Iowa Admin. Code r. 441-81.16 - Nurse aide requirements and training and testing programs
(1)
Deemed meeting of
requirements. A nurse aide is deemed to satisfy the requirement of
completing a nurse aide training and competency evaluation approved by the
department of inspections and appeals if:
a.
The nurse aide successfully completed a nurse aide training and competency
evaluation program before July 1, 1989, and
(1) At least 60 clock hours were substituted
for 75 clock hours, and the person has made up at least the difference in the
number of clock hours in the program the person completed and 75 clock hours in
supervised practical nurse aide training or in regular in-service nurse aide
education, or
(2) The person was
found to be competent (whether or not by the state) after completion of a nurse
aide training of at least 100 clock hours' duration, or
(3) The person can demonstrate that the
person served as a nurse aide at one or more facilities of the same employer in
Iowa for at least 24 consecutive months before December 19, 1989, or
(4) The person completed, before July 1,
1989, a nurse aide training and competency evaluation program that the
department of inspections and appeals determines would have met the
requirements for approval at the time it was offered; or
b. The person is a veteran, an active duty
service member, or a member of the reserve forces, who has:
(1) Successfully completed a U.S. military
training program that includes a curriculum comparable to the nurse aide
training program required by this rule and has documented successful completion
of that program with either a diploma, certifications, or Form DD 214 showing
completion of hospital corpsman or medical service specialist or equivalent
training, and
(2) Provided
documentation showing that the person has 75 clock hours of practical
experience in a nurse aide role, which may include classroom instruction, prior
equivalent experience, or a combination of the two, and
(3) Successfully completed the nurse aide
training and competency examination.
(2)
State review and approval of
nurse aide training and competency evaluation programs or competency evaluation
programs.
a. The department of
inspections and appeals shall, in the course of all surveys, determine whether
the nurse aide training and evaluation requirements of
81.13(19)"e" and 81.16(1) are met.
b. Requirements for approval of programs.
(1) Before the department of inspections and
appeals approves a nurse aide training and competency evaluation program or
competency evaluation program, the department of inspections and appeals shall
determine whether:
1. A nurse aide training
and competency evaluation program meets the course requirements of
81.16(3).
2. A nurse aide
competency evaluation program meets the requirements of 81.16(4).
(2) Except as provided by
paragraph 81.16(2)"f," the department of inspections and
appeals shall not approve a nurse aide training and competency evaluation
program or competency evaluation program offered by or in a facility which, in
the previous two years:
1. Has operated under
a nurse staffing waiver for a period in excess of 48 hours per week;
or
2. Has been subject to an
extended or partial extended survey; or
3. Has been assessed a civil money penalty of
not less than $5,000; or
4. Has
operated under temporary management appointed to oversee the operation of the
facility and to ensure the health and safety of the facility's residents;
or
5. Pursuant to state action, was
closed or had its residents transferred; or
6. Has been terminated from participation in
the Medicaid or Medicare program; or
7. Has been denied payment under subrule
81.40(1) or 81.40(2).
c. Application process. Applications shall be
submitted to the department of inspections and appeals before a new program
begins and every two years thereafter on Form 427-0517, Application for Nurse
Aide Training. The department of inspections and appeals shall, within 90 days
of the date of a request or receipt of additional information from the
requester:
(1) Advise the requester whether or
not the program has been approved; or
(2) Request additional information from the
requesting entity.
d.
Duration of approval. The department of inspections and appeals shall not grant
approval of a nurse aide training and competency evaluation program for a
period longer than two years. A program shall notify the department of
inspections and appeals and the department of inspections and appeals shall
review that program when there are substantive changes made to that program
within the two-year period.
e.
Withdrawal of approval.
(1) The department of
inspections and appeals shall withdraw approval of a nurse aide training and
competency evaluation program or nurse aide competency evaluation program
offered by or in a facility described in 81.16(2)"b"
(2).
(2) The department of
inspections and appeals may withdraw approval of a nurse aide training and
competency evaluation program or nurse aide competency evaluation program if
the department of inspections and appeals determines that any of the applicable
requirements for approval or registry, as set out in subrule 81.16(3) or
81.16(4), are not met.
(3) The
department of inspections and appeals shall withdraw approval of a nurse aide
training and competency evaluation program or a nurse aide competency
evaluation program if the entity providing the program refuses to permit
unannounced visits by the department of inspections and appeals.
(4) If the department of inspections and
appeals withdraws approval of a nurse aide training and competency evaluation
program or competency evaluation program, the department of inspections and
appeals shall notify the program in writing, indicating the reasons for
withdrawal of approval of the program. Students who have started a training and
competency evaluation program from which approval has been withdrawn shall be
allowed to complete the course.
f. An exception to subparagraph
81.16(2)"b" (2) may be granted by the department of
inspections and appeals (DIA) for 75-hour nurse aide training courses offered
in (but not by) a facility under the following conditions:
(1) The facility has submitted Form 470-3494,
Nurse Aide Education Program Waiver Request, to the DIA to request a waiver for
each 75-hour nurse aide training course to be offered in (but not by) the
facility.
(2) The 75-hour nurse
aide training is offered in a facility by an approved nurse aide training and
competency evaluation program (NATCEP).
(3) No other NATCEP program is offered within
30 minutes' travel from the facility, unless the facility can demonstrate the
distance or program would create a hardship for program participants.
(4) The facility is in substantial compliance
with the federal requirements related to nursing care and services.
(5) The facility is not a poor performing
facility.
(6) Employees of the
facility do not function as instructors for the program unless specifically
approved by DIA.
(7) The NATCEP
sponsoring the 75-hour nursing aide training course is responsible for program
administration and for ensuring that program requirements are met.
(8) The NATCEP has submitted an evaluation to
the DIA indicating that an adequate teaching and learning environment exists
for conducting the course.
(9) The
NATCEP has developed policies for communicating and resolving problems
encountered during the course, including notice by the facility to the program
instructor and students on how to contact the DIA to register any concerns
encountered during the course.
(10)
The NATCEP shall require the program instructor and students to complete an
evaluation of the course. The instructor shall return the completed evaluations
to the NATCEP which shall return the evaluations to DIA.
(3)
Requirements for
approval of a nurse aide training and competency evaluation program.
The department has designated the department of inspections and appeals to
approve required nurse aide training and competency evaluation programs.
Policies and procedures governing approval of the programs are set forth in
these rules.
a. For a nurse aide training and
competency evaluation program to be approved, such program shall, at a minimum:
(1) Consist of no less than 75 clock hours of
training, and
(2) Include at least
the subjects specified in 81.16(3)"b," and
(3) Include at least 30 hours of didactic
theory instruction, which may be provided in a classroom setting or through
online course curricula, and
(4)
Include at least 16 hours of laboratory experience provided in a face-to-face
environment that complements the didactic theory curricula, and
(5) Include 30 hours of supervised clinical
training in a face-to-face environment and supervised by a department of
inspections and appeals-approved instructor in a manner not inconsistent with
the licensing requirements of the Iowa board of nursing. In extenuating
circumstances, a laboratory setting may be utilized in place of face-to-face
clinical training subject to the department's approval, and
(6) Ensure that students do not independently
perform any services for which they have not been trained and found proficient
by the department of inspections and appeals-approved instructor, and
(7) Meet the following requirements for
department of inspections and appeals-approved instructors who train nurse
aides:
1. The training of nurse aides shall be
performed by or under the general supervision of a registered nurse who
possesses a minimum of two years of nursing experience, at least one year of
which shall be in the provision of long-term care facility services.
2. Instructors shall be registered nurses and
shall have completed a course in teaching adults or have experience teaching
adults or supervising nurse aides.
3. In a facility-based program, when the
director of nursing is a registered nurse, the training of nurse aides may be
performed by registered nurses under the general supervision of the director of
nursing for the facility. The director of nursing is prohibited from performing
the actual training.
4. Other
personnel from the health professions as set forth in
42
CFR 483.152(5) may
supplement the instructor. Supplemental personnel shall have at least one year
of experience in their fields.
5.
The ratio of department of inspections and appeals-approved instructors to
students shall not exceed one registered nurse, or licensed practical nurse
functioning as an assistant to a registered nurse, who is in the proximate area
in the clinical setting, for every 15 students in the clinical setting,
and
(8) Contain
information regarding competency evaluation through written or oral examination
and skills demonstration.
b. The curriculum of the nurse aide training
program shall include:
(1) At least a total of
16 hours of training in the following areas prior to any direct contact with a
resident:
1. Communication and interpersonal
skills.
2. Infection
control.
3. Safety and emergency
procedures including the Heimlich maneuver.
4. Promoting residents'
independence.
5. Respecting
residents' rights.
(2)
Basic nursing skills:
1. Taking and recording
vital signs.
2. Measuring and
recording height and weight.
3.
Caring for the residents' environment.
4. Recognizing abnormal changes in body
functioning and the importance of reporting these changes to a
supervisor.
5. Caring for residents
when death is imminent.
(3) Personal care skills, including, but not
limited to:
1. Bathing.
2. Grooming, including mouth care.
3. Dressing.
4. Toileting.
5. Assisting with eating and
hydration.
6. Proper feeding
techniques.
7. Skin care.
8. Transfers, positioning, and
turning.
(4) Mental
health and social service needs:
1. Modifying
aide's behavior in response to residents' behavior.
2. Awareness of developmental tasks
associated with the aging process.
3. How to respond to resident
behavior.
4. Allowing the resident
to make personal choices, providing and reinforcing other behavior consistent
with the resident's dignity.
5.
Using the resident's family as a source of emotional support.
(5) Care of cognitively impaired
residents:
1. Techniques for addressing the
unique needs and behaviors of persons with dementia (Alzheimer's and
others).
2. Communicating with
cognitively impaired residents.
3.
Understanding the behavior of cognitively impaired residents.
4. Appropriate responses to the behavior of
cognitively impaired residents.
5.
Methods of reducing the effects of cognitive impairments.
(6) Basic restorative services:
1. Training the resident in self-care
according to the resident's ability.
2. Use of assistive devices in transferring,
ambulation, eating and dressing.
3.
Maintenance of range of motion.
4.
Proper turning and positioning in bed and chair.
5. Bowel and bladder training.
6. Care and use of prosthetic and orthotic
devices.
(7) Residents'
rights:
1. Providing privacy and maintenance
of confidentiality.
2. Promoting
the residents' rights to make personal choices to accommodate their
needs.
3. Giving assistance in
resolving grievances and disputes.
4. Providing needed assistance in getting to
and participating in resident and family groups and other activities.
5. Maintaining care and security of
residents' personal possessions.
6.
Promoting the residents' rights to be free from abuse, mistreatment, and
neglect and the need to report any instances of this type of treatment to
appropriate facility staff.
7.
Avoiding the need for restraints in accordance with current professional
standards.
c.
Prohibition of charges.
(1) A nurse aide who
is employed by, or who has received an offer of employment from, a facility on
the date on which the aide begins a nurse aide training and competency
evaluation program or competency evaluation program may not be charged for any
portion of the program including any fees for textbooks, course materials, or
nurse aide competency evaluations.
(2) If a person who is not employed, or does
not have an offer to be employed, as a nurse aide becomes employed by, or
receives an offer of employment from, a facility no later than 12 months after
completing a nurse aide training and competency evaluation program or
competency evaluation program, the facility shall reimburse the nurse aide for
costs incurred in completing the program or competency evaluation on a pro rata
basis during the period in which the person is employed as a nurse aide. The
formula for paying the nurse aides on a pro rata basis shall be as follows:
1. Add all costs incurred by the nurse aide
for the course, books, and competency evaluations.
2. Divide the total arrived at in paragraph
"1" above by 12 to prorate the costs over a one-year period and establish a
monthly rate.
3. The nurse aide
shall be reimbursed the monthly rate each month the nurse aide works at the
facility until one year from the time the nurse aide completed the
course.
d.
Setting and equipment. The classroom shall have appropriate equipment, be of
adequate size, and not interfere with resident activities.
e. Records and reports. Nurse aide education
programs approved by the department of inspections and appeals shall:
(1) Notify the department of inspections and
appeals:
1. Of dates of classroom and clinical
sessions as well as location of classrooms and clinical practice sites before
each course begins and if the course is canceled.
2. When a facility or other training entity
will no longer be offering nurse aide training courses.
3. Whenever the person coordinating the
training program is hired or terminates employment.
(2) Keep a list of faculty members and their
qualifications available for department review.
(3) Provide each nurse aide a record of
skills for which the nurse aide has been found competent during the course and
which may be performed before completion of the competency
evaluation.
(4) Complete a lesson
plan for each unit which includes behavioral objectives, a topic outline and
student activities and experiences.
(5) Provide the student, within 30 days of
the last class period, evidence of having successfully completed the course.
(4)
Nurse aide competency evaluation. A competency evaluation
program shall contain a written or oral portion and a skills demonstration
portion.
a. Notification to person. The
department of inspections and appeals shall advise in advance any person who
takes the competency evaluation that a record of the successful completion of
the evaluation will be included in the state's nurse aide registry.
b. Content of the competency evaluation
program.
(1) Written or oral examinations. The
competency evaluation shall:
1. Allow an aide
to choose between a written and oral examination.
2. Address each of the course requirements
listed in 81.16(3)"b."
3. Be developed from a pool of test
questions, only a portion of which is used in any one examination.
4. Use a system that prevents disclosure of
both the pool of questions and the individual competency evaluations.
5. If oral, be read from a prepared text in a
neutral manner.
6. Be tested for
reliability and validity using a nationally recognized standard as determined
by the department of education.
7.
Be in English, unless the prevailing language used in the facility where a
nurse aide will be working is other than English.
(2) Demonstration of skills. The skills
demonstration evaluation shall consist of a demonstration of randomly selected
items drawn from a pool consisting of tasks generally performed by nurse aides.
This pool of skills shall include all of the personal care skills listed in
81.16(3)"b"(3).
c. Administration of the competency
evaluation.
(1) The competency examination
shall be administered and evaluated only by an entity approved by the
department of inspections and appeals, which is neither a skilled nursing
facility that participates in Medicare nor a nursing facility that participates
in Medicaid.
(2) Charging nurse
aides for competency testing is prohibited in accordance with
81.16(3)"c."
(3)
The skills demonstration part of the evaluation shall be performed in a
facility or laboratory setting comparable to the setting in which the person
will function as a nurse aide and shall be administered and evaluated by a
registered nurse with at least one year's experience in providing care for the
elderly or the chronically ill of any age.
d. Facility proctoring of the competency
evaluation.
(1) The competency evaluation may,
at the nurse aide's option, be conducted at the facility in which the nurse
aide is or will be employed unless the facility is prohibited from being a
competency evaluation site.
(2) The
department of inspections and appeals may permit the competency evaluation to
be proctored by facility personnel if the department of inspections and appeals
finds that the procedure adopted by the facility ensures that the competency
evaluation program:
1. Is secure from
tampering.
2. Is standardized and
scored by a testing, educational, or other organization approved by the
department of inspections and appeals.
3. Requires no scoring by facility
personnel.
(3) The
department of inspections and appeals shall retract the right to proctor nurse
aide competency evaluations from facilities in which the department of
inspections and appeals finds any evidence of impropriety, including evidence
of tampering by facility staff.
e. Successful completion of the competency
evaluation program.
(1) A score of 70 percent
or above is passing for both the written or oral and skills demonstration parts
of the test.
(2) A record of
successful completion of the competency evaluation shall be included in the
nurse aide registry within 30 days of the date the person is found to be
competent.
(3) The competency
testing entity shall inform the nurse aide of the test score within 30 calendar
days of the completion of the test and shall inform the nurse aide registry of
the nurse aide's scores within 20 calendar days after the test is
administered.
f.
Unsuccessful completion of the competency evaluation program.
(1) If the person does not complete the
evaluation satisfactorily, the person shall be advised in writing within ten
working days after the test is scored:
1. Of
the areas which the person did not pass.
2. That the person has three opportunities to
take the evaluation.
(2)
Each person shall have three opportunities to pass each part of the test. If
one part of the test is failed, only that part need be taken a second or third
time. If either part of the test is failed three times, the 75-hour course
shall be taken or retaken before the test can be taken again.
g. Storage of evaluation
instrument. The person responsible for administering a competency evaluation
shall provide secure storage of the evaluation instruments when they are not
being administered or processed.
h.
Application process. Entities wishing to secure approval for a competency
evaluation program shall submit a copy of the evaluation plan and procedures to
the department of inspections and appeals. The department of inspections and
appeals shall notify the applicant of its decision within 90 days of receipt of
the application. The notification shall include the reason for not giving
approval if approval is denied and the applicable rule citation.
(5)
Registry of nurse
aides.
a. Establishment of registry.
The department of inspections and appeals shall establish and maintain a
registry of nurse aides that meets the following requirements. The registry:
(1) Shall include, at a minimum, the
information required in 81.16(5)"c."
(2) Shall be sufficiently accessible to meet
the needs of the public and health care providers promptly.
(3) Shall provide that any response to an
inquiry that includes a finding of abuse, neglect, mistreatment of a resident
or misappropriation of property also include any statement made by the nurse
aide which disputes the finding.
b. Registry operation.
(1) Only the department of inspections and
appeals may place on the registry findings of abuse, neglect, mistreatment of a
resident or misappropriation of property.
(2) The department of inspections and appeals
shall determine which persons:
1. Have
successfully completed a nurse aide training and competency evaluation program
or nurse aide competency evaluation program.
2. Have been deemed as meeting these
requirements.
3. Do not qualify to
remain on the registry because they have performed no nursing or
nursing-related services for monetary compensation during a period of 24
consecutive months.
(3)
The department of inspections and appeals shall not impose any charges related
to registration on persons listed in the registry.
(4) The department of inspections and appeals
shall provide information on the registry promptly.
c. Registry content.
(1) The registry shall contain at least the
following information on each person who has successfully completed a nurse
aide training and competency evaluation program or competency evaluation
program which was approved by the department of inspections and appeals or who
may function as a nurse aide because of having been deemed competent:
1. The person's full name.
2. Information necessary to identify each
person.
3. The date the person
became eligible for placement in the registry through successfully completing a
nurse aide training and competency evaluation program or competency evaluation
or by being deemed competent.
4.
The following information on any finding by the department of inspections and
appeals of abuse, neglect, mistreatment of residents or misappropriation of
property by the person: documentation of the department of inspections and
appeals' investigation, including the nature of the allegation and the evidence
that led the department of inspections and appeals to conclude that the
allegation was valid; the date of the hearing, if the person chose to have one,
and its outcome; and a statement by the person disputing the allegation, if the
person chooses to make one. This information must be included in the registry
within ten working days of the finding and shall remain in the registry
permanently, unless the finding was made in error, the person was found not
guilty in a court of law, or the department of inspections and appeals is
notified of the person's death.
5.
A record of known convictions by a court of law of a person convicted of abuse,
neglect, mistreatment or misappropriation of resident property.
(2) The registry shall remove
entries for persons who have performed no nursing or nursing-related services
for monetary compensation for a period of 24 consecutive months unless the
person's registry entry includes documented findings or convictions by a court
of law of abuse, neglect, mistreatment or misappropriation of
property.
d. Disclosure
of information. The department of inspections and appeals shall:
(1) Disclose all of the information listed in
81.16(5)"c"(1), (3), and (4) to all requesters and may
disclose additional information it deems necessary.
(2) Promptly provide persons with all
information contained in the registry about them when adverse findings are
placed on the registry and upon request. Persons on the registry shall have
sufficient opportunity to correct any misstatements or inaccuracies contained
in the registry.
e.
Placement of names on nurse aide registry. The facility shall ensure that the
name of each person employed as a nurse aide in a Medicare- or
Medicaid-certified nursing facility in Iowa is submitted to the registry. The
telephone number of the registry is (515)281-4963. The address is Nurse Aide
Registry, Lucas State Office Building, Des Moines, Iowa 50319-0083.
(1) Persons employed as nurse aides shall
complete Form 427-0496, Nurse Aide Registry Application, within the first 30
days of employment. This form shall be submitted to the department of
inspections and appeals. Form 427-0496 may be obtained by calling or writing
the nurse aide registry.
(2) A
nurse aide who is not employed may apply for inclusion on the registry by
submitting a copy of completed Form 427-0496 to the nurse aide
registry.
(3) When the registry has
received a signed application and entered the required training and testing
information on the registry, a letter will be sent to the nurse aide that
includes all the information the registry has on the nurse aide. A nurse aide
may obtain a copy of the information on the registry by writing the nurse aide
registry and requesting the information. The letter requesting the information
must include the nurse aide's social security number, current or last facility
of employment, date of birth and current mailing address and must be signed by
the nurse aide.
(6)
Hearing. When there is
an allegation of abuse against a nurse aide, the department of inspections and
appeals shall investigate that allegation. When the investigation by the
department of inspections and appeals makes a finding of an act of abuse, the
nurse aide named will be notified of this finding and the right to a hearing.
The nurse aide shall have 30 days to request a hearing. The request shall be in
writing and shall be sent to the department of inspections and appeals. The
hearing shall be held pursuant to department of inspections and appeals rules
481-Chapter 10. After 30 days, if the nurse aide fails to appeal, or when all
appeals are exhausted, the nurse aide registry will include a notation that the
nurse aide has a founded abuse report on record if the final decision indicates
the nurse aide performed an abusive act.
(7)
Appeals. Adverse
decisions made by the department of inspections and appeals in administering
these rules may be appealed pursuant to department of inspections and appeals
rules 481-Chapter 10.
This rule is intended to implement Iowa Code section 249A.4.
Notes
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