CNA training requirements: the 75-hour federal floor and what your state adds

The federal floor

Every state-approved nurse aide training and competency evaluation programme must, at minimum, under 42 CFR 483.152(a):

• Consist of no less than 75 clock hours of training.
• Include at least 16 hours of supervised practical training — training in a laboratory or other setting where the trainee performs tasks on an individual under the direct supervision of a registered nurse or licensed practical nurse.
• Ensure trainees perform no service they have not been trained in and found proficient at, and that trainees providing services to residents are under the general supervision of a licensed or registered nurse.

The federal figure is a minimum ("at a minimum" in 483.152(a)), and your state may require more — check your state handbook.

The 16 hours that come first

Section 483.152(b)(1) requires at least 16 hours of training in five areas before any direct contact with a resident:

1. Communication and interpersonal skills
2. Infection control
3. Safety and emergency procedures, including the Heimlich maneuver
4. Promoting residents' independence
5. Respecting residents' rights

These are named in the regulation, and they map directly onto areas of the written exam.

Who may teach

Training must be performed by, or under the general supervision of, a registered nurse with at least two years of nursing experience, at least one year of which is in long-term care. Instructors must have completed a course in teaching adults, or have experience teaching adults or supervising nurse aides. Other health professionals may supplement the instructor if they have at least a year in their field.

In a facility-based programme the director of nursing may supervise the training but is prohibited from performing the actual training.

The curriculum

Section 483.152(b) lists the areas the curriculum must cover, and section 483.154(b)(1)(ii) requires the examination to address each one. That is the legal link between what you are taught and what you are tested on:

• Basic nursing skills — vital signs, height and weight, the resident's environment, recognising and reporting abnormal changes, care when death is imminent
• Personal care skills — bathing, grooming including mouth care, dressing, toileting, eating and hydration, proper feeding technique, skin care, transfers, positioning and turning
• Mental health and social service needs
• Care of cognitively impaired residents
• Basic restorative services
• Residents' rights

You may not be charged

This is worth knowing and is routinely missed. Under 483.152(c) and 483.154(c)(2), a nurse aide who is employed by, or who has received an offer of employment from, a facility may not be charged for any part of the training or the competency evaluation.

And under 483.152(c)(2) (training) and 483.154(c)(3) (competency evaluation), if you were not employed when you completed the programme but a facility employs you or offers you a job within 12 months, the state must provide for pro rata reimbursement of what you paid.

The registry

A record of successful completion must be entered in the state nurse aide registry within 30 days of your being found competent, under 483.154(e)(2). The state must tell you in advance that this will happen.