdedication to this project and their willingness to openly share their experience and expertisePage 3 of 215

NYS DOH NATPJANUARY 2006in the training of nursing home nurse aides.1997 GroupBarbara Brooks RN, Heritage House; Chris Cameron RN, NYSHFA; RitaCoddington, River Mede Manor; Barbara Coleman RN, Delaware County CountrysideCare Center; Gail Diffey RN, Welsey Health Care Center; Barbara Folks RN, EdenPark Nursing Home; Jeanette Geggelbruch, GNYHFA; Barbara Gerolami RN,Thomson Nursing Home; Ann Gignac RN, Baptist Retirement Center; Mary GuarinoRN, Elderwood Affiliates, Inc.; Barbara Jackson RN, Clove Lakes Health Care Center;Adrienne Liander RN, Eger Health Care Center; Diane Moyer RN, Episcopal ChurchHome; Jessica Locke Richer, HANYS; Pearl Stanford RN, Coler Memorial Hospital;Nancy Tucker RN, NYAHSA; and Karen Zick RN, Eastern Star Home.2003 and 2005 GroupJune Barbera RN, Elderwood Affiliates, Inc.; Smyra Clause RN, Consortiumfor Worker Education; Gail Diffley RN, Welsey Health Care Center; Mary Guarino RN,Elderwood Affiliates, Inc.; Joyce Long RN, BOCES; Linda Ramono RN, Elant atGoshen; and Patricia Venttiquarttro RN, BOCES.New York State StaffDepartment of Health: Nancy Abeel, Denise Dwyer RN, Diane Lenzner Cohen,Brian Morris, and Curtis Rogers.State Education Department: Patricia Hodgins, RNPage 4 of 215

NYS DOH NATPJANUARY 2006B. NURSING HOME NURSE AIDE TRAINING AND CERTIFICATIONPROGRAMThe nursing home nurse aide training program consists of seven (7) instructional units plussupervised clinical training in a nursing home. The seven instructional units are: Introductory Curriculum; Basic Nursing Skills; Personal Care Skills; Mental Health and Social Service Needs; Care of Cognitively Impaired Residents; Basic Restorative Services; and Residents Rights.Incorporated throughout the nursing home nurse aide training program (NATP) is theunderlying concept of “core values”. These core values have been identified as thefoundation for all aspects of care. They are not unique to the care provided in nursinghomes but are universal, regardless of the care setting. The core values influence theeffectiveness and resident satisfaction. They must be incorporated into the provision of allcare and services beginning with the NATP to teach and reinforce these concepts to entrylevel nurse aides that they may implement them throughout their careers in health care.The core values that the care and services provided in the facility must demonstrate are: (1)the dignity and worth of each resident as an individual; (2) respect for the range of diversityof individuals; (3) a demonstration of a therapeutic relationship. A therapeutic relationshipbetween the care giver and the care receiver is defined as the value of autonomy andcontrol, adapting to resident’s preferences and routines and limits, maintaining privacy andconfidentiality, and encouraging individuals to be as independent as possible. The impactof the actual setting/environment on the resident and the resident’s adjustment to care mustbe understood and responded to throughout the program.Each unit of the NATP is comprised of the specific training topics and lessons required fortraining of nursing home nurse aides. Each lesson identifies the minimum training time forclassroom and laboratory instruction, lesson objectives and measurable performance criteria.The objective is the observable behavior, skill or knowledge the nurse aide trainee will bedoing when demonstrating achievement of the objective. The Measurable PerformanceCriteria are the criterion or standards that are to be used to measure how well and to whatextend the nurse aide trainee learns or meets the objectives of the lesson. The NATP mustinclude all of the topics and lessons as specified in the State-approved NATP curriculum. Ifthe facility admits special needs residents and/or is certified for pediatrics, ventilatordependent, AIDS or traumatic brain injury (TBI) services, state regulations [10 NYCRR415.26(d)(3)(i)] require the nursing home to provide additional training specific to the needsof those residents.The State-approved NATP requires that each nurse aide trainee receive a minimum of 100clock hours of training comprised of at least 70 hours of actual classroom and lab trainingtime plus 30 hours of supervised clinical training time with residents in a nursing home.Page 5 of 215

NYS DOH NATPJANUARY 2006Actual training time does not include evaluation or testing time, break or meal times.Information relating to facility personnel and general orientation issues for employees,including nurse aide trainees, must be taught in separate and distinct training sessions eitherprior to or after the successful completion of the nurse aide program.Some units in the NATP curriculum have been identified as [BASIC CORE]. The Basic Coredesignation refers to those units that are required curriculum in the DOH Personal CareAide/Home Health Aide training program as well as the nursing home nurse aide trainingprogram. Upon verification of a trainee’s successful completion of a Personal Care Aide(PCA) or Home Health Aide (HHA) training program on or after January 1, 2006, anddemonstration of competency in the BASIC CORE material, the NATP trainee would nothave to repeat training in these units. However, all NATP trainees must successfullydemonstrate all skills listed on the Clinical Skills Performance Record Evaluation Checklist,regardless of previous training.Facilities may, if desired, expand and augment the curriculum as they see fit. Additionaltopics and lessons may be added or incorporated into the required NATP curriculum.However each individual’s nurse aide trainee training record must clearly document thetrainee’s competence in each lesson and required clinical skill of the State-approved nursinghome nurse aide curriculum prior to the individual taking the state nurse aide certificationexamination.The training program must designate a Program Coordinator (PC) and a Primary Instructor(PI) for the nurse aide training program. The PC and PI must be a New York Stateregistered professional nurse and may be the same individual, however a nursing home’sDirector of Nursing may not serve as the PI. The qualification for the PC and PI are specifiedin department regulations 10 NYCRR 415.26(1). The Program Coordinator and PrimaryInstructor must identify and obtain or develop the necessary materials and tools to teach,instruct and evaluate the performance of each nurse aide trainee enrolled in the NATPprovided by the facility. The PC/PI must have access to suitable resources in the facility tofacilitate the success of each trainee in the program.During the supervised clinical training period (at least 30 hours) of the NATP, the nurse aidetrainees must be under the direct supervision of a New York State licensed nurse. Thenurse (RN or LPN) may not be the charge nurse due to the need for continuous directsupervision of the trainees. If the supervising clinical training nurse is not the PC or PI, thesupervising clinical training nurse is under the direction of the PC who retrains responsibilityfor the clinical portion of the training program. The ratio of trainees to trainee supervisor maybe no more that 8:1 to ensure adequate supervision and instruction during the clinical portionof the training program.The regulations that govern New York State nurse aide training programs are located in theDepartment of Health regulations, Title 10 NYCRR 415.26(d). These regulations are notrepeated in this document but may be obtained from the DOH website rr10.htm.Page 6 of 215

NYS DOH NATPJANUARY 2006This document does provide nursing homes and other providers of nursing home nurse aidetraining with the mandated nursing home nurse aide training program curriculum and theclinical skills checklist, required for approval of all nursing home nurse aide training programsregardless of the entity or organization providing the training. Please note that in mostinstances this document refers to nursing home or facility as the entity conducting or offeringthe NATP and should be interpreted to include community based organizations, and othersponsors/providers seeking approval from DOH for a state-approved NATP.Upon determination that the facility wishes to offer nurse aide training to employees orpotential employees, the facility should contact the Department to request the currentapplication for a Nursing Home Nurse Aide Training Program. All NATPs approved by DOHare offered and provided free of charge to the individual nurse aide trainee. The sponsorof the NATP seeking DOH approval may not charge tuition or fees to the individual for anycosts associated with the NATP or initial attempt of the nurse aide certification competencyexamination. The sponsor should contact the State Education Department if they plan tocharge any tuition or fees to students for the NATP.The completed NATP application must be signed by the facility’s Administrator of Recordand submitted with all supporting documentation to the Department at the following address:Bureau of Professional CredentialingDivision of Quality and Surveillance for Nursing Homes and ICFs/MRNew York State Department of Health161 Delaware AvenueDelmar, New York 12054-1393.The Department shall review the submitted NATP for compliance with applicable federal andstate statutes and regulations. The nursing home or community based organization (facility)will receive the written results of this review from the Department within 90 days of receiptby the Department. If the NATP does not meet all requirements, the Department shallindicate the area(s) that are deficient in a written letter to the sponsor. The facility staffshould use the information in the letter to make all necessary corrections, clarifications oradditions prior to re-submission of the NATP to the Department for approval. Upon approvalof the NATP, the Department shall issue the facility a Nurse Aide Training Program approvalnumber and notify the nurse aide competency evaluation contractor of the program’sapproval. The testing contractor shall provide information for in-facility testing for nursinghome nurse aide certification directly to the facility. Information on the administration andcontent of the state’s nursing home nurse aide certification examinations are contained inthe New York State Nursing Home Nurse Aide Certification Program Manual issued by theDepartment’s nurse aide testing contractor.The training program is responsible for scheduling the trainee’s first nurse aide competencyexamination test date. The competency examination must be administered within 10 daysof the last day of the state-approved NATP. The nursing home is responsible for paying thetesting fees for the initial clinical skills and written/oral testing fees for all students taking theirNATP. Further, nursing homes may not charge any nurse aide training or testing fees toPage 7 of 215

NYS DOH NATPJANUARY 2006individuals employed or offered employment by the facility.The training program approval is valid for two (2) years or until the facility/training programis otherwise notified by the Department. The Department shall determine continued facilitycompliance with the nurse aide training program requirements through on-site reviews andtheir trainees’ competency examination performance. Failure to comply with all federal andstate regulations or requirements pertaining to the training and/or competency testing ofnursing home nurse aides may result in the withdrawal of approval for the nurse aide trainingprogram.Pursuant to federal statute, the nurse aide training and/or testing may not be provided in anynursing home that, within the previous 24 consecutive months, has been subject to any ofthe following surveillance or enforcement occurrences. Extended or partial extended survey;Denial of payment for new admissions;Denial of payment for all individuals;Assessed civil money penalty of 5,000 or greater; orImposition of a temporary manager.The Department shall notify the nursing home, SED and the nurse aide testing contractorwhen such situations occur. If a state-approved nurse aide training program is in progressin the nursing home when the 24-month ban is imposed, the training program shall contactthe Department immediately to develop a plan to complete the NATP as expeditiously aspossible without penalizing the trainees. In specific circumstances, another nurse aidetraining program may obtain a waiver that will permit DOH to approve the outside trainingprogram to provide nursing home nurse aide training in a facility that is subject to the 2-yearonsite training prohibition. Federal law has established the circumstances when a waivermay be granted. Training programs that are interested in pursuing such a waiver shouldcontact the Bureau of Professional Credentialing at [email protected] formore information.Page 8 of 215

NYS DOH NATPJANUARY 2006C. DOH NURSE AIDE TRAINING PROGRAM APPROVALThe training program curriculum for nursing home nurse aides has been designed to preparethe Certified Nursing Home Nurse Aide (CNA) with the skills and knowledge necessary toprovide safe and effective care and services to nursing home residents.The facility Administrator of Record, Program Coordinator (PC) and Primary Instructor (PI)are responsible for ensuring that all elements necessary for the implementation of the nurseaide training program are in place prior to the first training session. The facility seekingapproval of a nurse aide training program (NATP) must have in place Policies andProcedures for both the training of new CNAs as well as the utilization of CNAs in the facility.Such Policies and Procedures would include, but not be limited to: Qualifications and criteria for the NATP; Employment status of nurse aide trainees; State required criminal history background checks for nurse aide traineesand CNAs; Location where NATP will take place including classroom and laboratoryspace; Supervision of nurse aide trainees during supervised clinical training timeand if appropriate, during working time; and CNA inservices.The State-approved nurse aide training program is comprised of seven (7) training programunits and a period of supervised clinical training in a nursing home with residents. Theseunits correspond to the federally required nurse aide training program content.Each unit in the mandated curriculum contains specific training topics and lessons. Eachlesson is comprised of minimum training time, learning objectives, measurable performancecriteria to evaluate the candidate’s competency, and suggested teaching and evaluationmethodologies. The PC/PI should use available resources to prepare the teaching materialsand lesson plans for each lesson necessary to instruct the trainees and meet the NATPobjectives.Minimum training times for each lesson have been provided as part of the curriculum. Theserepresents the minimum amount of instructional time determined necessary to adequatelypresent the knowledge and skills to an “average” nursing home nurse aide trainee. Neitherbreak/meal time or student evaluation time is considered part of, or included in, the statedminimum training time. The PC/PI must be able to increase instructional time as necessaryin order to accommodate students possessing a vast range of learning skills and educationalexperiences; thereby, guaranteeing that each trainee learns all of the presented information.The minimum training times specified for each lesson may not be decreased. The PC maywant to increase the minimum training time for required training units or additional trainingunits, topics or lessons. Such additions of training program lessons must be documentedin the facility’s nurse aide training program curriculum when submitted for DOH approval.Page 9 of 215

NYS DOH NATPJANUARY 2006DOH does not mandate the use of any specific nursing home nurse aide textbook or trainingmaterials. Each NATP should research and identify the training and teaching resources andtools that will best provide their nurse aide trainees with a successful educational experience.Resources are readily available to assist the PC/PI in the development of the NATPperformance evaluation tools. These can include, but are not limited to nursing and nurseaide textbooks, audiovisual materials, demonstrations, role-playing, and professionalliterature. Suggestions have been provided throughout the mandated NATP curriculum.The PC must identify and develop the means, methods and formats of the performanceevaluation for each of the required and taught training units. The performance evaluationsare to be utilized by the PC/PI to determine the competency and successful completion ofthe nurse aide training program by each student. Competency of the nurse aide trainee ineach area may be assessed through oral or written tests/quizzes/questions and throughdirectly supervised performance of the skills on individuals or residents. These must besubmitted to the Department when the NATP is submitted to DOH for approval.The Department has provided, as part of the curriculum, a Nursing Home Nurse Aide ClinicalSkills Performance Record Evaluation Checklist for use by the facility. The facility must usethis form and format to document the individual’s successful demonstration of all clinicalskills at the completion of the facility’s State-approved nurse aide training program.Additional clinical skills may be added to this checklist but no skill can be deleted. Facilitiesshould supplement this checklist if additional knowledge and/or skills are taught to studentsduring the nurse aide training program. The competency checklist must be signed by the PCor PI, the Nurse Aide Trainee, and the facility’s Administrator of Record documenting theindividual’s successful completion of the facility’s State-approved nurse aide trainingprogram. If the NATP is not operated by a nursing home, the sponsor’s Director must signthe checklist in place of the Administrator of Record.The facility must maintain training records for each individual completing the NATP, includinga copy of their completed skills checklist, and performance evaluation records. Trainingrecords must be maintained and made available to Department staff upon request.Upon the successful completion of the Nurse Aide Training Program, the trainee is eligibleto sit for the New York State Nursing Home Nurse Aide Certification Examination. Thecertification examination or competency examination includes a performance-basedcomponent referred to as the Clinical Skills Test and a knowledge assessment called theWritten Test. The trainee or candidate is permitted three opportunities to pass the ClinicalSkills Test and then three opportunities to pass the Written Test. An oral administration ofthe written test is available. The certification examination is administered by registeredprofessional nurses through the state’s nurse aide testing and registry contractor. TheDepartment has contracted with Thomson Prometric, formerly known as The ChaunceyGroup International, for nurse aide certification or competency testing and management ofthe NYS Nursing Home Nurse Aide Registry.The NATP is responsible for scheduling the certification examination for its successfulPage 10 of 215

NYS DOH NATPJANUARY 2006trainees within ten (10) business days of the last day of the NATP. The trainee must passboth the clinical skills test and the written (or oral) test in order to obtain New York StateNursing Home Nurse Aide Certification.Specific information on the New York State Nurse Aide Certification Examination iscontained in the New York State Nursing Home Nurse Aide Certification Program Manual(Manual) and the New York State Nursing Home Nurse Aide Candidate Handbook(Handbook). Each nursing home and approved NATP receives a copy of the Manual andan initial supply of Handbooks from the testing contractor. Additional copies may berequested directly from the contractor. A copy of this handbook must be given to eachNurse Aide Trainee during the training program.Individuals successfully completing the facility’s Nurse Aide Training Program are to receivea Certificate of Successful Completion from the facility. A copy of the certificate ofcompletion must be maintained in the Nurse Aide Trainee’s personnel folder at the facility.The Certificate of Successful Completion is to contain the following information: Full name of the nurse aide trainee, Name and address of the facility, Training Program Identification Number and the date the individualsuccessfully completed the nurse aide training program, Name, title and signature of the training program Program Coordinator, Signature of the nurse aide trainee; and Name and signature of the nursing home Administrator [AOR] or, for a nonnursing home based programs, the Director or owner.Individuals successfully passing both components of the certification examination shall havetheir name added to the New York State Nursing Home Nurse Aide Registry and shallreceive in the mail their New York State Nursing Home Nurse Aide Certification certificateand wallet card. Individuals that are not successful in passing either the clinical skills testor the written/oral test shall receive an official score report that includes diagnosticinformation by knowledge or content area. The NATP and the employing nursing homes willreceive weekly reports from Thomson Prometric providing examination performance of eachof their candidate(s) tested during the report period.If the individual has not passed the certification examination within the three attempts and/orwithin 120 days of their first day of training or employment, the individual may no longer workas a nurse aide trainee in the nursing home. The facility may assign the individual to nonresident contact duties.Page 11 of 215

NYS DOH NATPJANUARY 2006D. NURSING HOME NURSE AIDE TRAINING PROGRAM CONTENT OUTLINEThe content outline provides an easy to read listing of the units, topics and lessons requiredto be taught during the state-approved nursing home nurse aide training program. For eachl

2. Content outline for the minimum 100-hour Nursing Home Nurse Aide Training Program. This program includes as part of the 100-hours, 30 hours of supervised clinical training in a New York