Section R4-19-802. CNA Program Requirements

A.      Organization and Administration

1.        A nursing assistant program may be offered by:

a.         An educational institution licensed by the State Board for Private Postsecondary Education,

b.        A public educational institution or a program funded by a local, state or federal governmental agency,

c.         A health care institution licensed by the Arizona Department of Health Services or a federally autho- rized health care institution,

d.        A private business that meets the requirements of this Article and all other legal requirements to oper- ate a business in Arizona.

2.        If a nursing assistant program is offered by a private busi- ness, the program shall meet the following requirements.

a.         Hold a surety bond from a surety company with a financial strength rating of “A-” or better by Best’s Credit Ratings, Moody’s Investors Service, Standard and Poor’s rating service or another comparable rat- ing service as determined by the Board in the amount of a minimum of $15,000. The program shall ensure that:

i.         Bond distributions are limited to students or former students with a valid claim for instruc- tional or program deficiencies;

ii.        The amount of the bond is sufficient to reim- burse the full amount of collected tuition and fees for all students during all enrollment peri- ods of the program; and

iii.      The bond is maintained for an additional 24 months after program closure; and

b.        Upon initial use and remodeling, provide the Board with a fire inspection report from the Office of the State Fire Marshal or the local authority with juris- diction, indicating that each program classroom and skill lab location is in compliance with the applica- ble fire code.

3.        Programs approved by the Board before the effective date of this Section shall comply with subsection (A)(2) within one year of the effective date. If a program does not charge tuition or fees, the bond requirement is waived.

4.        A Medicare or Medicaid certified long-term care facility- based certified nursing assistant program shall not require a student to pay a fee for any portion of the program including the initial attempt on the state competency exam.

5.        In addition to the policies required in R4-19-801(B), the Board may approve a nursing assistant program to offer an advanced placement option to a student with a back- ground in health care. A nursing assistant program wish- ing to offer an advance placement option shall submit their advanced placement policy to the Board and receive approval before implementing the policy. The program shall include, at a minimum, the following provisions in its policy:

a.         Advanced placement is limited to students with at least one year full-time employment in the direct provision of health care within the past five years or students who have successfully completed course work that included direct patient care experiences in

allied health, medicine or nursing in the past five years.

b.        The program, at a minimum, shall require an advanced placement student to meet the same out- comes as regular students on all examinations and skill performance demonstrations.

c.         The program shall require an advanced placement student to successfully accomplish all clinical objec- tives during a minimum of 16 hours of clinical prac- tice under the direct supervision and observation of a qualified instructor and in a long-term care facility.

d.        Upon successful completion of advanced placement and any other program requirements, the program shall credit the graduate with the same number of didactic, laboratory and clinical hours as the regular graduate.

B.       Program coordinator qualifications and responsibilities

1.        Program coordinator qualifications include:

a.         Holding a current, registered nurse license that is active and in good standing or multistate privilege to practice as an RN under A.R.S. Title 32, Chapter 15; and

b.        Possessing at least two years of nursing experience at least one year of which is in the provision of long- term care facility services.

2.        A director of nursing in a health care facility may assume the role of a program coordinator for a nursing assistant training program that is housed in the facility but shall not function as a program instructor.

3.        A program coordinator’s responsibilities include:

a.         Supervising and evaluating the program;

b.        Ensuring that instructors meet Board qualifications and there are sufficient instructors to provide for a clinical ratio not to exceed 10 students per instruc- tor;

c.         Ensuring that the program meets the requirements of this Article; and

d.        Ensuring that the program meets federal require- ments regarding clinical facilities under 42 CFR 483.151.

4.        Other than the director of nursing in a long-term care facility, a program coordinator may also serve as a pro- gram instructor.

C.      Program instructor qualifications and duties

1.      Program instructor qualifications include:

a.         Holding a current, registered nurse license that is active and in good standing under A.R.S. Title 32, Chapter 15 and provide documentation of a mini- mum of one year full time or 1500 hours employ- ment providing direct care as a registered nurse in any setting; and

b.        At a minimum, one of the following:

i.         Successful completion of a three semester credit course on adult teaching and learning concepts offered by an accredited post-second- ary educational institution,

ii.        Completion of a 40 hour continuing education program in adult teaching and learning con- cepts that was awarded continuing education credit by an accredited organization,

iii.      One year of full-time or 1500 hours experience teaching adults as a faculty member or clinical educator, or

iv.       One year of full time or 1500 hours experience supervising nursing assistants, either in addi-

tion to or concurrent with the one year of expe- rience required in subsection (C)(1)(a).

2.        In addition to the program instruction requirements in R4-19-801(C), a nursing assistant program instructor shall provide on-site supervision for each student placed in a health care facility not to exceed 10 students per instructor;

D.      Clinical and classroom hour requirements and resources

1.        A nursing assistant training program shall ensure each graduate receives a minimum of 120 hours of total instruction consisting of:

a.         Instructor-led teaching in a classroom setting for a minimum of 40 hours;

b.        Instructor-supervised skills practice and testing in a laboratory setting for a minimum of 20 hours; and

c.         Instructor-supervised clinical experiences for a min- imum of 40 hours, consistent with the goals of the program. Clinical requirements include the follow- ing:

i.         The program shall provide students with clini- cal orientation to any clinical setting utilized.

ii.        The program shall provide a minimum of 20 hours of direct resident care in a long-term care facility licensed by the Department of Health Services, except as provided in subsection (iv). Direct resident care does not include orienta- tion and clinical pre and post conferences.

iii.      If another health care facility is used for addi- tional required hours, the program shall ensure that the facility provides opportunities for stu- dents to apply nursing assistant skills similar to those provided to long-term care residents.

iv.       If a long-term care facility licensed by the Department of Health Services is not available within 50 miles of the training program’s class- room, the program may provide the required clinical hours in a facility or unit that cares for residents or patients similar to those residing in a long-term care facility.

d.        To meet the 120 hour minimum program hour requirement, a CNA program shall designate an additional 20 hours to classroom, skill or clinical instruction based upon the educational needs of the program’s students and program resources.

2.        A nursing assistant training program shall ensure that equipment and supplies are in functional condition and sufficient in number for each enrolled student to practice required skills. At a minimum, the program shall provide:

a.         Hospital-type bed, over-bed table, linens, linen pro- tectors, pillows, privacy curtain, call-light and night- stand;

b.        Thermometers, stethoscopes, including a teaching stethoscope, aneroid blood pressure cuffs, and a scale;

c.         Realistic skill training equipment, such as a manikin or model, that provides opportunity for practice and demonstration of perineal care;

d.        Personal care supplies including wash basin, towels, washcloths, emesis basin, rinse-free wash, tooth brushes, disposable toothettes, dentures, razor, shav- ing cream, emery board, orange stick, comb, sham- poo, hair brush, and lotion;

e.         Clothes for dressing residents including undergar- ments, socks, hospital gowns, shirts, pants and shoes or non-skid slippers;

f.         Elimination equipment including fracture bed pans, bed pans, urinals, ostomy supplies, adult briefs, specimen cups, graduate cylinder, and catheter sup- plies;

g.        Aseptic and protective equipment including running water, sink, soap, paper towels, clean disposable gloves, surgical masks, particulate respirator mask for demonstration purposes, gowns, hair protectors and shoe protectors;

h.        Restorative equipment including wheelchair, gait belt, walker, anti-embolic hose, adaptive equipment, and cane;

i.         Feeding supplies including cups, glasses, dishes, straws, standard utensils, adaptive utensils and clothing protectors;

j.         Clean dressings, bandages and binders; and

k.        Documentation forms.

E.       Consolidated Programs

1.        A nursing assistant program may request, in writing, to consolidate more than one site of a program under one program approval for convenience of administration. The site of a program is where didactic instruction occurs. The Board may approve the request for a consolidated program if all the following conditions are met:

a.         The program is not based in a long-term care facil- ity;

b.        The program does not offer an innovative program as defined in R4-19-214 at any consolidated site;

c.         A single RN administrator has authority and respon- sibility for all sites including hiring, retention and evaluation of all program personnel;

d.        Curriculum and policies are identical for all sites;

e.         Instructional delivery methods are substantially sim- ilar at all sites;

f.         Didactic, lab practice and clinical hours are identical for all sites;

g.        The program presents sufficient evidence that all sites have comparable resources, including class- room, skill lab, clinical facilities and staff. Evidence may include pictures, videos, documentation of equipment purchase and instructor resumes;

h.        The program provides an application to the Board a minimum of 30 days before consolidation of the pro- gram or use of the new site;

i.         The site is fully staffed before accepting students;

j.         The program evaluates each site separately under R4-19-801(A)(9);

k.        The program arranges for the test vendor to provide a separate program number for each site;

2.        There have been no substantiated complaints against the program or failure to follow the provisions of this Article in the past two years.

3.        The program shall notify the Board if a site is closed or has not been used in two years.

4.        A program that has been Board-approved as a consoli- dated program may request to add additional sites 30 days in advance of site utilization. The Board may approve the new site if the site meets the criteria in subsection (E)(1).

5.        The Board may deny a request to consolidate programs or add a site if the requirements of this section are not met. Denial of such a request is not a disciplinary action and does not affect the program’s approval status.

6.        The Board shall not renew or visit any site that was not used in the previous approval period.

F.       Curriculum: a nursing assistant training program shall provide classroom and clinical instruction regarding each of the fol- lowing subjects:

1.        Communication, interpersonal skills, and documentation;

2.        Infection control;

3.        Safety and emergency procedures, including abdominal thrusts for foreign body airway obstruction and cardio- pulmonary resuscitation;

4.        Patient or resident independence;

5.        Patient or resident rights, including the right to:

a.         Confidentiality;

b.        Privacy;

c.         Be free from abuse, mistreatment, and neglect;

d.        Make personal choices;

e.         Obtain assistance in resolving grievances and dis- putes;

f.         Security of a patient's or resident's personal prop- erty; and

g.        Be free from restraints;

6.        Recognizing and reporting abuse, mistreatment or neglect to a supervisor;

7.        Basic nursing assistant skills, including:

a.         Taking vital signs, height, and weight using stand- ing, wheelchair and bed scales;

b.        Maintaining a patient's or resident's environment;

c.         Observing and reporting pain;

d.        Assisting with diagnostic tests including obtaining specimens;

e.         Providing care for patients or residents with drains and tubes including catheters and feeding tubes;

f.         Recognizing and reporting abnormal patient or resi- dent physical, psychological, or mental changes to a supervisor;

g.        Applying clean bandages;

h.        Providing peri-operative care; and

i.         Assisting in admitting, transferring, or discharging patients or residents.

8.        Personal care skills, including:

a.         Bathing, skin care, and dressing;

b.        Oral and denture care;

c.         Shampoo and hair care;

d.        Fingernail care;

e.         Toileting, perineal, and ostomy care;

f.         Feeding and hydration, including proper feeding techniques and use of assistive devices in feeding; and

9.        Age specific, mental health, and social service needs, including:

a.         Modifying   the    nursing   assistant's    behavior   in response to patient or resident behavior,

b.        Demonstrating an awareness of the developmental tasks and physiologic changes associated with the aging process,

c.         Responding to patient or resident behavior,

d.        Allowing the resident or patient to make personal choices and providing and reinforcing other behav- ior consistent with the individual’s dignity,

e.         Providing culturally sensitive care,

f.         Caring for the dying patient or resident, and

g.        Using the patient's or resident's family as a source of emotional support for the resident or patient;

10.     Care  of  the  cognitively  impaired  patient  or  resident including;

a.         Understanding and addressing the unique needs and behaviors of patients or residents with dementia or other cognitive impairment,

b.        Communicating with cognitively impaired patients or residents,

c.         Reducing the effects of cognitive impairment, and

d.        Appropriate responses to the behavior of cognitively impaired individuals.

11.     Skills for basic restorative services, including:

a.         Body mechanics;

b.        Resident self-care;

c.         Assistive devices used in transferring, ambulating and dressing;

d.        Range of motion exercises;

e.         Bowel and bladder training;

f.         Care and use of prosthetic and orthotic devices; and

g.        Turning and positioning a resident in bed, transfer- ring a resident between bed and chair and position- ing a resident in a chair.

12.     Health care team member skills including the role of the nursing assistant and others on the health care team, time management and prioritizing work; and

13.     Legal aspects of nursing assistant practice, including:

a.         Board-prescribed requirements for certification and re-certification including criminal background checks, testing, Board application, felony bar under

A.R.S. § 32-1606 (B)(17), proof of legal presence, allotted time to certify and practice requirement for re-certification;

b.        Delegation of nursing tasks;

c.         Ethics;

d.        Advance  directives  and do-not-resuscitate  orders; and

e.         Standards of conduct under R4-19-814.

14.     Body structure and function, together with common dis- eases and conditions.

G.      Curriculum sequence: A nursing assistant training program shall provide a student with a minimum of 16 hours instruction in the subjects identified in subsections (F)(1) through (F)(6) before allowing a student to care for patients or residents.

H.      Skills: A nursing assistant instructor shall verify and document that the following skills are satisfactorily performed by each student before allowing the student to perform the skill on a patient or resident without the instructor present:

1.        Hand hygiene, gloving and gowning; and

2.        Skills in subsection (F)(7), (8) and (11)(a), (c), (d), (f), and (g).

I.        One-year approval: following receipt and review of a complete initial application as specified in R4-19-804 the Board may approve the program for a period that does not exceed one year, if requirements are met, without a site visit.

J.        A Medicare or Medicaid certified long-term care facility- based program shall provide in its initial and each renewal application, a signed, sworn, and notarized document, exe- cuted by the program coordinator, affirming that the program does not require a nursing assistant student to pay a fee for any portion of the program including the initial attempt on the state competency exam.

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).