Certification Requirements and Trends for Nursing Assistant/Nurse Aide Exam (page 4)
Although there is no national organization for the certification of nursing assistants, there is a certification exam that is utilized by several states. The National Nurse Aide Assessment Program (NNAAP) is the largest nursing assistant certification examination in the United States. The National Council of State Boards of Nursing (NCSBN) develops the examination program and administers it with a test service.
State Certification and Training
Since OBRA (Omnibus Budget and Reform Act) was passed in 1987, the federal government has been setting regulations and creating standards for the quality of nursing home care. Specific guidelines and standards were prescribed—one major change was the training and testing of nursing assistants/nurse aides. In many states, nurse aides are required to go through a minimum of 75 hours of training approved by the federal government to be certified. Most programs are between 75 and 150 hours and vary by state. Some states have created their own standards for nursing assistants. These standards include the minimum training requirements as well as a written exam of multiple- choice questions and clinical/practical evaluations. Most healthcare facilities now require nurse aides to have a high school diploma or GED and pass a state- approved program. Nurse aides completing these programs must obtain certification within four months of being hired at a healthcare facility. Once you pass the written exam, you will be placed on your state’s registry for nurse aides. Your certification is then valid for 24 months. After being certified, CNAs are usually required to earn 12 continuing- education credits annually, often through inservice training.
Eligibility for Certification
Most states have multiple eligibility options to meet the needs of nursing assistants with various backgrounds. The following list represents most types of eligibility, but you should check with your state’s nurse aide registry for its requirements.
- New Nursing Assistants are persons who have never been certified as a nursing assistant/nurse aide. These candidates must complete a stateapproved nursing assistant education program prior to taking the exam.
- Nursing Students include those who have successfully completed a nursing fundamentals course through a state-approved nursing program within one year of applying to take the examination, and those who have successfully completed the fundamentals course and are currently enrolled in a nursing program.
- Graduate Nurses are nurses who graduated from a state-approved nursing program and who are waiting to take the state nursing licensing examination.
- Foreign Graduate Nurses graduated a nursing program in a foreign country and are currently nurses in that country.
- Nursing Assistants in another state can apply for reciprocity. These are persons currently certified as a nurse aide in another state and listed in that other state’s nurse aide registry (and usually who have not had their certificate revoked in any state or been listed on any state’s nurse aide abuse registry).
- Military Nurse Aides have equivalent nurse aide training and experience in a military service.
- Lapsed or Expired Certification pertains to persons who are applying back to the state in which they were originally certified and whose certification has lapsed or expired (and usually who have not had their certificate revoked in any state or been listed on any state’s nurse aide abuse registry).
Nursing assistant training programs prepare students for employment as nursing assistants in hospitals, long-term care facilities, hospices, home health agencies, and other healthcare agencies. Programs average a total of 120 hours of combined classroom and clinical education, allowing those who complete the program to sit for the certification exam.
Content is similar from one program to the next and typically includes:
- Overview of the Healthcare System
- The Healthcare Team
- The Role of the Nursing Assistant
- Working with Coworkers and Supervisors
- Work Ethic
- Problem Solving and Conflict Management
- Client and Resident Rights
- Violations of Criminal and Civil Law
- Medical Terminology
- Effective Communications
- Human Growth and Development
- The Human Body and Common Disorders:
- The Integumentary System (Skin, Hair and Nails)
- The Respiratory System
- The Cardiovascular System
- The Digestive System
- The Endocrine System
- The Hematologic System
- The Musculoskeletal System
- The Nervous System
- The Sensory System
- The Immunologic System
- Admissions and Discharges
- Infection Control
- Client Safety and Restraint
- Workplace Safety
- Nutrition and Feeding
- Urinary and Bowel Elimination
- Basic First Aid
- Basic Emergency Care
- Death and Dying
- Specific Populations
- Older Adults
- Mothers and Newborns
- Persons with Disabilities
- Persons with Mental Illness
- Surgical Clients
- Home Health Clients
- Hospice Clients
Nursing assistant students also learn and practice jobrelated skills:
- Handwashing and Hand Hygiene
- Vital Signs: Blood Pressure, Temperature, Pulse, and Respiration
- Measuring Height and Weight
- Oral Care
- Denture Care
- Fingernail Care
- Foot Care
- Perineal Care
- Bed Baths
- Applying Knee-High Stockings
- Dressing Clients with One-Sided Weakness
- Feeding Clients
- Measuring Urinary Output
- Urinary Catheter Care
- Ostomy Care
- Administering Enemas
- Administering Hot and Cold Applications
- Assisting with Dressing Changes
- Ambulating Clients Using a Transfer Belt
- Positioning Clients
- Transferring Clients from Bed to Wheelchair (Wheelchair to Bed)
- Passive Range of Motion Exercises
- Using Personal Protective Equipment
- Postmortem Care
A major part of the job of being a CNA involves being able to manipulate patients physically in order to clean them and help them change their clothes, exercise, or use the bathroom. The clinical part of the training programs helps to determine if a student is capable of performing these tasks.
Training programs are given in a number of settings, including both public and private vocational technical schools, community colleges, public-health agencies, and for-profit and not-for-profit healthcare agencies, such as visiting nurse associations. Since hands-on clinical experience is usually required, schools that do not have their own healthcare services often affiliate with a healthcare facility. Then the course work is given in the school and the clinical work is performed in the healthcare facility or in a home setting served by a healthcare agency.
In the states that require certification, there are usually a large number of locations that offer training programs. In Illinois, for example, there are some 300 approved CNA training programs. Agencies that offer training programs often hire the people they have trained, so they are good places to sign up for a training program that may lead to a job offer when you complete the course.
Each program has its own admission requirements. But, like program content, requirements tend to be similar among programs:
- Minimum age of 16 or 18 years, depending on program
- Completion of COMPASS, ACT, or ASSET test before entering program (these test your verbal, reading and numerical skills). Minimum scores are set by the training program.
- Ability to pass a national criminal background check and a caregiver background check. (Certain convictions may limit a student’s ability to participate in clinical experiences or be employed in healthcare facilities. Examples include convictions related to drugs, theft, violence, disorderly conduct, domestic abuse, theft, and fraud.)
- Physical exam (certain vaccinations may be required)
Other possible requirements:
- High school diploma or GED
- Health insurance
- Ability to lift heavy weight and stand for long periods
Training programs usually conclude with a written (or oral) examination that determines whether the student is qualified to receive certification. Some institutions that offer training make up their own examinations, while others may use an exam prepared by a company that specializes in developing tests. Tests typically range from 50 to 150 questions and are in sections that relate directly to the subject areas covered in the training, such as patient-care procedures, emergency procedures, or observation and charting. Usually a candidate must achieve a passing grade in each of the sections, and not just overall, in order to qualify for certification.
The main reason behind the trend to CNA certification is the growth of home healthcare. Home-based healthcare has been on the increase because of costsaving measures in the health industry: Patients are being encouraged to leave relatively expensive hospital- based care to complete their recuperations in lower-cost alternative settings, including short-term and long-term care facilities, as well as the home. Nursing assistants work in a wide variety of healthcare settings, including skilled-nursing facilities, doctors’ offices, hospices, board-and-care retirement facilities, acute-care hospitals, clinics, rehabilitation hospitals, psychiatric hospitals, facilities for the developmentally disabled, and daycare facilities. But the delivery of services in patient homes is what has increased awareness on the part of state and national authorities, leading to the increase of requirements for certification.
Certification offers assurance that nursing assistants, who have such immediate, important, and intimate contact with elderly or disabled persons, have been properly trained to deal with the many and varied tasks they will have to perform. It is also important to healthcare agencies that, in addition to providing care for the patient, CNAs be able to acknowledge the psychosocial needs of the patient’s family. The federal government, which is often the funding source for home healthcare under the Medicare program, also wants to know that its funds are being spent for high-quality services.
Emphasis on Interpersonal Skills
While it has always been important for healthcare professionals of all kinds to be able to make patients feel safe and comfortable, these skills become even more crucial when care is being delivered in the patient’s own home or in long-term care. Thus, many training programs are now emphasizing interpersonal skills more than ever before. Interpersonal skills, such as Effective Communication and Client and Resident Rights, are emphasized.
Combining CNA and Home Health Aide Certification
The trend to certification is also spurred by the fact that the training programs for nursing assistants typically include the training requirements for the job of home health aide (HHA), as well. HHA training follows a federally mandated 75-hour curriculum. The federal mandate is there because home-healthcare agencies are eligible for Medicare funds for the services they provide to the elderly.
Since CNAs can perform medical tasks beyond what HHAs are trained to do, someone who has training and certification in both job categories is obviously of greater value to the agency doing the hiring. The employer is better off hiring one person who can perform two different jobs, even if that one person’s salary is a little higher than that of a person with one certification.
A representative of one major home-healthcare agency in Austin, Texas, reported that the Sunday newspaper usually contains almost a full page of ads from home-healthcare agencies calling for people to work as home health aides. However, she noted that most of these ads want CNAs to fill these positions because they have skills that go beyond those required of a home health aide.
The home health aide profession is growing faster than average and should continue growing. The reason for this is the increased need for home care of the elderly—patients are being moved out of hospitals and nursing homes to lower healthcare costs. In 2006, more than 787,000 people were employed as home health aides and most were employed in home-health agencies, nursing facilities, hospitals, visiting-nurse associations, residential- care facilities, and temporary-help firms. Full-time aides work about 40 hours per week, while many aides work part time. The actual job can be difficult both physically and emotionally; it includes a good portion of standing, lifting, changing bed linens, and dealing with uncooperative clients. Generally, a home health aide works independently and with a variety of patients. Supervisors visit sporadically, and the aide is always given explicit instructions pertaining to schedule and patient care.
In Massachusetts, persons entering home health aide programs are often encouraged to undergo dual training and become CNAs in order to improve their employment opportunities.
In some states, such as Illinois, people who want to become home health aides are required to take the same training program as CNAs. The HHA training is included within the program as part of the CNA training. As a result, the certification that follows the successful completion of the CNA training and the passage of the written competency examination serves as a dual certification for home health aides as well.
The good news for people who want to become nursing assistants is that the growth of healthcare in alternative settings ensures that workers will be needed. CNAs can look forward to good job prospects for the foreseeable future.
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