Section 129.07. Standards for nurse aide training programs.

 

(1)   Curriculum. A training program shall include theory and practice in all of the following care areas:

(a) Interpersonal communication and social interaction. The program shall include the theory of and practice in communicating and interacting on a one-to-one basis with a client; serving as part of a team implementing client care objectives; demonstrating sensitivity to a client's emotional; social and psychological needs through directed interactions; and skills that enable expressions of age-appropriate behavior by allowing a client to make personal choices and by reinforcing behavior that supports a client's sense of dignity. After completion of this portion of the training program, a nurse aide shall do all of the following:

1. Identify the components of a caregiver-client relationship and be able to recognize and demonstrate understanding of all of the following:

a. The uniqueness of each client, in terms of that person's age, disability, family status, financial status, gender, marital status, race, and sexual orientation, and cultural, generational, social, ethnic, religious or other background, values or characteristics.

b. The needs of a client with Alzheimer's disease, dementia, mental illness, mental retardation or other cognitive disabilities or impairments.

c. Ways both nurse aides and clients can cope with stress.

d. What constitutes caregiver misconduct.

e. The messages conveyed by body language, speech and facial expressions.

2. Demonstrate an ability to establish effective relationships with clients and be able to do all of the following:

a. Communicate with clients in a respectful manner that affords clients dignity.

b. Explain procedures and activities to clients before carrying out those procedures or beginning those activities.

c. Demonstrate concern for clients who have long-term or disabling illnesses or who are dying.

d. Identify developmental tasks associated with the aging process.

3. Demonstrate an ability to use appropriate verbal and nonverbal communication skills with clients and be able to do all of the following:

a. Recognize effective listening techniques.

b. Distinguish assertive from aggressive responses.

c. Identify the difference between non-acceptable and acceptable touching during job performance.

d. Identify therapeutic interventions and specialized techniques for responding to client's wandering and confusion.

4. Recognize common barriers to communication, including language, vision changes, hearing loss, speech problems, memory loss, disorientation and pain.

5. Demonstrate an ability to promote the independence of clients within the limitations of their physical, mental and intellectual impairments by fostering self-help skills through appropriate responses to clients' attempts to provide self care, including recognizing clients' level of ability in self care activities.

6. Identify the role of the family and other persons of importance to the client in the client's care and as resources for client emotional support.

(b) Basic nursing skills . The program shall include the theory of and practice in basic nursing skills, including bed making, taking vital signs, measuring height and weight, caring for the client's environment, measuring fluid and nutrient intake and output, assisting in the provision of proper nutritional care, walking or transferring the client using body mechanics and appropriately selected equipment with regard to principles of client care ergonomics, and maintaining infection control and safety standards. A nurse aide shall do all of the following:

1. Use acceptable personal hygiene.

2. Recognize the components of working relationships.

3. Identify how and when to seek guidance, using the supervisory channels of communication within the facility or agency.

4. Use proper body mechanics.

5. Demonstrate an understanding of the meaning of common medical terms and abbreviations.

6. Observe and report changes in client behavior and physical status, including signs and symptoms of common diseases and conditions.

7. Recognize when a client may be choking and respond appropriately.

8. Recognize the normal physical and psychological changes associated with aging.

9. Identify the basic principles of nutrition and hydration.

10. Recognize and report deviations from a client's normal food and fluid intake and output.

11. Recognize the basic requirements of commonly prescribed therapeutic diets.

12. Use common measures to promote a client's skin integrity, considering the client's ethnicity, race and age.

13. Demonstrate appropriate techniques in walking, transferring, positioning and transporting clients.

14. Recognize and respond appropriately to unsafe environmental conditions, including damp floors, frayed electrical cords and loose hand rails.

15. Recognize and respond appropriately to emergency situations including following emergency evacuation procedures.

16. Demonstrate appropriate hand washing techniques.

17. Understand and use commonly used alternatives to restraints in accordance with current professional standards.

18. Maintain the safety and cleanliness of client care areas.

19. Make use of proper isolation technique.

20. Perform commonly accepted infection control practices, including proper gloving technique and proper disposal of blood and body fluids and secretions.

21. Make occupied and unoccupied beds.

22. Measure temperature, pulse and respiration.

23. Measure a client's weight and height.

24. Record objective information.

25. Apply nonprescription ointments to unbroken skin areas.

26. Recognize the general effects of prescribed routine medications.

27. Recognize therapeutic interventions and specialized non-pharmacological pain control interventions.

28. Assist with care of clients when death is imminent.

29. Assist with post-mortem care.

30. Maintain the safety and cleanliness of areas where food is stored.

(c) Personal care skills . The program shall include the theory of and practice in basic personal care skills, including bathing, mouth care, grooming, dressing, toileting, and assistance with eating, hydration and skin care. A nurse aide shall demonstrate the ability to do all of the following:

1. Give a complete or partial bed bath to a client and assist a client in taking a bath or a shower.

2. Provide care of the client's perineal area.

3. Apply appropriate oral hygiene practices when assisting a client with oral hygiene, including caring for the client's dentures.

4. Care for a client's nails, hair and skin.

5. Shave and shampoo a client, including applying nonprescription medicated shampoos.

6. Dress and undress a client.

7. Prepare a client for meals.

8. Assist in feeding a client, including helping a client use adaptive devices and feeding utensils and encouraging a client to eat nutritionally balanced meals.

9. Assist a client with bowel and bladder elimination.

(d) Basic restorative services . The program shall include the theory of and practice in providing restorative services. Basic restorative services include the application of assistive devices for ambulation; eating and dressing; maintenance of range of motion through appropriate exercises; proper turning and positioning both in bed and chair; proper transferring techniques; bowel and bladder training; and care and use of prosthetic devices such as hearing aids, artificial eyes and artificial limbs. A nurse aide shall demonstrate the ability to do all of the following:

1. Recognize the importance of bowel and bladder programs.

2. Recognize the method for maintaining and improving musculoskeletal functioning by promoting joint mobility, body alignment and movement, including being able to do all of the following:

a. Position clients by use of pillows, towel rolls, padding and footboards.

b. Perform simple range of motion exercises.

c. Assist clients in the use of crutches, walkers, wheelchairs, canes, prostheses and appliances.

3. Transfer clients safely and according to principles of patient care ergonomics and with proficiency in use of available equipment that is used to transfer clients.

4. Reinforce breathing exercises, including coughing and deep breathing.

5. Help clients use hearing aids and visual aids.

(e) Rights of clients .

1. The program shall provide instruction on the principles of and requirements relating to clients' rights. The nurse aide shall demonstrate an understanding of all of the following obligations:

a. Providing privacy for clients in treatment, living arrangements and personal care needs.

b. Maintaining the confidentiality of client health and personal records.

c. Allowing clients to make personal choices to accommodate the clients' needs.

d. Providing help clients need in getting to and participating in activities, including client and family group meetings.

e. Maintaining the personal possessions of clients in good and secure condition.

f. Interacting with clients without abusing or neglecting the clients.

g. Interacting with clients without misappropriating the clients' property.

h. Immediately reporting to appropriate facility or agency staff every instance of abuse or neglect of a client or misappropriation of a client's property as defined in s. DHS 13.03 (1) , (12) , and (14) .

2. The nurse aide shall demonstrate behavior that recognizes that clients have rights and that the aide respects those rights. The nurse aide shall do all of the following:

a. Demonstrate respect and concern for each client's rights, preferences and awareness of age, color, disability, family status, financial status, gender, marital status, race, sexual orientation, and ethnic, cultural, social, generational and religious differences.

b. Show respect for cultural, ethnic and religious food preferences.

c. Recognize what constitutes abuse of clients and demonstrate an understanding of how to interact with clients without abusing them or without appearing to abuse them.

d. Demonstrate prevention and intervention skills with combative clients that balance appropriate client care with a need to minimize the potential for injury to the aide and others.

e. Recognize the role of state and federal regulatory agencies in licensing or otherwise approving providers and in investigating complaints of abuse of client property.

f. Demonstrate an understanding of the process by which a client or staff member may file a complaint on behalf of a client and seek redress for a perceived violation of client rights.

g. Recognize the role of client advocacy groups as client resources.

h. Demonstrate awareness of how to file a complaint with the department regarding operations within the provider setting.

(f) Dementias . The program shall include instruction about dementia and specific techniques for meeting the basic needs of clients with dementia. The nurse aide shall demonstrate an understanding of all of the following:

1. The nature of dementia, including the cause, course and symptoms of the impairment. The effects that brain changes have on the person's moods, abilities and functioning.

2. The effects on the client of staff verbal and nonverbal communication with the client and means of modifying these communications and approaches to facilitate effective interaction between clients and staff.

3. The feeding and fluid intake problems associated with dementia and the specialized techniques for addressing those problems.

4. The effect of the environment on clients with dementia and the appropriate environmental stimuli to use with those clients to reduce stress and maximize normal functioning and how to incorporate strategies that preserve function and prevent excess disability.

5. Possible causes of dementia related symptomatic behavior changes, specifically focusing on understanding behavior as an attempt to communicate unmet needs and then how to address the unmet need including an understanding of how pain impacts behavior.

6. Ways to help the person with dementia continue meaningful involvement in his or her day, the importance of structure and routine and the incorporation of the person's life story and past interests, routines, tastes, values and background.

7. The stress involved for the client, family and nurse aide in caring for a client with dementia and techniques for coping with this stress and ways to address the person with dementia's core needs of having self-esteem boosted, being useful, giving and receiving love, and caring for self and others.

(2)   program operation.

(a) Class setting.

1. Programs shall ensure that classrooms and lab facilities are adequate to meet the needs of the program, based on the number of students enrolled and how the classroom space is used. Programs shall ensure that classroom and skills labs have adequate temperature controls, clean and safe conditions, adequate space to accommodate students, adequate lighting, and all training equipment needed, including audiovisual equipment and any equipment needed for simulating resident care. Lab equipment shall be in the skill lab at all times necessary for demonstration, practice, and student demonstration. Any area designated as a classroom or lab in a facility-based program shall be an area that is not designated for resident care.

2. The program shall have qualified faculty members for both the classroom and the skills portion of the program.

3. The program shall have reasonable accommodations for students and prospective students with handicapping conditions.

(b) Program standards.

1. A training program shall be a minimum of 120 hours in length. This requirement includes at least 32 hours of clinical experience in a clinical setting approved by the department. The first 16 hours of training shall be provided in a classroom setting before a student has direct contact with clients. Tours of a facility including observations of clients and day-to-day facility activities may be incorporated into the classroom hours. Competency evaluation and provider orientation may not be counted toward meeting the 120-hour minimum requirement.

2. The program shall cover all of the following during the first 16 hours of classroom training:

a. Communication and interpersonal skills.

b. Infection control.

c. Safety and emergency procedures.

d. Promoting residents' independence.

e. Residents' rights.

3. A health care provider may employ a student as a nurse aide after the student has completed 16 hours of classroom training in the topics in subd. 2. , and if the student is a full-time permanent employee, and is enrolled in an approved training program. The training program shall provide the health care provider with verification that the program has provided the instruction specified in subd. 2.

4. The program shall provide notification to students sponsored by Medicaid-certified nursing facilities that the students are not responsible for any costs associated with training, including deposits for textbooks or supplies used.

(c) Clinical setting . Before a student performs any client-related services, the RN primary instructor shall determine that the student has been trained and found proficient in providing those services. The training program shall ensure all of the following:

1. Access to a clinical setting approved by the department that is adequate to meet the needs of the program.

a. Clinical settings shall be in compliance with state and federal law. The program designee or primary instructor and the health care provider with whom the program has contracted are responsible for verifying that the clinical facility is in compliance with state and federal law. This verification shall be documented in the program's files and shall be available during the evaluation process.

b. The agreement between the program and the clinical setting shall be reviewed and renewed annually by the department and upon any change of facility or school administration. A copy of the agreement shall be submitted to the department.

c. During classroom and lab instructions, students shall be oriented to the various forms used to document resident information. Instructors shall supervise documentation on the appropriate flow sheets and forms during the clinical rotation.

d. Before a student begins a clinical rotation, the primary instructor shall evaluate and document that the student successfully demonstrated the ability to perform a skill.

e. Students may not give hands-on care to a resident who is not assigned to the student unless the student is under the direct supervision of the primary instructor.

f. Students who are under the general supervision of the primary instructor may be paired, during the student's clinical rotation, with nurse aides who are employed by the health care provider.

g. Students shall maintain safe practices, infection control and respect resident rights at all times.

h. Students shall demonstrate knowledge regarding their assigned residents' diagnoses and identified needs.

i. Students and instructors shall wear clothing that is in compliance with program policy and that is appropriate for performing resident care. The clothing shall include a nametag that designates the name of the nurse aide training program and the person's status as a student or instructor.

j. The scheduled clinical hours shall provide experiences that meet expected outcomes outlined in the program curriculum.

k. The length of the clinical day may not exceed 8 hours.

L. A health care facility may serve as the site of clinical instruction for up to 2 nurse aide training programs at the same time, except that the department may decide to allow more than 2 programs at a single health care facility on a case-by-case basis in conjunction with the facility's administrative staff.

m. The program shall not be used as a substitute for staff orientation or staff education programs.

2. An adequate number of primary instructors in the clinical setting to provide safe and effective supervision and assistance of students.

a. Primary instructors shall not function in another role while supervising students in the clinical setting.

b. A ratio of 6 to 8 students per instructor is considered to be adequate in most circumstances.

c. The primary instructor shall evaluate and document that a student demonstrated successfully the ability to perform a skill before the student begins a clinical rotation.

d. The primary instructor shall make all student clinical assignments with the approval of the health care provider. The instructor shall complete a review of each resident's chart to retrieve pertinent information needed by the students to provide the required cares. Care plan information shall be reviewed at the beginning of each clinical experience and shall include new orders or changes in each resident's status.

e. A student's assignment shall be shared with the clinical setting to which the student is assigned before the student arrives at the clinical setting.

f. Each student shall be given an individual assignment. More than 2 students shall not be assigned to the same resident at the same time.

g. Clinical assignments shall include all of the following:

h. The RN primary instructor is responsible for supervising the clinical performance of each LPN program trainer.

(d) Nursing home-based program . Training of nurse aides may be performed under the general supervision of the director of nursing for a facility; however, the director of nursing may not act as the primary instructor or as a program trainer. Instructors shall not be involved in more than one role while supervising students in the clinical area.

(e) Expectations and records .

1. The training program shall maintain a list of the skills and a summary of the knowledge that a student will complete by the end of the training program.

2. On the list of skills, the primary instructor shall verify, by initialing and dating each individual skill, that the student has satisfactorily performed that skill. When a student has satisfactorily completed all required skills and competencies and attained the necessary knowledge, as well as achieved the stated course completion criteria, the trainee qualifies to enter a competency evaluation program.

3. The primary instructor shall provide a copy of the student's performance record to the student at the conclusion of the student's training.

(f) Record retention . The training program shall retain all records required by this section for a period of at least 3 years after a student completes the training program.

CR 08-042 : cr. register November 2008 No. 635, eff. 12-1-08; correction in (1) (e) 1. h. made under s. 13.92 (4) (b) 7. , Stats., Register November 2008 No. 635 ; renumbering in (2) (c) 2. g. made under s. 13.92 (4) (b) 1. , Stats., Register November 2008 No. 635 .

Note

Equipment used to transfer clients includes, but is not limited to, mechanical lifts, friction reducing devices; wheelchairs and gait belts. Microsoft Windows NT 6.1.7601 Service Pack 1 i. Care of clients with varied levels of care needs. Microsoft Windows NT 6.1.7601 Service Pack 1 ii. The opportunity to be evaluated on organizational skills and time management. Microsoft Windows NT 6.1.7601 Service Pack 1