The competency evaluation has a written test and a skills test (Appendix B). The written test has multiple-choice questions. The skills test involves performing certain skills learned in your training program.

You take the competency evaluation after your training program. Your instructor tells you the testing service used in your state and when and where the tests are given. He or she helps you complete the application. Or you can go to the testing service website to complete the application on-line. The evaluation has a fee. If working in a nursing center, the employer pays the fee. Otherwise you pay the fee.

If you listen, study hard, and practice safe care, you should do well. If the first attempt was not successful, you can retest. OBRA allows 3 attempts to successfully complete the evaluation.

Nursing Assistant Registry

OBRA requires a nursing assistant registry in each state. It is an official record or listing of persons who have successfully completed a NATCEP. The registry has information about each nursing assistant.

• Full name, including maiden name and any married names.

• Last known home address.

• Registry number and the date it expires.

• Date of birth.

• Last known employer, date hired, and date employment ended.

• Date the competency evaluation was passed.

• Information about findings of abuse, neglect, or dishonest use of property. It includes the nature of the offense and supporting evidence. If a hearing was held, the date and its outcome are included. The person has the right to include a statement disputing the finding. All information stays in the registry for at least 5 years.

Any health care agency can access registry information. You also receive a copy of your registry information. The copy is sent when the first entry is made and when information is changed or added. You can correct wrong information.

Certification.

After successfully completing your state’s NATCEP, you have the title used in your state.

• Certified nursing assistant (CNA) or certified nurse aide (CNA). CNA is used in most states.

• Licensed nursing assistant (LNA).

• Registered nurse aide (RNA).

• State tested nurse aide (STNA).

Nursing assistants can have their certifications (licenses, registrations) denied, revoked, or suspended. See Box 3-1 for the reasons listed by the National Council of State Boards of Nursing (NCSBN).

Box 3-1 Losing Certification, a License, or Registration

The National Council of State Boards of Nursing (NCSBN) lists these reasons for doing so.

• Substance abuse or dependency.

• Abandoning, abusing, or neglecting a person.

• Fraud or deceit. Examples are:

• Filing false personal information

• Providing false information when applying for initial certification, re-instatement, or renewal

• Violating professional boundaries (p. 25).

• Giving unsafe care.

• Performing acts beyond the nursing assistant role.

• Misappropriation (stealing, theft) or mis-using property.

• Obtaining money or property from a patient or resident. This can be done through fraud, falsely representing oneself, or by force.

• Being convicted of a crime. Examples include murder, assault, kidnapping, rape or sexual assault, robbery, sexual crimes involving children, criminal mistreatment of children or a vulnerable adult (p. 28), drug trafficking, embezzlement (to take a person’s property for one’s own use), theft, and arson (starting fires).

• Failing to conform to the standards of nursing assistants (p. 18).

• Putting patients and residents at risk for harm.

• Violating a person’s privacy.

• Failing to maintain the confidentiality of patient or resident information.

To work in another state, you must meet that state’s NATCEP requirements.

Maintaining Competence

Re-training and a new competency evaluation program are required for nursing assistants who have not worked for 24 months. It does not matter how long you worked as a nursing assistant before. What matters is how long you did not work. States can require:

• A new competency evaluation

• Both re-training and a new competency evaluation

Agencies must provide 12 hours of educational programs to nursing assistants every year. Performance reviews also are required. That is, your work is evaluated. These requirements help ensure that you have the current knowledge and skills to give safe, effective care.

See Focus on Surveys: Maintaining Competence.

Focus on Surveys

Maintaining Competence

Surveyors must make sure that nursing assistants are competent to safely care for residents. They will:

• Check if all nursing assistants have completed a NATCEP.

• Ask nursing assistants:

• Where they received their training

• The length of their training

• How long they have worked in the agency

• Observe if nursing assistants are able to:

• Maintain or improve the person’s independent functioning.

• Perform range-of-motion exercises (Chapter 23).

• Transfer the person from bed to a wheelchair (Chapter 14).

• Observe, describe, and report the person’s behavior and condition to the nurse (Chapter 5).

• Follow instructions.

• Practice infection control (Chapter 12) and safety measures (Chapters 9 and 10).

Roles and Responsibilities

Nurse practice acts, OBRA, state laws, and legal and advisory opinions direct what you can do. To protect persons from harm, you must understand what you can do, what you cannot do, and the legal limits of your role. In some states, this is called scope of practice. The NCSBN calls it range of functions.

Licensed nurses supervise your work. You perform nursing tasks related to the person’s care. A nursing task is the nursing care or a nursing function, procedure, activity, or work that can be delegated to nursing assistants when it does not require an RN’s professional knowledge or judgment. Often you function without a nurse in the room. At other times you help nurses give care. The rules in Box 3-2 will help you understand your role.

Box 3-2 Rules for Nursing Assistants

• You are an assistant to the nurse.

• A nurse assigns and supervises your work.

• You report observations about the person’s physical and mental status to the nurse (Chapter 5). Report changes in the person’s condition or behavior at once.

• The nurse decides what is done for a person. The nurse decides what should not be done for a person. You do not make these decisions.

• Review directions and the care plan with the nurse before going to the person.

• Perform only those nursing tasks that you are trained to do.

• Ask a nurse to supervise you if you are not comfortable performing a nursing task.

• Perform only the nursing tasks that your state and job description allow.

The range of functions for nursing assistants varies among states and agencies. Before you perform a nursing task make sure that:

• Your state allows nursing assistants to do so.

• It is in your job description.

• You have the necessary education and training.

• A nurse is available to answer questions and to supervise you.

You perform nursing tasks to meet the person’s hygiene, safety, comfort, nutrition, exercise, and elimination needs. You also move and transfer persons and make observations. You also measure temperatures, pulses, respirations, and blood pressures. And you help promote the person’s mental comfort.

Box 3-3 describes the limits of your role—the tasks that you should never do. State laws differ. Know what you can do in the state in which you are working.