Nurse Aides
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Nurse Aide I + 4 Process

As of January 1, 2019, the North Carolina Board of Nursing (NCBON) no longer receives notification from an agency regarding the skills selected, changed, or deleted for Nurse Aide I + 4.

The Nurse Aide I + 4 process is as follows:

  1. Up to 4 Nurse Aide II skills can be selected by an agency. Note: That 1-4 skills can be selected, and only those skills can be included in the Nurse Aide I + 4 designation for the agency. All units in the agency do not have to do all selected skills, but alternative skills may not be substituted on a unit by unit basis for the selected 1-4 skills for the Nurse Aide I + 4 designation.
  2. All of the skills selected for Nurse Aide I + 4 must be taught using the designated NCBON required modules. This includes fulfilling the timeframe required for each module (found at the start of each module). Each Nurse Aide must then have skill competency validated and a record of the education and skill validation using the appropriate skill competency checklist must be retained by the agency. The education and the skill validation must be done by a Registered Nurse. Note: The Registered Nurse retains the responsibility and accountability for appropriate delegation, and must be certain that the Nurse Aide has completed the education and skill competency validation and that the patient status is appropriate for the skill assignment before assigning the task even if the Nurse Aide has the Nurse Aide I + 4 designation.
  3. There is no listing process for a Nurse Aide I + 4, but the Nurse Aide I must hold current Nurse Aide I listing on the DHSR Registry.
  4. The Nurse Aide I + 4 skills, education and competency validation is agency specific. The Nurse Aide I is not approved for the skills at any other agency.
  5. There is no NCBON listing process for Nurse Aide I + 4. However, the Nurse Aide I must hold current Nurse Aide I listing on the Division of Health Service Regulation (DHSR) Registry.
  6. Written policies and procedures must be in place for each skill based on the NCBON Nurse Aide II Module (Developed by your agency based on module selected).
  7. Formal education and competency validation of Nurse Aide II skills must be performed by a Registered Nurse with an unrestricted license to practice.
  8. A record of Nurse Aide I + 4 skills, education and competency validation must be kept at said agency.
  9. A Nurse Aide I is not approved for Nurse Aide II skills except the approved Nurse Aide I + 4 skills within the agency. Additional skills performance requires education and credentialing as a Nurse Aide II.
  10. Although the Nurse Aide I may complete the Nurse Aide I + 4 education and competency validation of skills, the Registered Nurse is still responsible for:
    1. Making appropriate decisions related to delegation for each patient, each skill, and the aide to whom he/she is delegating.
    2. Assessing the patient and the patient's response to care, for assuring that the skill has been carried out appropriately, and for planning, modifying, and evaluating care. All judgement related to the patient care situation remains with the Registered Nurse.

The Nurse Aide II process is as follows:

  1. Offering of the course must be approved by NCBON via an application that can be obtained from the Education Department at education@ncbon.com.
  2. All of the required modules must be taught using the required timeframe identified for each module. A total of 80 hours of theory (more if including the fingerstick module) and 80 hours of direct patient care supervised by an NCBON-approved Nurse Aide II instructor must be completed.
  3. Nurse Aide skill competency validation must be done by an NCBON-approved Nurse Aide II instructor for all skills using the NCBON required skill competency checklists.
  4. The approved instructor must validate the Nurse Aide in the NCBON electronic Nurse Aide II Registry. The Nurse Aide must complete the process within 30 days of completion of the course in order to be listed. If the process is not completed within the required timeframe, the Nurse Aide will not be listed, and will have to retake the course.

You may not alter the timeframe for any of the modules if you are seeking Nurse Aide I + 4 designation or Nurse Aide II listing for the staff in your system.

If neither of these processes meet your needs, you may instead use the Decision Tree for Delegation to UAP. If you choose to use this method for delegation, note that there must be:

  1. Written policies and procedures.
  2. Formal education and competency validation of skills by a Registered Nurse.
  3. A record of the education and skill validation must be kept.
  4. The Registered Nurse must make appropriate decisions related to delegation for each patient, each skill, and the aide to whom he/she is delegating.
  5. The Registered Nurse retains responsibility for assessment of the patient and the patient's response to care, for assuring that the skill has been carried out appropriately, and for planning, modifying, and evaluating care. All judgement related to the patient care situation remains with the Registered Nurse.
Last Changed 5-Feb-2019

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