Transcript State Nurse Aide and NNAAP 2013

State Nurse Aide and NNAAP 2013
Kathy Turner – DHSR
Diana Brosko-Carelli
– Pearson VUE
Susan Worthington –
NACES
September 26, 2013
Overview of Session
• Updates from Pearson VUE – registration
issues, improvements, standardized testing,
reports, scores
• Updates from NACES – clarifications, skill
areas needing attention, testing tips, in-facility
• Updates from DHSR – projects & initiatives,
consultant activity for 2013-14, refresher
programs, statistics
Copyright © 2012 Pearson Education, Inc. or its affiliate(s). All rights reserved. 800 837 8969
Copyright © 2012 Pearson Education, Inc. or its affiliate(s). All rights reserved. 800 837 8969.
Pearson VUE Confidential. Do Not Distribute.
3
Testing Topics
• On-Line Registration
• Reports
• 2012 Skills Results
• Standardized Testing
• 2013 Skills Changes
• New Skills Results
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Copyright © 2012 Pearson Education, Inc. or its affiliate(s). All rights reserved. 800 837 8969.
4
NNAAP® Registration
25000
25709
25001
20000
15000
10000
5000
0
PULSE
On Line Registration
Dec 2011 - Aug 2012
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Dec 2012 - Aug 2013
Copyright © 2012 Pearson Education, Inc. or its affiliate(s). All rights reserved. 800 837 8969.
5
On-Line Registration and Scheduling
Improvements
Lessons Learned
Challenges
Reduced # of steps to
complete registration and
scheduling
Keep process simple
Is it a registration or a
scheduling issue?
Clarified instructions for Infacility candidates
Obtain client input prior to
implementation
Perception/confidence in
system
Improved website
navigation
Deploy usability testing/or
training prior to
implementation
Review of system
procedures prior to
registration
Reduce # of days between
scheduling & testing
(effective 8/24/13)
Allow correction of errors
when registering/Prevent
errors in the first place
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BI PORTAL Training Program Performance Report
 Generated monthly
 Reports summary pass/fail performance for written & skills
 Reports individual candidate performance
 Lists skills
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Sample BI PORTAL Pass/Fail Roster
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Training Program Reports
 Generated quarterly
 Reports summary pass/fail performance for written & skills
 Your students
 Overall candidates within the state
 Reports candidate performance by
 Individual content category
 Individual skill
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Sample Training Program Reports
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10
2012 Highest to Lowest Skills for NC CC
Skill
Pass %
 Washes hands
99%
 Makes occupied bed
98%
 Assists to ambulate using transfer
belt
 Cleans upper or lower denture
 Donning and removing PPE
 Performs passive ROM knee & ankle
 Positions on side




Performs passive ROM shoulder
Provides fingernail care
Provides foot care
Transfers from bed to wheelchair
 Applies knee-high stocking
 Counts and records respirations
 Measures and records urinary
output
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97%
96%
95%
94%
93%
Skill
 Feeds client who cannot feed self
 Measures and records weight
 Provides mouth care
Pass
%
92%
 Dresses client with weak right arm
 Provides catheter care
90%
 Assists with the use of bedpan
 Measures and records blood
pressure
 Gives modified bed bath
89%
 Provides perineal care for female
 Counts and records radial pulse
86%
85%
88%
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Why Is NNAAP A Quality Examination?
 Examinations are based on a job analysis regularly
conducted by National Council of State Boards of Nursing
(NCSBN)
 Conducted every 5 years
 Most recent JA conducted in 2009 with results published in 2010
 Two examination components: Written & Skills
 Developed by the NCSBN, and includes participation of
subject-matter experts (SMEs) from across the country
(2011)
 Developed according to the Standards for Educational &
Psychological Testing
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Job Analysis
Content Outline
 Periodic Job Task Analysis:
 What does a nurse aide do?
 Has the job changed?
 How is this determined?
 Conduct a national survey of:
 Multiple job settings: Long-term care, acute care, and home care
settings
 Directors of nursing
 Training program instructors
 Experienced nurse aides
 Identify knowledge, skills and activities (KSAs) required
for competent performance
 Required knowledge, skills, and abilities (KSAs) linked with tasks
 Skills weighted for each KSA
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Standards for Educational & Psychological Testing
 Use standards developed by American Psychological
Association, American Educational Research Association,
and National Council on Measurement in Research
 Nationally recognized standards for assessment
 Concerned with:
 Validity
 Are you measuring what you intend to measure?
 Reliability
 How accurate is your measurement
 Test development
 Administration, scoring, equating, and reporting of scores
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14
2012 Skill Changes
Minor changes effective July 1, 2013
 Skills Eliminated
- Makes an Occupied Bed
- Provides Fingernail Care
- Two-Step Blood Pressure (was only in PA)
 Skill Name Changes
- Washes Hands  Hand Hygiene (Hand Washing)
- Performs Passive Range of Motion (PROM) for One Knee an One Ankle 
Performs Modified Passive Range of Motion (PROM) for One Knee an One
Ankle
- Performs Passive Range of Motion (PROM) for One Shoulder
 Performs Modified Passive Range of Motion (PROM) for One Shoulder
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2012 Skill Changes
More significant changes
• Revised passing standard (not percentage based)
- Increased minimal competency level
 Increased the cut scores
- Some skills now require additional steps to be performed correctly
- Some skills now have/additional critical elements (7 skills)
- Revised skills steps
- Clarity, Consistency, Infection Control, Order dependency
- Combining of steps
- Clarity
This change in the certification standard addresses the evolving role of the
CNAs in caring for the elderly and chronically ill by ensuring a level of minimal
competency and preparedness.
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July 1 – September 15, 2013
North Carolina CC
Skill
Pass %
 Hand Hygiene (hand washing)
98% (-1)
 Cleans upper or lower denture
+1





Counts and records respirations
Provides foot care
Applies knee-high stocking
Donning and removing PPE
Performs passive ROM knee & ankle
96% (-2)
95% (-1)
93% (-2)
(-4)
(-4)
Skill
Pass %
 Assists with the use of bedpan
 Feeds client who cannot feed self
 Measures and records urinary
output
89% n/c
 Dresses client with weak right
arm
 Performs passive ROM shoulder
 Positions on side
 Counts and records radial pulse
88% (-2)
84% (-4)
 Measures and records weight
 Assists to ambulate using transfer
belt
92% n/c
91% (-6)
 Gives modified bed bath
 Provides catheter care
 Measures and records blood
pressure
 Transfers from bed to wheelchair
90% +1
 Provides perineal care for female
 Provides mouth care
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(-6)
(-3)
(-4)
(-8)
(-9)
87% +2
(-6)
83% (- 3)
81% (-11)
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Questions
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18
Tips for Programs & Instructors (NACES)
• Review Candidate Handbook!
• Cut Score – each step weighted
differently
• Candidates are allowed to correct steps
before they finish with skill
• Exception is Gloving
• Prior to skills exam candidate are allowed to
try equipment and look at supplies/stations –
highly encouraged
Scoring of Skills Exam
• Scored Objectively
– YES or NO
– Multiple component steps
– Order dependent steps
• Be aware of over exposure
• Hand Hygiene
–
–
–
–
Will be scored YES if introduces self in next skill
20 seconds by clock
Hands lower than elbows, fingertips down
Cleans fingernails (step 6) not part of Step 5
Scoring of Skills Exam
• Applies One Knee-High Elastic Stocking
• Mannequin or client
• Heel is on heel, no twists or wrinkles
• Assists to Ambulate Using Transfer Belt
– Client must have shoes on
• Candidate or Client
– Watch for order dependent steps “Before”
• Steps 2 – 7
– Step 5 – Client “assisted”
• Candidate must be touching client
• “Feet flat on the floor”
• “Maintain stability of client’s legs”
Scoring of Skills Exam
• Assists with Use of Bedpan
– Standard bedpan
• Proper placement!
– Often forget gloving as applied and removed twice
• Counts Radial Pulse
– Any wrist
– If recorded measurement not within 4 +/-,
evaluator will ask if candidate is finished with skill,
stop clock, and retake pulse on same wrist as
candidate
Scoring of Skills Exam
• Feeds Client who Cannot Feed Self
– Safety Stop! Step 3, client seated at 75-90
degrees
• Gives Modified Bed Bath
– Step 3 – removes gown and places in soiled linen
container
• Will miss Steps 3, 13, 16, and 18
• Measures and Records Blood Pressure
– Candidate can try two times on each arm
– Step 7 – inflating cuff
– Safety Stop! If inflates over 200 mm Hg
Scoring of Skills Exam
• Measures and Records Blood Pressure
– If candidate hears systolic again at 200 mm Hg,
use that as the systolic reading and listen and
record diastolic
– If recorded measurement not within 8 +/-,
evaluator will ask if candidate is finished with skill,
stop clock, and retake B/P on same arm as
candidate
• Measures and Records Urinary Output
– Can record in cc / ml, not in ounces!
Scoring of Skills Exam
• Measures and Records Weight
– Step 2, client must have shoes on
• Candidate can put on or ask client to put on
– Steps 3 & 4, candidate must set scale to ZERO
before client steps onto scale
• If scale not set to ZERO will miss Steps 3 & 4
• Performs PROM for 1 Knee and 1 Ankle
– Step 4, supports leg and ankle
• Performs PROM for 1 Shoulder
– Step 5, raises to ear level
Scoring of Skills Exam
• Positions on Side
– Step 5 – Candidate must roll client, not just ask
client to roll onto side.
– Step 6 – In order to receive credit the candidate
must touch the pillow.
– Step 7 – In order to receive credit must touch the
arm.
– Step 10 – Support the ankle as well as the knee.
Scoring of Skills Exam
• Provides Catheter Care for Female
– Must hold the catheter AT THE MEATUS.
• Frequently missed step.
– Steps 8, 9 & 10 do NOT specify how many strokes
– Step 5 – If the candidate does not place the linen
protector under the client, then they will be scored
“NO” for Steps 5, 13 & 15.
• Provides Foot Care
– Candidates must use water with this skill.
– Foot must be washed, rinsed and dried including
between the toes.
– Step 11 – The candidate must apply lotion.
Scoring of Skills Exam
• Provides Mouth Care
– Safety Stop! Step 3, client seated at 75-90
degrees
– Step 6 & 7 – Both relate to the toothbrush needing
to be moistened. If not done in step 6, then step 7
will be scored as a “NO” also.
• Provides Perineal Care
– Steps 8, 9 & 11 do NOT specify how many strokes
they must do.
• Suggestion….candidate gather 4 washcloths for the peri
care. One for washing, one for rinsing, one for drying (or
use towel) and one for the rectal area.
Scoring of Skills Exam
• Transfer from Bed to Wheelchair
– Steps 2 – 11, order dependent, all need to be
done BEFORE assisting to stand.
• Client “assisted” -candidate must be touching client
• “Feet flat on the floor”
• “Maintain stability of client’s legs”
– After Step 19 (last step), candidates does not
need to put the client back in bed. If they have
another skill following this skill, then they should
continue on and the evaluator will tell the client to
get back in bed.
New In-Facility Testing Process
• 5 Skills candidates required prior to
scheduling test date with the assigned
evaluator.
• Evaluator may test up to 10 candidates
– Some evaluators are willing to test up to 11-12
candidates per test date, must be pre-approved
with evaluator.
• Be flexible with the test dates when arranging
mutually agreeable test date and time.
New In-Facility Testing Process
• If the designated evaluator not available
please contact NACES @ 1-888-282-6904.
• In-facility test sites are required to submit a
roster students testing to Cheryl Anderson @
NACES no later than 15 calendar days
prior to the scheduled test date.
– Roster can be emailed
to [email protected] or faxed to
Cheryl’s attention at 1-877-696-2237.
– Please note: NACES will not verify if all your
students sign up for INF testing.
New In-Facility Testing Process
• Students may now register for a test date 12
calendar days out (weekends and holidays DO count
towards calendar days), instead of the original 16.
• If testing at an In-facility testing site, must
have correct test site code.
• Students who miss the deadline to
register must test at a regional test site.
• If less than 5 students registered for an Infacility test date for skills exam, exam will be
cancelled and students rescheduled into a
regional test site/date.
New In-Facility Testing Process
Test Date
Roster due to
Cheryl @ Naces
(15 days prior)
Last Date Candidate
May Register
(12 days prior)
10/7/13
9/23/13
9/25/13
To apply to become an In-facility test site,
please contact Cheryl at
[email protected]
or 1-888-282-6904 ext 187.
Aging Trends to Consider
• In the next 20 years the number of persons
65 and older will almost double from 1.3
million to 2.3 million
• By 2025, 86 of the NC’s 100 counties are
projected to have more people over age 60
than age 17 and under
• Over the next two decades, the 75-84 age
group will be the fastest growing of those
ages 65 and older
Program Statistics
2010-11
2011-12
2012-13
New CC programs
added
Program renewals
11
14
18
61
75
71
# clinical sites
475
597
608
CC program
300
296
324
Total programs
646
674
693
Number Active
Aides
121,233
123,822
124,323
Preparing for the Challenge
• Revised NA I curriculum
- to meet learning
needs of students and
care needs of citizens
• Identify additional
training opportunities to
educate caregivers
(examples PHCAST,
Med Aide, Oral Care
project, refresher
programs)
• Identify recruitment and
retention activities to
ensure competent and
well-qualified workers
(examples PHCAST
and building linkages)
Active Nurse Aides Employment
Breakdown – 9/17/13
Employment Type
Number of Aides Percentage
reporting
of Total
Nursing Homes
23,263
Home Health/Care/Hospice
28,312
Hospital
17,217
Mental Health
278
Clinic
3243
Adult Care Home
8368
Other
Not employed in healthcare
TOTAL
42,154
399
123,234
19%
23%
14%
--3%
34%
7%
--100%
Changes to the Nurse Aide Refresher
Program Requirements
• All NAI Refresher programs will be approved.
• Proprietary programs may offer, however
they must be approved.
• As community college NAT programs are
reviewed, associated Refresher programs will
also be reviewed.
• Applications for state-approved refresher
programs are available through DHSR.
Refresher Program – application
A 4-page application consists of:
• Basic program information
• Clinical site information (if used – not
mandated)
• Required signatures
• Statement of understanding
• Policy statements such as:
– 40 clock hours
– Must have offered full NAT program during 2-year
cycle
– Other “NAT-type” policies
NAT Refresher Program – student
requirements
This course is designed for individuals:
• whose listing has expired or
• for individuals with a state recognized or
military health care credential who wish to be
listed on the NC Nurse Aide I Registry.
Refresher Program – content topics
At minimum programs MUST teach:
• Basic nursing skills
• Personal care skills
• Recognition of mental health and social
service needs
• Care of cognitively impaired residents
• Basic restorative services
• Resident’s rights
Medication Aides in Adult Care Homes
Session Law 2011, House Bill 474
An Act to Protect Adult Care Home Residents
Among other requirements, this law:
• Increases minimum continuing education, training and
competency evaluation requirements for Adult Care Home
Medication Aides
• Strengthens Adult Care Home Infection Control Requirements
As a result, the following curricula will be posted to the Adult Care
Home web pages:
• Infection Control Course Instructor Manual – 2013
• Medication Aide Training Courses for Adult Care Homes
--5 hour
--10/15 hour
• http://www.ncdhhs.gov/dhsr/acls/
Oral Health Project
• New, improved method of oral hygiene for persons
with cognitive and physical impairment
• New DVD “Mouth Care Without a Battle”, developed
by UNC
• Best practices will be implemented in nurse aide
training
• Funding - approved to purchase one per school via
PHCAST
• For more info:
www.mouthcarewithoutabattle.unc.edu
Contact Information
Kathy Turner
[email protected]
919-855-3972
Fax 919-733-9764