Unlicensed Assistive Personnel
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Nurse Aide II Course Guidelines

The Nurse Aide II Training Program shall consist of classroom, laboratory, and clinical components. The student must successfully complete all components in order to be eligible to apply for listing on the North Carolina Board of Nursing Nurse Aide II Registry.

The first module in the program should be Role of Nurse Aide II. The module "Sterile Technique" is a prerequisite for the modules on Wound Care, Suctioning, Tracheostomy Care, IV Fluids, and Urinary Catheter. The student must successfully complete the "Sterile Technique" module and master all skills identified in the module before beginning any of the other modules listed above. The remaining modules may be taken in any sequence. The module time frame noted for each module is the minimum required number of hours for program completion. Although not required, additional time may be added to each module as the program coordinator deems necessary.

The program is encouraged to include any learning activities and teaching methodologies which will facilitate student learning.

Competency validation should occur in the clinical area; however, in those limited situations where this is not possible, laboratory simulation of the clinical setting is permissible.  Only the Registered Nurse may provide nurse aide training and competency validation. The Licensed Practical Nurse may provide subsequent delegation and supervision when working with a nurse aide.


Below are identified general guidelines and procedures which should be reflected in each of the components of the program. The program needs to assure that those marked with "*" are incorporated into the program.

1. Testing:

a. Testing should occur frequently enough to allow students to demonstrate mastery of content as he/she progresses through the program. These can be at the end of each unit or after several short units have been covered.

b. Tests given throughout the program should enable both the instructor and student to identify area(s) with which the student may need additional help in order to master the content.

*c. The final examination must be comprehensive, covering all content areas within the program.

d. Major tests and final examination should consist of a majority of multiple choice questions with plausible distracters, but one clearly correct answer.

*e. There must be a system for testing which ensures security of the test questions, i.e., a test bank, secure test administration measures, etc.

*f. Tests must measure student’s knowledge of content presented in class and laboratory, as well as ability to select appropriate clinical application when given written clinical situations.

2. Class Laboratory:

*a. There must be opportunity for student to see demonstration of expected skills and then practice, with instructor assistance, prior to completing the required Skills Competency Checklist Evaluation.

b. Student must successfully complete the Skills Competency Checklist Evaluation before being permitted to perform the skill without direct instructor supervision in the clinical area. This "final exam" can be done as the module is being completed.

3. Clinical Practice:

a. Student may perform, without direct supervision by the instructor, those skills for which he/she has successfully completed the Skills Competency Checklist Evaluation.

*b. The program must have a Clinical Performance Evaluation form which includes, and clearly states, the clinical performance expectations that the student must satisfactorily meet in order to be deemed safe and competent.

*c. There must a process by which the student receives ongoing assessment and feedback related to clinical performance, with sufficient opportunity for the student to satisfactorily meet clinical objectives.


Below are identified specific guidelines and procedures which should be incorporated within each of the components of the program.

1. Test Construction:

a. Multiple choice should have four possible answers.

b. "Always", "Never", and combination answers (i.e., "a,b,d", etc.) should be avoided.

c. Distracters should parallel the correct answer in length.

d. Stem of the test question should be concise and to the point without containing unnecessary information.

e. Test questions and terminology should be based on training program content and objectives. This is particularly important if a textbook test bank is utilized.

f. Reading level should be at the 5th-8th grade level.

g. Use only those technical terms and abbreviations that the student is expected to know.

h. Major tests (unit test, test covering several units, final examination) should have a minimum of fifty questions, with 100 questions being more desirable.

i. Questions should be randomly selected from the test bank for each test.

j. Test questions should be arranged in logical sequence according to topic.

k. Test questions should include some questions related to prior knowledge, which the student must apply to the newly acquired content.

2. Security of Tests:

*a. Individual tests and test items should be kept in a secure location prior to and after use.

*b. A system should be in place to assure that all written tests and answer sheets are distributed and returned.

*c. If tests are reviewed as a learning strategy, a system should be in place to assure that no notes or written materials are taken from the review session.

3. Administration of Test:

*a. A time limit should be established for the written test. Students should be informed of this time limit prior to administering the test.

b. The suggested time frame is one hour for each fifty questions.

c. Each written test should be conducted in one sitting, i.e., the test time should not include any breaks nor be conducted over several periods of time.

*d. The administrator of the test must:

(1) be present throughout the entire testing time;

(2) maintain test security before, during, and after testing;

(3) understand procedure for handling testing irregularities (including answering student questions);

(4) verify that students understand testing process.

4. Skills Competency Testing:

1. Testing should occur in the clinical area; however, in those limited situations where this is not possible, competency validation of up to three required nurse aide II skills is permitted in the laboratory simulated environment.

*2. The student must satisfactorily demonstrate all steps identified on the Skills Competency Checklist Evaluation form. A Registered Nurse must observe the student performing satisfactory skills demonstration on two separate occasions, at a minimum. There should be scheduled at least twenty-four hours apart.

*3. The program shall establish, and inform students of, the maximum number of times the Skill Competency Checklist Evaluation may be attempted.

*4. All skills competencies required by the Board of Nursing must be successfully completed in order for the student to pass the classroom/laboratory component of the program.

*5. Skills criteria included with the modules refer to reporting information to the Registered Nurse. Reporting information only to the Registered Nurse is applicable during the training process. Once in practice, the Nurse Aide II can report to both the Registered Nurse and Licensed Practical Nurse.

5. Clinical Practice:

*1. The student may not perform any skill for which he/she has not had the classroom/laboratory content.

*2. The clinical instructor must directly supervise any student who is performing skills for which the student has not successfully completed the related Skills Competency Checklist Evaluation.

*3. The program shall have developed, and shared with students, objectives for clinical experiences.

*4. The program shall have a clinical performance evaluation tool which is used by the student and instructor to evaluate student performance in the clinical area.

*5. Opportunity must be available for the student to master all required clinical skills prior to being evaluated for final clinical competency.

*6. A Nurse Aide II education course shall not use simulation as a substitute for the required 80 hours of clinical experience.

Last Changed 15-Feb-2019

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