Section R4-19-801. Common Standards for Certified Nursing Assis- tant (CNA) and Certified Medication Assistant (CMA) Train- ing Programs

A.      Program Administrative Responsibilities

1.        Any person or entity offering a training program under this Article shall, before accepting tuition from prospec- tive students, and at all times thereafter, provide program personnel including a coordinator and instructors, as applicable, who meet the requirements of this Article.

2.        If at any time, a person or entity offering a training pro- gram cannot provide a qualified instructor for its stu- dents, it shall immediately cease instruction and, if the training program cannot provide a qualified instructor within 5 business days, the training program shall offer all enrolled students a refund of all tuition and fees the students have paid to the program.

3.        A training program shall obtain and maintain Board approval or re-approval as specified in this Article and

A.R.S § 32-1650.01(B) before advertising the program, accepting any tuition, fees, or other funds from prospec- tive students, or enrolling students.

4.        A training program that uses external clinical facilities shall execute a written agreement with each external clin- ical facility that:

a.         Provides the program instructor the ability to assign patient care experiences to students after consulta- tion with facility staff, and

b.        Contains a termination clause that provides suffi- cient time for enrolled students to complete their clinical training upon termination of the agreement.

5.        A training program that requires students to pay tuition for the program shall:

a.         Make all program costs readily accessible on the school’s website with effective dates,

b.        Publicly post any increases in costs on the school’s website 30 days in advance of the increase;

c.         Include in the cost calculation and public posting, all fees directly paid to the program including but not

limited to tuition, lab fee, clinical fee, enrollment fee, insurance, books, uniform, health screening, credit card fee and state competency exam fee; and

d.        Provide a description of all program costs to the stu- dent that are not directly paid to the program.

6.        Before collecting any tuition or fees from a student, a training program shall notify each prospective student of Board requirements for certification including legal pres- ence in the United States, criminal background check requirements, and ineligibility for certification under A.R.S. § 32-1606(B)(17).

7.        Within the first 14 days of the program and before 50% of program instruction occurs, a training program shall transmit to the Board-approved test vendor, accurate and complete information regarding each enrolled student for the purposes of tracking program enrollment, attrition and completion. Upon receipt of accurate completion information, the vendor shall issue a certificate of com- pletion to the program for each successful graduate.

8.        A training program shall provide the Board, or its desig- nee, access to all training program records, students and staff at any time, including during an announced or unan- nounced visit. A program’s refusal to provide such access is grounds for withdrawal of Board approval.

9.        A training program shall provide each student with an opportunity to anonymously and confidentially evaluate the course instructor, curriculum, classroom environ- ment, clinical instructor, clinical setting, textbook and resources of the program.

10.     A training program shall provide and implement a plan to evaluate the program that includes the frequency of eval- uation, the person responsible, the evaluative criteria, the results of the evaluation and actions taken to improve the program. The program shall evaluate the following ele- ments at a minimum every two years:

a.         Student evaluations consistent with subsection (A)(9);

b.        First-time pass rates on the written and manual skills certification exams for each admission cohort;

c.         Student attrition rates for each admission cohort;

d.        Resolution of student complaints and grievances in the past two years; and

e.         Review and revision of program policies.

11.     A training program shall submit written documentation and information to the Board regarding the following pro- gram changes within 30 days of instituting the change:

a.         For a change or addition of an instructor or coordi- nator, the name, RN license number, and documen- tation that the coordinator or instructor meets the applicable requirements of R4-19-802(B) and (C) for CNA programs and R4-19-803(B) for CMA pro- grams;

b.        For a change in classroom location, the previous and new location, and a description of the new class- room;

c.         For a change in a clinical facility, the name and address of the new facility and a copy of the signed clinical contract;

d.        For a change in the name or ownership of the train- ing program, the former name or owners and the new name or owners; and

e.         For a decrease in hours of the program, a written revised curriculum document that clearly highlights new content, strikes out deleted content and includes revised hours of instruction, as applicable.

B.       Policies and Procedures

1.        A training program shall promulgate and enforce written policies and procedures that comply with state and fed- eral requirements, and are consistent with the policies and procedures of the parent institution, if any. The program shall provide effective and review dates for each policy or procedure.

2.        A training program shall provide a copy of its policies and procedures to each student on or before the first day the student begins the program.

3.        The program shall promulgate and enforce the following policies with accompanying procedures:

a.         Admission requirements including:

i.         Criminal background, health and drug screen- ing either required by the program or necessary to place a student in a clinical agency; and

ii.        English language, reading and math skills nec- essary to comprehend course materials and per- form duties safely.

b.        Student attendance policy, ensuring that a student receives the hours and types of instruction as reported to the Board in the program’s most recent application to the Board and as required in this Arti- cle. If absences are permitted, the program shall ensure that each absence is remediated by providing and requiring the student to complete learning activ- ities that are equivalent to the missed curriculum topics, clinical experience or skill both in substance and in classroom or clinical time.

c.         A final examination policy that includes the follow- ing provisions;

i.         Require that its students score a minimum 75% correct answers on a comprehensive secure final examination with no more than one re- take. The program may allow an additional re- take following documented, focused remedia- tion based on past test performance. Any re- take examination must contain different items than the failed exam, address all course compe- tencies, and be documented with score, date administered and proctor in the student record; and

ii.        Require that each student demonstrate, to pro- gram faculty, satisfactory performance of each practical skill as prescribed in the curriculum before performance of that skill on patients or residents without the instructor’s presence, direct observation, and supervision;

d.        Student record maintenance policies consistent with subsection (D) including the retention period, the location of records and the procedure for students to access to their records.

e.         Clinical supervision policies consistent with clinical supervision provisions of this Section, and:

i.         R4-19-802(C) and (D) for CNA programs, or

ii.        R4-19-803(B) and (C) for CMA programs;

f.         Student conduct policies for expected and unaccept- able conduct in both classroom and clinical settings;

g.        Dismissal and withdrawal policies;

h.        Student grievance policy that includes a chain of command for grade disputes and ensures that stu- dents have the right to contest program actions and provide evidence in support of their best interests including the right to a third party review by a per- son or committee that has no stake in the outcome of the grievance;

i.         Program progression and completion criteria.

C.      Classroom and clinical instruction

1.        During clinical training sessions, a training program shall ensure that each student is identified as a student by a name badge or another means readily observable to staff, patients, and residents.

2.        A training program shall not utilize, or allow the clinical facility to utilize, students as staff during clinical training sessions.

3.        A training program shall provide a clean, comfortable, distraction-free learning environment for didactic teach- ing and skill practice.

4.        A training program shall provide, in either electronic or paper format, a written curriculum to each student on or before the first day of class that includes a course descrip- tion, course hours including times of instruction and total course hours, instructor information, passing require- ments, course goals, and a topical schedule containing date, time and topic for each class session.

5.        For each unit or class session the program shall provide, to its students, written:

a.         Measurable learner-centered objectives,

b.        An outline of the material to be taught, and

c.         The learning activities or reading assignment.

6.        A training program shall utilize an electronic or paper textbook corresponding to the certification level of the course that has been published within the previous five years. Unless granted specific permission by the pub- lisher, a training program shall not utilize copies of pub- lished materials in lieu of an actual textbook.

7.        A training program shall provide, to all program instruc- tors and enrolled students, access to the following instructional and educational resources:

a.         Reference materials, corresponding to the level of the curriculum; and

b.        Equipment and supplies necessary to practice skills.

8.        A training program instructor shall:

a.         Plan each learning experience;

b.        Ensure that the curriculum meets the requirements of this Section;

c.         Prepare written course goals, lesson objectives, class content and learning activities;

d.        Schedule and achieve course goals and objectives by the end of the course; and

e.         Require satisfactory performance of all critical ele- ments of each skill under R4-19-802(H) for nursing assistant and R4-19-803(D)(4) for medication assis- tant before allowing a student to perform the skill on a patient or resident without the instructor’s pres- ence at the bedside.

9.        A qualified RN instructor shall be present at all times and during all scheduled classroom, skills laboratory and clin- ical sessions. In no instance shall a nursing assistant or other unqualified person provide any instruction, rein- forcement, evaluation or independent activities in the classroom or skills laboratory.

10.     A qualified RN instructor shall supervise any student who provides care to patients or residents by:

a.         Remaining in the clinical facility and focusing atten- tion on student learning needs during all student clinical experiences;

b.        Providing the instructor’s current and valid contact information to students and facility staff during the instructor’s scheduled teaching periods;

c.         Observing each student performing tasks taught in the training program;

d.        Documenting each student’s performance each day, consistent with course skills and clinical objectives;

e.         During the clinical session, engaging exclusively in activities related to the supervision of students; and

f.         Reviewing all student documentation.

D.      Records

1.        A training program shall maintain the following program records either electronically or in paper form for a mini- mum of three years for CNA programs and five years for CMA programs:

a.         Curriculum and course schedule for each admission cohort;

b.        Results of state-approved written and manual skills testing;

c.         Documentation of program evaluation under subsec- tion (A)(10);

d.        A copy of any Board reports, applications, or corre- spondence, related to the program; and

e.         A copy of all clinical contracts, if using outside clin- ical agencies.

2.        A training program shall maintain the following student records either electronically or in paper form for a mini- mum of three years for CNA programs and five years for CMA programs:

a.         A record of each student's legal name, date of birth, address, telephone number, e-mail address and Social Security number, if available;

b.        A completed skill checklist containing documenta- tion of student level of competency performing the skills in R4-19-802(F) for nursing assistant, and in R4-19-803(D)(4) for medication assistants;

c.         An accurate attendance record, which describes any make-up class sessions and reflects whether the stu- dent completed the required number of hours in the course; and

d.        Scores for each test, quiz, or exam and whether such test, quiz, or exam was retaken.

E.       Certifying Exam Passing Standard: A training program and each site of a consolidated program under R4-19-802(E) shall attain, at a minimum, an annual first-time passing rate on the manual skill and written certifying examinations that is equal to the Arizona average pass rate for all candidates on each examination minus 20 percentage points. The Board may waive this requirement for programs with less than five stu- dents taking the exam during the year. The Board shall issue a notice of deficiency under A.A.C. R4-19-805 to any program with five or more students taking the exam that fails to achieve the minimum passing standard in any calendar year.

F.       Distance Learning; Innovative Programs

1.        A training program may be offered using real-time inter- active distance technologies such as interactive television and web based conferencing if the program meets the requirements of this Article.

2.        Before a training program may offer, advertise, or recruit students for an on-line, innovative or other non-tradi- tional program, the program shall submit an application for innovative applications in education under R4-19-214 and receive Board approval.

G.      Site visits: A training program shall permit the Board, and its designee, including another state agency, to con- duct an onsite scheduled evaluation for initial Board approval and renewal of approval in accordance with R4- 19-804 and announced or unannounced site visits at any other time the Board deems necessary.

Historical Note

New Section adopted by final rulemaking at 6 A.A.R.

757, effective February 4, 2000 (Supp. 00-1). Amended by final rulemaking at 11 A.A.R. 4254, effective Decem- ber 5, 2005 (Supp. 05-4). Section repealed; new Section made by final rulemaking at 20 A.A.R. 1859, effective September 8, 2014 (Supp. 14-3).