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Training and Certification of Nursing Assistants

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It is important to gather all available information before making a decision about a training program for Nursing Assistants.

The term training relates to the teaching/learning process. Nursing assistant instructors facilitate and guide learning experiences through lectures, audiovisual tools (videos, films, and filmstrips), and self-discovery learning experiences that include group discussions. Nursing care theories answer questions about why tasks are done in certain ways.

Nursing care skills answer questions about how tasks are done. The task of hand-washing combines theories about infection control and skill to maintain cleanliness using a step-by-step procedure to wash your hands. Instructors discuss and demonstrate one nursing skill at a time, and students are expected to complete a return demonstration for each skill. This evaluative process shows instructors that students have gained initial skill mastery. The next teaching/learning step concerns supervised clinical practice. Clinical learning experiences combine learned abilities to use theories and skills and apply them to perform nursing care tasks. Nursing assistants who are in training for working at patient care units and are directed and observed by nursing assistant instructors. It is important that aide trainees do not complete patient care tasks until they have been given information about patients and have received instructions about how to complete nursing care tasks. A safe rule to follow is, when in doubt always seek answers from resource persons. Resource persons include nursing assistant instructors and nursing unit staff members. Nursing instructors who teach C.N.A. courses are often multi-skilled R.N.s who have completed teacher certification courses.

OBRA Training Guidelines for C.N.A.S

The health care financing administration for the U.S. Department of Human Services developed the Omnibus Budget Reconciliation Act of 1987 (OBRA). OBRA defined federal guidelines for a seventy-five-hour training course for nursing assistants who worked with the elderly in long-term care facilities, particularly nursing homes. Implementation of OBRA guidelines was delegated by the federal government to state credentialing agencies.

C.N.A. training content must include the following subjects: communication and interpersonal skills, infection control theories and skills, safety and emergency procedures, residents rights and patient abuse is-sues, legal responsibilities, basic nursing skills (e.g. bed making), personal care skills (activities of daily living), restorative nursing (e.g. care of the skin) and rehabilitative nursing (like encouraging body movement through exercise), mental health guidelines (learned skills to communicate with people who have cognitive problems or mental disabilities), and social service interactions (learned skills to communicate with families and encourage residents to make independent choices).

Types of Training Programs

There are two types of training programs: on-the-job programs are conducted at work, school programs are conducted at accredited training schools.

Both on-the-job and school-based training programs include class-room learning and supervised hands-on experiences on patient care units. Both kinds of programs are completed through a certification process. The certification process happens after training is completed. To become certified, C.N.A. candidates currently are required to success-fully demonstrate the completion of five nursing care skills and pass a written examination.

Nursing homes follow federal training guidelines that include seventy-five hours of classroom experience and sixty hours of supervised hands-on clinical learning experiences. These training courses must be completed within four months of hire. Hospitals that offer geriatric care services also must follow the federal guideline C.N.A. training course.

Home health agencies follow the National Council of Home Caring Agency's seventy-five-hour training course that includes sixty hours of classroom instruction and fifteen hours of supervised hands-on experience caring for clients of all age groups in their homes.

On-the-job Training Programs

On-the-job training programs are conducted in hospitals, nursing homes, and home health agencies and are free-of-charge for nursing assistant candidates who are also paid for training time.

Curriculum content includes general information about the care of the elderly with particular emphasis on types of patients/residents/clients cared for by individual facilities and home care agencies. Recent nursing home training statistics show that more than 75 percent of nursing homes provide C.N.A. training courses. Smaller homes do not have the financial resources to provide training courses and often hire C.N.A.s trained in vocational school.

Health care institutions that do not care for the elderly might not have C.N.A. training systems in place. Nursing assistants who work for these institutions can grow and develop professionally within their workplaces. However, opportunities for job growth and job mobility are limited to those institutions only.

School-Based Training Programs

School-based training programs are conducted at schools and require tuition. Information about tuition assistance programs often is available in adult education departments. Curriculum content includes federal guidelines for C.N.A. training. Theories and skills that are pertinent to hospital care include hospital terminology, postoperative nursing care, admission, transfer and discharge procedures, and job getting/ keeping skills. Home health nursing theories, procedures, and skills also are addressed in many school-based training programs. In addition, school instructors tend to have more opportunities to select more varied types of patients for their students to care for.

School-based programs differ among states because of state-to-state educational guidelines. Some schools provide adult education C.N.A. training courses that must be completed without options. Other schools provide exit options. For instance, vocational/technical schools in the state of Mississippi tend to allow students to exit the nursing assistant program after completing a short course on home health nursing (Mississippi Department of Education, Office of Vocational-Technical Education). Students who choose to take the longer course for C.N.A. certification can work in hospitals, nursing homes, or home health agencies. In addition, credits are awarded to C.N.A.s who choose to enter a licensed practical nursing course within the state of Mississippi.

Vocational/technical high schools in California tend to offer C.N.A. training courses for high school students and adults that include both acute care and chronic care practices. As a result, C.N.A.s can gain employment in nursing homes, home health agencies, and within specialty nursing units in hospitals such as cardiac care (CCU) and intensive care (ICU) units.

Some local and regional community colleges offer C.N.A. training courses within their nursing departments. Schools tend to provide more information about theories and skills and less information about practical applications. They often provide job placement services at the completion of C.N.A. training courses. Area health care employers send representatives to discuss job opportunities for newly trained nursing assistants.

Bilingual C.N.A. Training Courses

A seventy-five-hour training course sponsored by the American Red Cross began in Cleveland, Ohio, during the mid-1990s. The first class included five bilingual nursing assistants. More bilingual training courses are expected to develop to serve the needs of the Hispanic elderly, the fastest growing group for people aged sixty-five and over. This training program provides tuition scholarships for qualified applicants who have gained language competency in English and Spanish. Information can be obtained by calling the national headquarters of the American Red Cross located in Washington, DC.

Certification Procedures

Different certification requirements exist among the fifty states. The state of Florida has different C.N.A. certification requirements for hospitals, nursing homes, and home health agencies. The state of Ohio pro-vides state training and state certification. New York, Pennsylvania, Texas, and California are some states that provide nationwide, state-to-state certification processes. Nationwide certification will become a reality and provide opportunities for C.N.A. job mobility. Uniform certification procedures among states, based on federal government guidelines, will soon permit C.N.A.s to work in all fifty states. Certification does not mean C.N.A.s have been awarded professional licenses. However, C.N.A.s are assigned numbers that are similar to those that are assigned to professional nurses (R.N.s) and licensed nurses (L.P.N.s) through their state licensing agencies. C.N.A. certification identifies individuals who are qualified to practice as geriatric nursing assistants and also can be used by C.N.A.s for reciprocity purposes. Reciprocity refers to a state-to-state process that allows C.N.A.s to relocate and work in other states.

Multiservice Training Support/Financial Assistance Programs

Many government and private agencies provide informational ser-vices and financial assistance for young people beginning new careers, displaced homemakers, mid-life people who have been downsized and are unemployed, people who are classified as disadvantaged because of financial circumstances, unemployed older workers, the disabled, and people who are members of minority groups having difficulties getting and/or keeping jobs.

The Employment and Training Administration provides national job training information about nursing assistant careers. The Congressional Quarterly Washington Information Directory gives locations of U.S. Labor Department job/training resources.
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