Nurse Aide II Course Guidelines
While the information found in this document is not mandated in the NCBON Law and Administrative Code (Rules), this document provides guidelines for planning and implementing the NA II course based on sound educational principles.
The Nurse Aide II Training Course consists 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 module "Sterile Technique" serves as a prerequisite for the modules on Wound Care, Suctioning, Tracheostomy Care, IV Fluids, and Urinary Catheter. Successful student completion of the "Sterile Technique" module and mastery of all included module skills establishes the foundation needed before beginning any of the modules listed above which require the use of sterile procedure for successful completion.
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 course completion. Although not required, additional time may be added to each module as the course coordinator deems necessary.
The course is encouraged to include any learning activities and teaching methodologies which will facilitate student learning.
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.
The general guidelines and procedures identified below reflect evidence-based adult learning principles. Inclusion of these in each of the course components is strongly encouraged to support course and student success.
Those guidelines and principles in BOLD are considered essential to course and student success.
- Frequent testing allows students to demonstrate mastery of content as he/she progresses through the course. Testing may be done at the end of each unit or after several short units have been covered.
- Tests given throughout the course enable both the instructor and student to identify area(s) with which the student may need additional help in order to master the content.
- Administration of a final, comprehensive examination, covering all content areas within the course is strongly recommended to validate student mastery of the course materials.
- Major tests and the final examination may consist of a majority of multiple choice questions with plausible distracters, but one clearly correct answer.
- A system for testing which ensures security of the test questions, such as a test bank, secure test administration measures, secure test review, and processes is strongly recommended to prevent fraudulent practices.
- Tests are intended to measure students’ knowledge of content presented in class and laboratory, as well as ability to select appropriate clinical application when given written clinical situations.
- Class Laboratory:
- It is strongly recommended that students are given the opportunity to see demonstrations of expected skills and then practice, with instructor assistance, prior to completing the required Skills Competency Checklist Evaluation.
- It is strongly recommended that students successfully complete the Skills Competency Checklist Evaluation in the laboratory setting before being permitted to perform the skill under direct instructor supervision in the clinical area. This "final laboratory exam" can be done as the module is being completed.
- Clinical Practice:
- It is strongly recommended that students successfully complete the Skills Competency Checklist Evaluation in the clinical practice setting under direct instructor supervision before being permitted to perform the skill without instructor supervision in the clinical area. This “final clinical exam” completes the Skills Competency Checklist Evaluation.
- It is strongly recommended that the course’s Clinical Performance Evaluation form include, and clearly state, the clinical performance expectations that the student must satisfactorily meet in order to be deemed safe and competent.
- It is strongly recommended that there be 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.
The general guidelines and procedures identified below reflect evidence-based adult learning and testing principles. Inclusion of these in each of the course components is strongly encouraged to support student and course success.
Those guidelines and principles in BOLD are considered essential to course and student success.
- Test Construction It is recommended that:
- Multiple choice should have four possible answers.
- "Always", "Never", and combination answers (e.g., "a,b,c", etc.) be avoided.
- Distracters parallel the correct answer in length.
- Stem of the test question should be concise and to the point without containing unnecessary information.
- Test questions and terminology be based on training course content and objectives. This is particularly important if a textbook test bank is utilized.
- Reading level should be at the 5th-8th grade level.
- Only those technical terms and abbreviations that the student is expected to know be used.
- Major tests (unit test, test covering several units, final examination) have a minimum of fifty questions, with 100 questions being more desirable.
- Questions should be randomly selected from the test bank for each test.
- Test questions should be arranged in logical sequence according to topic.
- Test questions include some questions related to prior knowledge, which the student must apply to the newly acquired content.
- Security of Tests - It is strongly recommended that:
- Individual tests and test items be kept in a secure location prior to and after use.
- A system be in place to assure that all written tests and answer sheets are distributed and returned.
- If tests are reviewed as a learning strategy, a system be in place to assure that no notes or written materials are taken from the review session.
- Administration of Test
- It is strongly recommended that a time limit be established for written tests and that students are informed of this time limit prior to test administration.
- The suggested testing time frame is one hour for each fifty questions.
- It is recommended that each written test be conducted in one sitting, i.e., the test time does not include any breaks nor be conducted over several periods of time.
- It is strongly recommended that the administrator of the test:
- be present throughout the entire testing time;
- maintain test security before, during, and after testing;
- understand the procedure for handling testing irregularities (including answering student questions); and,
- verify that students understand testing process.
- Skills Competency Testing - It is strongly recommended that:
- The student satisfactorily demonstrate all steps identified on the Skills Competency Checklist Evaluation form in the laboratory setting. A Registered Nurse observes the student performing satisfactory skills demonstration on two separate occasions, at a minimum. Ideally, laboratory demonstrations are scheduled at least twenty-four hours apart.
- The course establish, and inform students of, the maximum number of times the Skill Competency Checklist Evaluation may be attempted.
- All skills competencies required by the Board of Nursing are successfully completed in order for the student to pass the classroom/laboratory component of the course.
Note: 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.
- Clinical Practice - It is strongly recommended that:
- Final validation of skill competence occurs in the clinical practice setting; 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.
- The student does not perform any skill in the clinical practice setting for which he/she has not had the classroom content and successfully completed laboratory competency validation.
- The clinical instructor directly supervises any student who is performing skills for which the student has not successfully completed the related Skills Competency Checklist Final Clinical Evaluation.
- The course develops, and shares with students, objectives for clinical experiences.
- The course develops a clinical performance evaluation tool which is used by the student and instructor to evaluate student performance in the clinical area.
- Opportunity be available for the student to master all required clinical skills prior to being evaluated for final clinical competency.
- A Nurse Aide II education course does not use simulation as a substitute for the required 80 hours of clinical experience. This is not permitted in Nursing Law and Rules.
Suggestions for Assessing a Clinical Agency for Nurse Aide II
Prior to placing students in a clinical setting an assessment of the appropriateness of the area is important. The information detailed below is intended to provide guidance to the Program Dean/Director or designee for the completion of the assessment of a clinical site for student use, as well as suggestions for what to include in the contract/letter of agreement with the clinical site. This information is for the use of the Program Dean/Director or designee. Do not send this information to the Consultant at the North Carolina Board of Nursing.
The Consultants at the North Carolina Board of Nursing remain available to assist in a consultative role as you gather information and determine the appropriateness of clinical sites for students.
Determining Appropriateness of Site (Program Aspects)
- Determine objective(s) to be met relative to level of student and course content.
- How do the objectives play out in the clinical experience?
- Will this be a faculty-supervised or a precepted/buddy experience?
- What is the faculty experience/competency in this clinical area?
- Identify an appropriate clinical site/agency.
- Initiate contact with the clinical site/agency.
- Identify person(s) with authority for approving clinical site/agency use and coordination of student experiences. (The person with authority to approve clinical placement of students may be different from the person who coordinates student placement)
- Determine units or areas available for student use. Do the available experiences and average patient census support the curriculum and the objectives of the course in which the students will be enrolled during this clinical experience?
- Are there sufficient staff members available for mentoring and/or role identification? (Are a high number of supplemental/agency staff utilized? Are there staff members appropriately performing in the role for which you are preparing the student to function as a graduate?)
- Determine and resolve scheduling conflicts with other nursing education programs.
Determining Appropriateness of Site (Clinical Site Aspects)
- Identify the organizational structure. Who has authority for nursing personnel and nursing activities?
- Review the position descriptions for nursing personnel (look at all that have nursing responsibilities. For example, the unit secretary or a tech may also function as a Nurse Aide I or Nurse Aide II) Are the responsibilities defined within the legal scope of practice or within the legal activity limit for that category of worker?
- Is the staff functioning within the legal scope of practice/activity limit?
- Are there sufficient equipment and supplies available for the students to meet the objectives of the experience? (for example, if the objective is to learn to take blood pressures, are there enough blood pressure cuffs available that the students could complete the assignment in a reasonable time?
- Have there been any findings from regulatory/accreditation surveys/reviews that are of concern or would interfere with the students meeting the objectives of the experience? (Division of Facility Services; Joint Commission on Accreditation of Healthcare Organizations )
Suggestions of Items to Include in the Contract/Letter of Agreement with the Clinical Site
- Responsibility for patient care
- Responsibility for students, including supervision and evaluation
- Number of students
- Communication of student scheduling; objective of the experience
- Availability of faculty (on site vs. on call)
- Requirements for immunization, special training (OSHA, BCLS)
- Right of denial of individual students at the clinical site.
- Inclusion of any other requirements of the College or the Clinical Site.
Orientation Needs to Consider Related to Use of the Clinical Site
- Is the faculty member experienced in caring for this type of patient?
- Is the faculty member familiar with this clinical agency? With the specific area where students will be assigned?
- Is there anything specific or unusual about the way this particular area functions that the faculty member will need to know?
- Who will provide/assure that regulatory/agency specific requirements are met (OSHA, BCLS, confidentiality statements, etc)?
- Who will provide orientation to the agency/clinical site?
- Who will provide orientation to the assigned clinical area?
- Where will pre- and/or post-conferences be held?
- Is there space for students to store items (coats, books, purses, etc)?
- Faculty and Students
- What documentation system is being used? Will the students be permitted to use it? Who will provide any needed orientation, and when will it be done? Does the faculty member need to cosign student entries? What policies are in place regarding student documentation?