WSR 07-22-113

PROPOSED RULES

DEPARTMENT OF HEALTH


(Nursing Care Quality Assurance Commission)

[ Filed November 7, 2007, 10:22 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 00-03-072.

Title of Rule and Other Identifying Information: WAC 246-841-400 Standards of practice and competencies of nursing assistants, 246-841-410 Purpose of review and approval of certified nursing assistant training programs, 246-841-420 Requirements for nursing assistant education and training program approval, 246-841-430 Denial of approval or withdrawal of approval for programs for which the board is the approving authority, 246-841-440 Reinstatement of approval, 246-841-450 Appeal of board decisions, 246-841-460 Closing of an approved nursing assistant training program, 246-841-470 Program directors and instructors in approved training programs, 246-841-480 Students (trainees) in approved training programs, 246-841-490 Core curriculum in approved training programs, 246-841-500 Physical resources for approved education programs, and 246-841-510 Administrative procedures for approved nursing assistant training programs.

Hearing Location(s): Comfort Inn of Tumwater, 1620 74th Avenue S.W., Tumwater, WA 98501, on December 13, 2007, at 9:00 a.m.

Date of Intended Adoption: December 13, 2007.

Submit Written Comments to: Kendra Pitzler, P.O. Box 47864, Olympia, WA 98504-7864, web site http://www3.doh.wa.gov/policyreview/, fax (360) 236-4723, by December 6, 2007.

Assistance for Persons with Disabilities: Contact Kendra Pitzler by November 29, 2007, TTY (800) 833-6388 or 711.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: Nursing assistant programs are reviewed by the department of social and health services (DSHS) and the department of health (DOH). Currently, there are two sets of requirements which are not consistent. Some language is outdated and ambiguous. The proposal addresses this by adding language to match that of the federal government (42 C.F.R. 483 152), updating language that required programs to keep files for thirty-five years and defining current rules for clarity and to allow more flexibility. In addition, the proposal addresses quality by assuring minimum standards for education, training and qualifications of the trainers are met.

Reasons Supporting Proposal: This proposal reduces confusion by merging some of the federal requirements with the state requirements. It also eliminates confusion and allows flexibility by clearly defining what is already in law or rule. Elimination of burdensome requirements make it easier to comply with the rules. In addition, the proposed requirements to assure programs, program directors and instructors meet specific standards better assure the quality of these programs.

Statutory Authority for Adoption: RCW 18.88A.060(1) and 18.88A.030(5).

Statute Being Implemented: RCW 18.88A.060(1).

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: Department of health, governmental.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Kendra Pitzler, Department of Health, 310 Israel Road S.E., Tumwater, WA 98501, (360) 236-4723.

No small business economic impact statement has been prepared under chapter 19.85 RCW. Per RCW 19.85.030 (1)(a) the proposed rules do not impose more than minor costs on businesses in the industry.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Kendra Pitzler, Department of Health, P.O. Box 47864, Olympia, WA 98504-7864, phone (360) 236-4723, fax (360) 236-4738, e-mail kendra.pitzler@doh.wa.gov.

November 7, 2007

Dr. Judith Personett, EdD, RN, Chair

Nursing Care Quality Assurance Commission

OTS-4601.10


AMENDATORY SECTION(Amending Order 214B, filed 11/19/91, effective 12/20/91)

WAC 246-841-400   Standards of practice and competencies ((of)) for nursing assistants.   ((The following standards are supported by statements of the competencies that a nursing assistant must hold to meet the standard to be certified to practice in the state of Washington. The)) Competencies and standards of practice are statements of skills and knowledge, and are written as descriptions of observable, measurable behaviors ((which can be observed and measured)). All competencies are performed((, as per RCW 18.88A.030,)) under the direction and supervision of a licensed ((())registered(())) nurse or licensed practical nurse as required by RCW 18.88A.030. ((The level or depth of accomplishment of any given competency is as appropriate to the "assisting" role of basic nursing care under supervision of the licensed nurse.)) The following competencies are considered standards of practice for both nursing assistant-certified and nursing assistant-registered:

(1) Basic technical skills. ((The)) A nursing assistant demonstrates basic technical skills which facilitate((s)) an optimal level of functioning for ((the)) client or resident, recognizing individual, cultural, and religious diversity. ((Competencies)) A nursing assistant:

(a) Demonstrates proficiency in cardiopulmonary resuscitation (CPR) and can perform CPR independently.

(b) Takes and records vital signs.

(c) Measures and records height and weight.

(d) Measures and records fluid and food intake and output ((of client)).

(e) Recognizes ((and reports abnormal signs and symptoms of common diseases and conditions)) normal body functions, deviations from normal body functions and the importance of reporting deviations in a timely manner to a supervising nurse.

(f) ((Demonstrates sensitivity to)) Recognizes, responds to and reports client's or resident's emotional, social, cultural and mental health needs.

(g) ((Makes observations of)) Recognizes, responds to and reports problems in client's or resident's environment to ensure safety and comfort of client.

(h) Participates in care planning and nursing reporting process.

(2) Personal care skills. ((The)) A nursing assistant demonstrates basic personal care skills. ((Competencies)) A nursing assistant:

(a) Assists client or resident with bathing, ((mouth)) oral care, and skin care.

(b) Assists client or resident with grooming and dressing.

(c) Provides toileting assistance to client or resident.

(d) Assists client or resident with eating and hydration.

(e) ((Utilizes)) Uses proper oral feeding techniques.

(3) Mental health and social service needs. ((The)) A nursing assistant demonstrates the ability to identify ((the)) psychosocial ((characteristics)) needs of all clients ((including persons with mental retardation, mental illness, dementia, Alzheimer's disease, and related disorders. Competencies:

(a) Modifies his/her own behavior in response to the client's behavior.

(b) Identifies adaptations necessary to accommodate the aging process.

(c) Provides training in, and the opportunity for, self care according to clients' capabilities.

(d) Demonstrates skills supporting client's personal choices.

(e) Identifies ways to use the client's family as a source of emotional support for the patient)) or residents based upon awareness of the developmental and age specific processes. A nursing assistant:

(((4))) (a) Addresses individual behavioral needs of the client or resident.

(b) Knows the developmental tasks associated with the developmental and age specific processes.

(c) Allows the client or resident to make personal choices, but provides and reinforces behaviors consistent with the client's or resident's dignity.

(d) Is sensitive and supportive and responds to the emotional needs of the clients or residents and their sources of emotional support.

(4) Care of cognitively impaired residents. A nursing assistant demonstrates basic care of cognitively impaired clients or residents. A nursing assistant:

(a) Uses techniques for addressing the unique needs and behaviors of individuals with cognitive impairment including Alzheimer's, dementia, delirium, developmental disabilities, mental illnesses and other conditions.

(b) Communicates with cognitively impaired clients or residents in a manner appropriate to their needs.

(c) Demonstrates sensitivity to the behavior of cognitively impaired clients or residents.

(d) Appropriately responds to the behavior of cognitively impaired clients or residents.

(5) Basic restorative services. The nursing assistant incorporates principles and skills ((of restorative nursing)) in providing ((nursing)) restorative care. ((Competencies)) A nursing assistant:

(a) Demonstrates knowledge and skill in using assistive devices in ambulation, transferring, eating, and dressing.

(b) Demonstrates knowledge and skill in the maintenance of range of motion.

(c) Demonstrates proper techniques for turning((/)) and positioning a client or resident in a bed and chair.

(d) Demonstrates proper techniques for transferring and ambulating client or resident.

(e) Demonstrates knowledge about methods for meeting the elimination needs of clients or residents.

(f) Demonstrates knowledge and skill for the use and care ((and use)) of prosthetic devices by client or resident.

(((5))) (g) Uses basic restorative services by training the client or resident in self care according to the client's or resident's capabilities.

(6) Client((s')) or resident rights and promotion of ((clients')) independence. ((The)) A nursing assistant demonstrates behavior which maintains and respects client((s')) or resident rights and promotes ((clients')) independence, regardless of race, religion, life-style, sexual preference, disease process, or ability to pay. ((Competencies)) A nursing assistant:

(a) Recognizes that ((the)) client or resident has the right to participate in decisions about his((/)) or her care.

(b) Recognizes and respects ((the)) clients' or residents' need for privacy and ((maintenance of)) confidentiality.

(c) Promotes and respects the client(('s)) or resident right to make personal choices to accommodate their needs.

(d) Reports client(('s)) or resident concerns.

(e) Provides assistance to client or resident in getting to and participating in activities.

(f) ((Provides care of client's personal possessions.

(g) Provides care which maintains the client free from abuse, mistreatment or neglect; and reports any instances to appropriate facility staff.

(h) Maintains the client's environment and care through appropriate nursing assistant behavior so as to minimize the need for physical and chemical restraints.

(6))) Respects the property of client or resident and employer and does not take equipment, material, property or medications for his, her or other's use or benefit. A nursing assistant may not solicit, accept or borrow money, material or property from client or resident for his, her or other's use or benefit.

(g) Promotes client or resident right to be free from abuse, mistreatment, and neglect.

(h) Intervenes appropriately on the client's or resident's behalf when abuse, mistreatment or neglect is observed.

(i) Complies with mandatory reporting requirements by reporting to the department of health and the department of social and health services instances of neglect, abuse, exploitation or abandonment.

(j) Participates in the plan of care with regard to the use of restraints in accordance with current professional standards.

(7) Communication and interpersonal skills. ((The)) A nursing assistant uses communication and interpersonal skills effectively ((in order)) to function as a member of the nursing team. ((Competencies)) A nursing assistant:

(a) Reads, writes, speaks, and understands English at the level necessary for performing duties of the nursing assistant.

(b) Listens and responds to verbal and nonverbal communication in an appropriate manner.

(c) Recognizes how ((one's)) his or her own behavior influences client's or resident's behavior and ((know)) uses resources for obtaining assistance in understanding the client's or resident's behavior.

(d) ((Makes adjustments for)) Adjusts his or her own behavior to accommodate client's or resident's physical or mental limitations.

(e) Uses terminology accepted in the health care ((facility)) setting to record and report observations and pertinent information.

(f) Appropriately records and reports observations, actions, and information accurately and in a timely manner.

(g) ((Demonstrates ability)) Is able to explain policies and procedures before and during care of the client or resident.

(((7))) (8) Infection control. ((The)) A nursing assistant uses ((procedures and techniques)) standard and transmission based precautions to prevent the spread of microorganisms. ((Competencies)) A nursing assistant:

(a) Uses principles of medical asepsis and demonstrates infection control techniques and ((universal)) standard and transmission based precautions.

(b) Explains how disease causing microorganisms are spread((; lists ways that HIV and Hepatitis B can spread from one person to another)).

(c) Is knowledgeable regarding transmission of bloodborne pathogens.

(((c))) (d) Demonstrates knowledge of cleaning agents and methods which destroy microorganisms on surfaces.

(((8))) (9) Safety((/)) and emergency procedures. ((The)) A nursing assistant demonstrates the ability to identify and implement safety((/)) and emergency procedures. ((Competencies)) A nursing assistant:

(a) Provides an environment with adequate ventilation, warmth, light, and quiet ((measures)).

(b) ((Uses measures that promote comfort, rest, and sleep.

(c))) Promotes a clean, orderly, and safe environment ((and)) including equipment for ((the)) a client or resident.

(((d))) (c) Identifies and utilizes measures for accident prevention.

(((e) Identifies and)) (d) Demonstrates principles of good body mechanics for self and client or resident, using the safest and most efficient methods to lift and move clients, residents, or heavy items.

(((f))) (e) Demonstrates proper use of protective devices in care of clients or residents.

(((g))) (f) Demonstrates knowledge ((of)) and follows fire and disaster procedures.

(((h))) (g) Identifies and demonstrates principles of health and sanitation in ((the service of)) food service.

(((i))) (h) Demonstrates the proper use and storage of cleaning agents and other potentially hazardous materials.

(((9))) (10) Rules and regulations knowledge. ((The)) A nursing assistant demonstrates knowledge of and ((is responsive to)) can explain the practical implications of the laws and regulations which affect ((his/her)) nursing assistant practice including but not limited to: ((Client abuse and neglect, client complaint procedures,))

(a) Mandatory reporting procedures related to client or resident abuse, neglect, abandonment, and exploitation.

(b) Scope of practice.

(c) Workers right to know((, and)).

(d) The Uniform Disciplinary Act.

[Statutory Authority: RCW 18.88A.060. 91-23-077 (Order 214B), 246-841-400, filed 11/19/91, effective 12/20/91; 91-07-049 (Order 116B), recodified as 246-841-400, filed 3/18/91, effective 4/18/91. Statutory Authority: RCW 18.88.080. 90-20-018 (Order 091), 308-173-210, filed 9/21/90, effective 10/22/90.]


AMENDATORY SECTION(Amending Order 214B, filed 11/19/91, effective 12/20/91)

WAC 246-841-410   Purpose of the review and approval of ((certified)) nursing assistant-certified training programs.   The ((board of)) nursing care quality assurance commission (commission) approve((s curriculum in)) nursing assistant ((education))-certified training programs ((qualifying for admission to examination for certification for the following purposes)). The commission reviews and approves training programs to:

(1) ((To)) Assure preparation for safe practice as a nursing assistant-certified by ((setting minimum standards for education)) requiring nursing assistant-certified programs meet minimum standards.

(2) ((To)) Provide guidance for ((the)) development of new nursing assistant-certified training programs.

(3) ((To)) Facilitate ((the)) career mobility of nursing assistants-certified ((in articulating)) into nursing educational programs in other levels of nursing.

(4) ((To)) Identify training standards and achieved competencies of nursing assistants-certified in the state of Washington for the purpose of interstate communications and endorsements.

[Statutory Authority: RCW 18.88A.060. 91-23-077 (Order 214B), 246-841-410, filed 11/19/91, effective 12/20/91; 91-07-049 (Order 116B), recodified as 246-841-410, filed 3/18/91, effective 4/18/91. Statutory Authority: RCW 18.88.080. 90-20-018 (Order 091), 308-173-220, filed 9/21/90, effective 10/22/90.]


AMENDATORY SECTION(Amending Order 116B, filed 3/18/91, effective 4/18/91)

WAC 246-841-420   Requirements for approval of nursing assistant ((education and))-certified training programs ((approval)).   ((Those institutions or facilities seeking approval to offer a program of training which qualifies graduates to apply for certification, in addition to other agency program approval requirements,)) To qualify as a nursing assistant-certified training program, an institution or facility must:

(1) ((Request an)) Submit a completed application((/guidelines)) packet ((from)) provided by the department of health((, professional licensing)). The packet will include forms and instructions ((for the program)) to submit the following:

(a) Program objectives.

(b) Curriculum content outline.

(c) Qualifications of program director and additional instructional staff.

(d) ((Agency)) Contractual agreements ((as appropriate)) related to providing this training. For any program that uses another facility to provide clinical training, this includes an affiliation agreement between the training program and the facility. The affiliation agreement must describe how the program will provide clinical experience in the facility. The agreement must specify the rights and responsibilities of both parties, students and clients or residents.

(e) ((A)) Sample lesson plan for one unit.

(f) ((A sample)) Skills checklist.

(g) Description of ((physical resources)) classroom facilities.

(h) ((Statement of assurance of compliance with administrative guidelines.

(2) If a program currently in existence as an approved program on the date of implementation of this code, submit the completed application, including all forms, fees, and assurances as specified, within sixty days of the effective date of the code for review for reapproval of the program.

(3) If a program not currently holding approval status, submit the completed application packet and fees as instructed, with all forms and assurances as specified, sixty days prior to the anticipated start date of the first class offered by the institution.

(4))) Declaration of compliance with administrative guidelines signed by the program director.

(i) Verification that the program director has completed a course on adult instruction as required by WAC 246-841-470(3) or has one year of experience in the past three years teaching adults. Acceptable experience does not include in-service education or patient teaching. A program director working exclusively in a postsecondary educational setting is exempt from this requirement.

(j) Verification that the nursing assistant-certified training program or school is approved to operate in the state of Washington by:

(i) The state board for community and technical colleges;

(ii) The superintendent of public instruction; or

(iii) The workforce training and education coordinating board.

(2) Agree to on-site survey of the training program, as requested by the ((board, on a date mutually agreed upon by the institution and the board)) commission. This on-site ((visit)) will be coordinated with other on-site review requirements when possible.

(((5) Provide review and update of program information)) (3) Participate in the renewal process every two years((, or as requested by the board or educational agency)). Failure to renew results in automatic withdrawal of approval of the program.

(((6))) (4) Comply with any ((future)) changes in ((education)) training standards and guidelines in order to maintain approved status.

(((7))) (5) Notify the ((board)) commission and ((education)) any other approving agency of any changes in overall curriculum plan or major curriculum content changes prior to implementation.

(((8))) (6) Notify the ((board)) commission and ((education)) any other approving agency of changes in program director or instructors.

[Statutory Authority: RCW 18.88A.060. 91-07-049 (Order 116B), recodified as 246-841-420, filed 3/18/91, effective 4/18/91. Statutory Authority: RCW 18.88.080. 90-20-018 (Order 091), 308-173-230, filed 9/21/90, effective 10/22/90.]


AMENDATORY SECTION(Amending Order 214B, filed 11/19/91, effective 12/20/91)

WAC 246-841-430   Denial ((of approval)) or withdrawal of approval for nursing assistant-certified training programs ((for which the board is the approving authority)).   (1) ((The board may deny approval to new programs)) When ((it)) the commission determines that a nursing assistant-certified training program fails ((substantially)) to meet the standards for training as contained in ((WAC 246-841-470 through 246-841-510. All such board actions shall be in accordance with the Washington Administrative Procedure Act and/or the administrative rules and regulations of the board.

(2) The board may withdraw approval from existing programs when it determines that a nursing education program fails substantially to meet the standards for nursing assistant training as contained in WAC 246-841-470 through 246-841-510. All such actions shall be effected in accordance with the Administrative Procedure Act and/or the administrative rules and regulations of the board)) this chapter, the commission may:

(a) Deny approval to a new program; or

(b) Withdraw approval from existing programs.

(2) The commission may conduct a review or site visit to investigate:

(a) Complaints relating to violations of this chapter.

(b) Failure to notify the commission of any changes in the overall curriculum plan or major content changes prior to implementation.

(c) Failure to notify the commission of changes in program director or instructor.

(d) Providing false or misleading information to students or the public concerning the nursing assistant-certified training program.

(e) Failure to secure or retain a qualified program director resulting in substandard supervision and teaching of students.

(f) Failure to maintain an average passing rate of eighty percent on the state-approved examination. If a program:

(i) Fails to maintain an average passing rate of eighty percent of first time test takers for two consecutive years, the commission will require the program to assess the problem and submit a plan of correction.

(ii) Fails to maintain an average passing rate of eighty percent of first time test takers for three consecutive years, the program must complete an assessment of possible problem areas within six months and the commission may conduct an evaluation visit. The commission may offer technical assistance.

(iii) Fails to maintain an average passing rate of eighty percent of first time test takers for four out of five consecutive years, the commission may place the program on conditional approval and require an evaluation visit.

(3) Commission approval is automatically terminated if the program does not renew.

[Statutory Authority: RCW 18.88A.060. 91-23-077 (Order 214B), 246-841-430, filed 11/19/91, effective 12/20/91; 91-07-049 (Order 116B), recodified as 246-841-430, filed 3/18/91, effective 4/18/91. Statutory Authority: RCW 18.88.080. 90-20-018 (Order 091), 308-173-240, filed 9/21/90, effective 10/22/90.]


AMENDATORY SECTION(Amending Order 214B, filed 11/19/91, effective 12/20/91)

WAC 246-841-440   ((Reinstatement of approval.)) How does a nursing assistant training program whose approval has been withdrawn become reinstated?   (1) The ((board)) commission may consider reinstatement ((of withdrawn approval)) of a nursing assistant-certified training program upon submission of satisfactory evidence that the program meets the standards of nursing assistant training((, WAC 246-841-470 through 246-841-510)) as contained in this chapter.

(2) A program that is automatically terminated for failure to participate in the renewal process may be immediately reinstated upon meeting all conditions for a new application approval.

[Statutory Authority: RCW 18.88A.060. 91-23-077 (Order 214B), 246-841-440, filed 11/19/91, effective 12/20/91; 91-07-049 (Order 116B), recodified as 246-841-440, filed 3/18/91, effective 4/18/91. Statutory Authority: RCW 18.88.080. 90-20-018 (Order 091), 308-173-245, filed 9/21/90, effective 10/22/90.]


AMENDATORY SECTION(Amending Order 116B, filed 3/18/91, effective 4/18/91)

WAC 246-841-450   Appeal ((of board decisions)) rights of a nursing assistant-certified training program when the commission has denied or withdrawn approval.   ((A nursing assistant training program deeming itself aggrieved by a decision of the board affecting its approval status shall have the right to appeal the board's decision in accordance with the provisions of chapter 18.88 RCW and the Administrative Procedure Act, chapter 34.05 RCW.)) A nursing assistant-certified training program that has been denied or had approval withdrawn shall have the right to a hearing to appeal the commission's decision according to the provisions of chapter 18.88A RCW and chapter 34.05 RCW, the Administrative Procedure Act, Parts IV and V.

[Statutory Authority: RCW 18.88A.060. 91-07-049 (Order 116B), recodified as 246-841-450, filed 3/18/91, effective 4/18/91. Statutory Authority: RCW 18.88.080. 90-20-018 (Order 091), 308-173-250, filed 9/21/90, effective 10/22/90.]


AMENDATORY SECTION(Amending Order 116B, filed 3/18/91, effective 4/18/91)

WAC 246-841-460   ((Closing)) Closure of an approved nursing assistant-certified training program.   When ((a governing institution decides to close a program)) an approved nursing assistant-certified training program closes, it shall notify the ((board)) commission in writing, stating the reason and the date of intended closing.

[Statutory Authority: RCW 18.88A.060. 91-07-049 (Order 116B), recodified as 246-841-460, filed 3/18/91, effective 4/18/91. Statutory Authority: RCW 18.88.080. 90-20-018 (Order 091), 308-173-255, filed 9/21/90, effective 10/22/90.]


AMENDATORY SECTION(Amending Order 214B, filed 11/19/91, effective 12/20/91)

WAC 246-841-470   Program directors and instructors in approved nursing assistant-certified training programs.   (1) The program director ((will be)) must hold a current license in good standing as a registered nurse ((licensed)) (RN) in the state of Washington.

(2) ((The program director will meet the minimum qualifications for instructors as required by the superintendent of public instruction in chapter 180-77 WAC or the state board for community college education in chapter 131-16 WAC.)) The commission may deny or withdraw a program director's approval if there is or has been any action taken against the director's health care license or any license held by the director which allows him or her to work with vulnerable populations.

(3) The program director ((will)) must complete a (("train-the-trainer" program approved by the state)) training course on adult instruction or have demonstrated ((competence to teach adults as defined by the state)) that he or she has one year experience teaching adults.

(a) Acceptable experience does not include in-service education or patient teaching.

(b) The training course on adult instruction must provide instruction in:

(i) Understanding the adult learner.

(ii) Techniques for teaching adults.

(iii) Classroom methods for teaching adults.

(iv) Audio visual techniques for teaching adults.

(c) A program director working exclusively in a postsecondary educational setting is exempt from this requirement.

(4) The program director will have a minimum of three years of experience as an RN, of which at least one year will be in direct patient care.

(5) The program director must meet the requirements for additional staff under subsection (7)(b) of this section if the program director will also be acting as an instructor.

(6) Program director responsibilities:

(a) Develop and implement a curriculum which meets as a minimum the requirements of WAC 246-841-490. The program director is responsible for all classroom and clinical training content and instruction.

(b) Assure compliance with and assume responsibility for ((all regulations as stipulated in)) meeting the requirements of WAC ((246-841-480)) 246-841-490 through 246-841-510.

(c) ((Directly supervise each course offering.)) Assure that all student clinical experience is directly supervised. Direct supervision means that an approved program director or instructor is observing students performing tasks.

(d) Assure that the clinical instructor has no concurrent duties during the time he or she is instructing students.

(e) Create and maintain an environment conducive to teaching and learning.

(((e))) (f) Select and supervise all other instructors involved in the course, ((to include)) including clinical instructors and guest lecturers.

(((f))) (g) Assure that students are not asked to, nor allowed to, perform any clinical skill with patients or clients until first demonstrating the skill satisfactorily to an instructor in a practice setting.

(((g))) (h) Assure evaluation of ((competency of)) knowledge and skills of students before ((issuance of verification of)) verifying completion of the course.

(((h))) (i) Assure that students receive a verification of completion when requirements of the course have been satisfactorily met.

(((6) Additional instructional staff:

(a))) (7) The program director may select instructional staff to assist in the teaching of the course((, teaching)).

(a) Instructional staff must teach in their area of expertise.

(b) ((All)) Instructional staff must have a minimum of one year experience within the past three years in caring for the elderly ((and/)) or chronically ill of any age or both.

((A guest lecturer, or individual with expertise in a specific course unit may be utilized for the teaching of that unit, following the program director's review of the currency of the content.))

(c) All instructional staff must ((be, where applicable, currently licensed, registered, and/or certified in their field in the state of Washington)) hold a current Washington state license to practice as a registered or licensed practical nurse. The commission may deny or withdraw an instructor's approval if there is or has been any action taken against a health care license or any license held by the applicant which allows him or her to work with vulnerable populations.

(d) Instructional staff may assist the program director in development of ((curriculum)) curricula, teaching modalities, and evaluation ((but)). The instructor will ((in all cases)) be under the supervision of the program director at all times.

(e) A guest lecturer, or individual with expertise in a specific course unit may be used in the classroom setting for teaching without commission approval, following the program director's review of the currency of content. The guest lecturer, where applicable, must hold a license, certificate or registration in good standing in their field of expertise.

[Statutory Authority: RCW 18.88A.060. 91-23-077 (Order 214B), 246-841-470, filed 11/19/91, effective 12/20/91; 91-07-049 (Order 116B), recodified as 246-841-470, filed 3/18/91, effective 4/18/91. Statutory Authority: RCW 18.88.080. 90-20-018 (Order 091), 308-173-260, filed 9/21/90, effective 10/22/90.]


AMENDATORY SECTION(Amending Order 214B, filed 11/19/91, effective 12/20/91)

WAC 246-841-490   Core curriculum in approved nursing assistant-certified training programs.   (1) The curriculum ((will)) must be competency based((; that is)). It must be composed of learning objectives and activities that will lead to ((the attainment of)) knowledge and skills required for the graduate to demonstrate mastery of the core competencies ((CNAs must hold, as per)) as provided in WAC 246-841-400.

(2) The program director will determine the amount of time required in the curriculum to achieve the objectives ((as above)). The time designated ((will be expected to)) may vary with characteristics of the learners and teaching((/)) or learning variables. ((In no case will the hours be less than)) There must be a minimum of eighty-five hours total, ((comprised of no less than)) with a minimum of thirty-five hours of classroom training and ((no less than)) a minimum of fifty hours of clinical training.

(a) Of the thirty-five hours of classroom training, ((no less than)) a minimum of seven hours must be in AIDS education ((and training, in the subject areas of: Epidemiology, pathophysiology, infection control guidelines, testing and counseling, legal and ethical issues, medical records, clinical manifestations and diagnosis, treatment and disease management, and psychosocial and special group issues)) as required by chapter 246-12 WAC, Part 8.

(b) Of the fifty hours of clinical training, at least forty clinical hours must be in the practice setting.

(c) Training to orient the student to the health care facility and facility policies and procedures are not to be included in the minimum hours above.

(3) Each unit of the core curriculum will have:

(a) Behavioral objectives, ((that is)) which are statements of specific observable actions and behaviors that the learner is to perform or exhibit.

(b) An outline of information the learner will need to know in order to meet the objectives.

(c) Learning activities (((that is,)) such as lecture, discussion, readings, film, or clinical practice((, etc.) that are)) designed to enable the student to achieve the stated objectives.

(4) Clinical teaching in a ((given)) competency area ((will be)) is closely correlated with classroom teaching((,)) to ((facilitate the integration of)) integrate knowledge with manual skills.

(a) Students must wear name tags clearly identifying them as students when interacting with patients, clients or residents, and families.

(b) An identified instructor(s) will supervise clinical teaching((/)) or learning at all times. At no time will the ratio of students to instructor exceed ten students to one instructor in the clinical setting.

(5) The curriculum ((will)) must include evaluation processes to ((assure)) assess mastery of competencies. ((Written and oral tests and clinical practical demonstrations are common methods.)) Students ((will not be asked to, nor allowed to,)) cannot perform any clinical skill on ((patients or)) clients or residents until first demonstrating the skill satisfactorily to an instructor in the practice setting.

[Statutory Authority: RCW 18.88A.060. 91-23-077 (Order 214B), 246-841-490, filed 11/19/91, effective 12/20/91; 91-07-049 (Order 116B), recodified as 246-841-490, filed 3/18/91, effective 4/18/91. Statutory Authority: RCW 18.88.080. 90-20-018 (Order 091), 308-173-270, filed 9/21/90, effective 10/22/90.]


AMENDATORY SECTION(Amending Order 116B, filed 3/18/91, effective 4/18/91)

WAC 246-841-500   Physical resources ((for)) required for approved ((education)) nursing assistant-certified training programs.   (1) Classroom facilities must provide adequate space, lighting, comfort, and privacy for effective teaching and learning.

(2) Adequate classroom resources, such as ((chalkboard, AV materials, written materials, etc., with which to accomplish program objectives)) white board or other writing device, audio visual materials, and written materials must be available.

(3) ((Adequate resources must also be provided for teaching and practice of clinical skills and procedures, before implementation of such skills with patients or residents.)) Appropriate equipment must be provided for teaching and practicing clinical skills and procedures before implementing the skills with clients or residents.

[Statutory Authority: RCW 18.88A.060. 91-07-049 (Order 116B), recodified as 246-841-500, filed 3/18/91, effective 4/18/91. Statutory Authority: RCW 18.88.080. 90-20-018 (Order 091), 308-173-275, filed 9/21/90, effective 10/22/90.]


AMENDATORY SECTION(Amending Order 116B, filed 3/18/91, effective 4/18/91)

WAC 246-841-510   Administrative procedures for approved nursing assistant-certified training programs.   (1) ((A student)) The program must establish and maintain a file ((will be established and maintained)) for each student enrolled ((which includes)). The file must include:

(a) Dates attended((, evaluation ()).

(b) Test(())) results((,)).

(c) A skills evaluation checklist with dates of skills testing and signature of ((evaluator, and)) instructor.

(d) Documentation of successful completion of the course, or ((other)) documentation of the course outcome.

(2) Each student file ((will)) must be maintained by the ((institution)) program for a period of ((thirty-))five years, and copies of documents made available to students who request them.

(((2))) (3) Verification of successful completion of the course of training will be provided to the ((board of nursing)) commission on forms provided by the ((board)) commission.

(((3))) (4) For those programs based in a health care facility: ((Training evaluation and verification of successful completion of the course, including mastery of the required knowledge and skills, will be determined by the program director separately from other employee/employer issues. Verification of completion will not be withheld from a student who has successfully met the requirements of the course.

(4) Programs which are not sponsored by a health care facility, must submit with their application for approval an affiliation agreement between the educational institution and the health care facility which will provide the program access to the experience needed for clinical teaching. This agreement must specify the rights and responsibilities of both parties, students and clients.

(5) Failure to adhere to administrative requirements for programs may result in withdrawal of approval status by the board.)) Verification of program completion and the application for state testing will not be withheld from a student who has successfully met the requirements of the program. Successful completion will be determined by the training program director separately from other employer issues.

[Statutory Authority: RCW 18.88A.060. 91-07-049 (Order 116B), recodified as 246-841-510, filed 3/18/91, effective 4/18/91. Statutory Authority: RCW 18.88.080. 90-20-018 (Order 091), 308-173-280, filed 9/21/90, effective 10/22/90.]


REPEALER

     The following section of the Washington Administrative Code is repealed:
WAC 246-841-480 Students (trainees) in approved training programs.

Washington State Code Reviser's Office