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Nurse Aide Training
Nurse aides are the front-line workers in nursing homes. The well-being of a nursing home resident depends not only on the skills of the nurse aide, but also on the relationship that develops between the nurse aide and the resident. Federal regulations require that all nurse aides, who work in nursing homes that participate in Medicare and Medicaid, complete a State-approved training program, pass a competency exam, and receive certification from the State in which they are employed. State-approved training programs must be a minimum of 75 hours and include 16 hours of supervised clinical training. To maintain certification, all nurse aides must complete 12 hours of continuing education annually.
We reviewed the Federal nurse aide training requirements as mandated in the Omnibus Budget Reconciliation Act of 1987 (OBRA 87). We examined factors affecting nurse aide training by obtaining data about current State nurse aide training requirements from 48 States and the District of Columbia. We compiled responses from nearly 1,000 nurse aides. We interviewed 29 nursing home administrators and nurse supervisors (hereinafter referred to as nursing home supervisors), 14 nurse aide trainers, 5 long-term care ombudsmen, 3 academicians, and 5 experts in the field. Overall, we held discussions with 39 licensed or registered nurses from the different respondent groups.
Nurse aide training has not kept pace with nursing home industry needs
Approximately 90 percent of our respondents (nursing home supervisors, nurse aide trainers, State ombudsmen, State directors of nurse aide training programs, and experts) reported that the medical and personal care needs of today’s nursing home residents have changed since implementation of OBRA 87. We held discussions with nursing home staff and experts who indicated that compared to nursing home residents 15 years ago, today’s nursing home residents are older, sicker, require more assistance with activities of daily living, and take more medications. Approximately half of the nursing home supervisors we interviewed, and 61 percent of State directors of nurse aide training programs believe that nurse aide training has not kept pace with demands of the changing care needs of nursing home residents.
Nurse aides need more skill training on behavior and cognitive disorders, catheter care, colostomy care, lifting, feeding, hydration, and infusion therapies. They also need more training in interpersonal skills, including communication, teamwork, coping with death and dying, time management, and new technologies.
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