4152878 Proposed Rulemaking to add Chapters 94 (Dialysis Technicians), 95 (Medication Aides), and 96 (Certified Nurse Assistants and Patient Care Technicians).
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DEPARTMENT OF HEALTH
NOTICE OF PROPOSED RULEMAKING
The Director of the Department of Health, pursuant to the authority set forth in
sectionSection 302(14) of the District of Columbia Health Occupations Revision Act of 1985, effective March 15, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1203.02(14) (2007 Repl.), and Mayor’s Order 98-140, dated August 20, 1998, hereby gives notice of proposed rulemaking action to adopt the following new Chapters 94 (Dialysis Technicians), 95 (Medication Aides), and 96 (Certified Nurse Assistants and Patient Care Technicians), to Title 17 (Business, Occupations and Professions) of the District of Columbia Municipal Regulations (DCMR).These regulations are required pursuant to the Practice of Nursing Amendment Act of 2009, effective July 7, 2009 (D.C. Law 18-18; D.C. Official Code § 3-1201.01 et seq.). The purpose of these regulations is establish registration processes and training programs for dialysis technicians, medication aides, certified nurse assistants, and patient care technicians in the District of Columbia.
)The Director also gives notice of the intent to take final rulemaking action to adopt the proposed rules in not less than thirty (30) days from the date of publication of this notice in the D.C. Register. The proposed rules shall not become effective until a Notice of Final Rulemaking is published in the D.C. Register.
Title 17 (Business, Occupations and Professions) of the DCMR is amended as follows:
Chapter 94 (Dialysis Technicians) is added to read as follows:
CHAPTER 94 DIALYSIS TECHNICIANS
9400 GENERAL PROVISIONS
9401 REGISTRATION
9402 TERM OF REGISTRATION
9403 CRIMINAL BACKGROUND CHECK
9404 APPLICATION FOR REGISTRATION
9405 RESERVED
9406 REGISTRATION BY ENDORSEMENT
9407 RENEWAL OF REGISTRATION
9408 INACTIVE STATUS; REACTIVATION OF REGISTRATION
9410 RESERVED
9411 PERFORMANCE REVIEWS; CONTINUING EDUCATION OR IN- SERVICE
9412 RESERVED
9413 ASSIGNMENT AND DELEGATION OF NURSING CARE TASKS TO DIALYSIS TECHNICIANS
9414 RESERVED
9415 DIALYSIS TECHNICIAN TASKS
9416 RESERVED
9417 DISCIPLINE
9418 RESERVED
9419 RESERVED
9420 STANDARDS FOR DIALYSIS TECHNICIAN TRAINING PROGRAMS
9421 SUPERVISED PRACTICE OF DIALYSIS TECHNICIAN TRAINEES
9422 RESERVED
9423 RESERVED
9424 DIALYSIS TECHNICIAN PROGRAM APPROVAL PROCEDURES
9425 PERIODIC REVIEW OF APPROVED PROGRAMS
9426 RESERVED
9427 DIALYSIS TECHNICIAN TRAINING PROGRAM
9428 MINIMUM QUALIFICATIONS FOR DIALYSIS TECHNICIAN TRAINEES
9429 RESERVED
9430 CLOSING OF EDUCATION AND TRAINING PROGRAMS
9431 RECORDS RETENTION
9432 RESOURCES, FACILITIES, AND SERVICES
9499 DEFINITIONS
9400 GENERAL PROVISIONS
9400.1 This chapter applies to applicants for, and holders of, a registration to practice as a dialysis technician (DT).
9400.2 Chapter 40 (Health Occupations: General Rules) and 41 (Health Occupations: Administrative Procedures) of this title shall supplement this chapter.
9401 REGISTRATION
9401.1 No person shall practice as a DT in the District of Columbia longer than eighteen (18) months without first being registered by the Board of Nursing (Board).
9401.2 A DT shall be certified pursuant to § 9404.1(d) and registered by the Board within eighteen (18) months of his or her hire date. If a DT who is not certified changes employment from one dialysis facility to another, the time he or she was employed in the first facility shall count towards the eighteen (18) month period for certification unless he or she had a gap in employment as a DT of more than eighteen (18) months.
9402 TERM OF REGISTRATION
9402.1 Subject to § 9401.1, a registration issued pursuant to this chapter shall expire at 11:59 a.m. of October 30 of each even-numbered year.
9402.2 The Director may modify the renewal system pursuant to § 4006.3 of chapter 40 of this title and may modify the date on which a registration expires.
9403 CRIMINAL BACKGROUND CHECK
9403.1 A person applying for registration as a DT shall undergo a criminal background check (CBC) prior to issuance of the registration.
9403.2 After issuance of an initial registration, the applicant shall undergo an additional background check every four (4) years or at another time interval as determined by the Department of Health.
9403.3 The applicant shall pay a fee for the CBC.
9403.4 The Board shall receive and review the results of a CBC of a person if, within the seven (7) years preceding the CBC, the person has been convicted in the District of Columbia, or in any state or territory of the United States where the person has worked or resided, of any of the following offenses or their equivalent:
(a) Murder, attempted murder, or manslaughter;
(b) Arson;
(c) Assault, battery, assault and battery, assault with a dangerous weapon, mayhem or threats to do bodily harm;
(d) Burglary;
(e) Robbery;
(f) Kidnapping;
(g) Theft, fraud, forgery, extortion or blackmail;
(h) Illegal use or possession of a firearm;
(i) Trespass or injury to property;
(j) Rape, sexual assault, sexual battery, or sexual abuse;
(k) Child abuse or cruelty to children;
(l) Adult abuse, neglect or exploitation; or
(m) Unlawful distribution or possession with intent to distribute, of a controlled substance.
9404 APPLICATION FOR REGISTRATION
9404.1 Persons applying for registration as a DT shall:
(a) Be at least eighteen (18) years of age;
(b) Have graduated from high school or have a graduate equivalency diploma (GED);
(c) Submit an application and application fee;
(d) Submit evidence of current certification by one of the following:
(1) The Certified Clinical Hemodialysis Technician (CCHT) Examination offered by the Nephrology Nursing Certification Commission (NNCC);
(2) The Board of Nephrology Examiners for Nursing and Technology (BONENT) examination;
(3) The National Nephrology Certification Organization (NNCO) examination; or
(4) Other certification program recognized by the Centers for Medicare and Medicaid Services and the Board of Nursing.
9405 RESERVED
9406 REGISTRATION BY ENDORSEMENT
9406.1 An applicant for endorsement as a DT shall provide proof of the following:
(a) That he or she is certified as a DT by a certifying body recognized by the Board; and
(b) That the certification is, registration or licensure from another
jurisdiction is unencumbered, if applicable.
9407 RENEWAL OF REGISTRATION
9407.1 An applicant for renewal shall have:
(a) Completed at least twenty four (24) hours of continuing education in the area of dialysis or areas relevant to practice during the certification period;
(b) Practiced for a minimum of one hundred (100) hours during the prior twenty-four (24) months as a DT under the supervision of a licensed nurse;
(c) Held a current certification as DT; and
(d) Completed a CBC as required.
9408 INACTIVE STATUS; REACTIVATION OF REGISTRATION
9409 REINSTATEMENT OF EXPIRED REGISTRATION
9409.1 If a DT fails to renew his or her registration, the Board shall reinstate the registration if the applicant:
(b) Provides evidence of current certification; and
9411 PERFORMANCE REVIEWS; CONTINUING EDUCATION OR IN- SERVICE
9411.1 An employer shall complete a performance review of every DT at least once every twelve (12) months.
9411.2 The employer shall provide regular in-service education or continuing education based on the outcome of the performance review. The in-service education or continuing education shall:
(a) Be sufficient to ensure the continuing competence of the DT, but not less than twelve (12) hours per year; and
(b) Address areas of weakness as determined in the DT’s performance review and may address the special needs of clients as determined by the employer’s staff.
9411.3 In-service programs or continuing education provided for the dialysis technician shall be:
(a) Current in subject matter;
(b) Developed and taught by qualified individuals; and
(c) Relevant to the role of the DT.
9411.4 A minimum of two (2) hours of in-service or continuing education per year shall be required and shall include any Board mandated topics.
9412 RESERVED
9413 ASSIGNMENT AND DELEGATION OF NURSING CARE TASKS TO DIALYSIS TECHNICIANS
9413.1 A licensed nurse may delegate nursing care tasks to a DT.
9413.2 A DT shall not practice independently but shall work under the supervision of a licensed nurse.
9413.3 Dialysis tasks that may be delegated to a technician shall depend upon:
(a) The knowledge and skills of the DT;
(b) Verification of the clinical competence of the DT by the employing agency;
(c) The stability of the client’s condition that involves predictability, absence of risk of complication, and rate of change;
(d) The variables in each health care setting which include, but are not limited to:
(1) The accessible resources and established policies, procedures, practices and channels of communication that lend support to the type of dialysis tasks, functions, or activities being delegated to a DT;
(2) The complexity and frequency of care needed by a given client population;
(3) The proximity of clients to staff;
(4) The number and qualifications of staff; and
(5) The accessibility of the licensed nurse or other licensed health professionals.
9413.4 Dialysis that inherently involves on-going assessment, interpretation or decision making that cannot be logically separated from the procedure(s) shall not be delegated to DT.
9414 RESERVED
9415 DIALYSIS TECHNICIAN TASKS
9415.1 Under the supervision of a licensed nurse, nurse practitioner, or physician,
a DT may provide the following services:
(a) Preparing and cannulation of peripheral access sites (arterial-venous fistulas and arterial-venous grafts);
(b) Initiating, deliver or discontinue dialysis care;
(c) Measuring and record temperature, pulse, respiration, and blood pressure when initiating, delivering, or discontinuing dialysis client care;
(d) Administering the following medications only:
(1) Anticoagulants either to prime the pump, initiate treatment, or for administration throughout the treatment, in an amount prescribed by a licensed provider;
(2) Normal saline via the dialysis machine to correct dialysis induced hypotension based on the facility’s medical protocol, provided that amounts beyond that established in the facility’s medical protocol shall not be administered without the direction from a registered nurse, nurse practitioner, physician, or physician assistant; and
(3) Intradermal anesthetics in an amount prescribed by a physician, physician’s assistant, or nurse practitioner.
(e) Assisting the registered nurse in data collection;
(f) Obtaining a blood specimen via a dialysis line or a peripheral access site;
(g) Responding to complications that arise in conjunction with dialysis care;
(h) Performing other acts, as delegated by the registered nurse, for which the DT is qualified;
(i) Initiating and discontinuing treatment via arterio-venous access; and
(j) Caring for a central venous catheter.
9415.2 The scope of practice of a DT shall not include:
(a) Dialysis care for a client whose condition is determined by the registered nurse to be critical, fluctuating, or unpredictable; and
(b) The administration of blood and blood products.
9415.3 A DT shall not take orders for dialysis treatment and shall not alter dialysis orders as prescribed by a nurse practitioner or physician.
9415.4 DTs, where appropriate, shall provide care based upon standing treatment protocols.
9416 RESERVED
9417 DISCIPLINE
9417.1 The Board may revoke, suspend, or deny the registration of any DT who is convicted during a period of registration, of any of the crimes listed in §9417.2 or any act specified in D.C. Official Code § 3-1205.14 (2012 Supp.).
9417.2 In addition to any other disciplinary action it may take, the Board may impose a civil penalty of not more than five thousand dollars ($5,000) per violation or file a letter of concern if the Board believes there is insufficient evidence to support direct action against the DT.
9417.3 Grounds for denial, suspension, revocation or other discipline of a DT include, but are not limited to evidence of: including but not limited to:
(a) Substance abuse or other chemical dependency;
(b) Client abandonment;
(c) Fraud or deceit, which may include but is not limited to:
(1) Filing false credentials;
(2) Falsely representing facts on an application for initial certification, reinstatement or renewal; or
(3) Giving or receiving assistance in taking the competency evaluation.
(d) Client neglect, abuse or misappropriation of funds;
(e) Boundary violations;
(f) Unsafe client care;
(g) Performing acts beyond the DT’s range of functions or beyond those tasks delegated;
(h) Misappropriation or misuse of property;
(i) Criminal conviction;
(j) Failure to conform to acceptable standards of practice as a dialysis technician;
(k) Putting clients at risk of harm; or
(l) Violating the privacy or failing to maintain the confidentiality of client information.
9417.3 The Board shall maintain records of disciplinary actions.
9417.4 DTs who are unable to perform their duties due to drug or alcohol dependency or mental illness may utilize the services offered under the Nurse’s Rehabilitation Program pursuant to D.C. Official Code §3-1251.01, et seq., (2012 Supp.). [cpe1]
9418 RESERVED
9419 RESERVED
9420 STANDARDS FOR DIALYSIS TRAINING PROGRAMS
9420.1 No institution shall provide DT training in the District of Columbia unless its training program has been approved by the Board.
9420.2 The following types of institutions may apply for approval to provide DT training:
(a) Private degree-granting educational institutions that operate or are incorporated in the District of Columbia and are licensed by the Education Licensure Commission pursuant to the Educational Institution Licensure Act of 1976; (D.C. Law 1-104; D.C. Official Code § 38-1301, et seq. (2001 Ed. and 2012 Supp.));
(b) Private non-degree-granting post secondary schools that operate in the District of Columbia and are licensed by the Education Licensure Commission;
(c) District public universities or colleges; and
(d) Health care facilities that are licensed and operate in the District of Columbia and that have received no adverse actions against them during the preceding two (2) years.
9420.3 The Board shall consider any one (1) of the following as an adverse action which would preclude a health care facility from providing DT training:
(a) The termination, restriction, or revocation of a facility's participation in the Medicaid or Medicare program;
(b) The fact that there is a restricted or provisional license for a facility, other than a new facility; or
(c) The fact that a facility has a provider agreement of less than one (1) year.
9420.4 All DT training programs shall have adequate faculty, preceptors, and clinical facilities to provide supervised clinical experience with early, realistic exposure to job requirements. The clinical experience shall include the full range of skills needed in the workplace.
9421 SUPERVISED PRACTICE OF DIALYSIS TRAINEES
9421.1 A trainee or DT applicant may practice as a dialysis technician only in accordance with the Act and this chapter.
9421.2 A trainee who is fulfilling educational requirements under this chapter shall be authorized to engage in supervised practice as a DT trainee without a District of Columbia registration.
9421.3 A DT who has completed a training program may function as a DT trainee for the eighteen (18) month period prior to sitting for a certification examination, consistent with federal requirements and following the examination until the scores are received.
9421.4 All supervised practice of a trainee shall take place under immediate or direct supervision of a licensed nurse.
9421.5 A person who has been denied registration, disciplined, convicted of an offense that bears directly upon his or her fitness to be registered, or who has a disciplinary or criminal action pending in the District of Columbia or other jurisdiction shall not practice pursuant to this section unless first authorized to practice by the Board in writing.
9421.6 A trainee shall identify himself or herself as such before practicing as a DT. A trainee shall wear a picture identification badge with lettering clearly visible to the client bearing the name of the trainee and the position title.
9421.7 A trainee shall not receive compensation of any nature, directly or indirectly, from a client, or his or her family member.
9421.8 The supervising nurse shall be responsible for all practice by a trainee during the period of supervision and may be subject to disciplinary action for violations of the Act or this chapter by the trainee.
9422 RESERVED
9423 RESERVED
9424 DIALYSIS TECHNICIAN PROGRAM APPROVAL PROCEDURES
9424.1 Each institution applying for approval to provide DT training shall do the following:
(a) Submit to the Board a statement of intent to establish a dialysis technician training program;
(b) Submit to the Board an application for approval which provides information regarding the following:
(1) A statement of purpose;
(2) A statement of need for the training program in the District of
Columbia;
(3) A description of the proposed program's potential effect on existing DT training programs in the area;
(4) The organizational structure of the institution showing the relationship of the proposed training program within the organization;
(5) The availability of qualified instructors;
(6) The number of budgeted instructor positions;
(7) The availability of adequate clinical facilities for the training program;
(8) The anticipated trainee population and tentative time schedule for planning and initiating the program; and
(9) Fee schedules.
(c) Submit the application fee.
9424.2 After reviewing the application, based on the applicant’s compliance with §§ 9427 and 9432, a decision shall be made to:
(a) Approve the application;
(b) Defer approval if additional information is needed; or
(c) Deny approval of the application.
9424.3 If an application approval has been granted, a site visit shall be conducted by the Board to determine the program’s compliance with § 9427 and the program’s ability to meet criteria set forth in §§ 9431 and 9432.
9424.4 After reviewing the site visit report, the Board shall vote to approve, deny, or defer program approval based upon resource, facility, or service concerns.
9424.5 A training program shall not admit trainees to the program before the program has been approved by the Board.
9425 PERIODIC REVIEWS OF APPROVED PROGRAMS
9425.1 Programs approved by the Board to train DTs shall submit to the Board an annual report in accordance with procedures set out by the Board.
9425.2 The Board shall re-evaluate DT training programs at least once a year.
9425.3 The Board may make unannounced visits to review and assess each DT training program to ensure that the program is in compliance with §§ 9427, 9431, and 9432.
9425.4 The Board shall assess each training program on the basis of visits to the facility, the progress of the training program, annual reporting, and any other information deemed appropriate by the Board.
9425.5 The Board shall withdraw approval of a training program if:
(a) It determines that the program is not in compliance with standards set forth in §§ 9427, 9431, and 9432;
(b) The program does not permit an unannounced site visit;
(c) The institution loses its license from the Education Licensure Commission or has an adverse action which would preclude a health care facility from providing DT training; or
(d) The training program has not enrolled a DT class in at least twelve (12) months or more.
9425.6 If the training program does not meet the requirements for continued approval, the Board may grant conditional approval pending correction of the deficiencies, for the following reasons:
(a) The program has not met or maintained the Board’s regulatory requirements;
(b) The program has failed to correct the deficiencies identified by the Board within the allotted time period;
(c) The program has failed to hire a nurse administrator for a minimum of one-half (0.5) full-time equivalent (FTE) instructor positions who meets the Board’s qualifications;
(d) The program fails to hire faculty who meet the Board’s qualifications;
(e) The program has not complied with their objectives or policies;
(f) The program fails to implement the District-approved curriculum;
(g) The program fails to submit records and reports to the Board in a timely
manner; or
(h) The program is noncompliant with any of the regulations in this chapter, and other activities or situations, as determined by the Board that indicate the program is not meeting the legal requirements and standards of vocational education.
9425.7 Programs placed in conditional approval status may be required to comply with any or all of the following conditions:
(a) Prohibit a program from admitting new students;
(b) Require the program to limit student admissions;
(c) Reduce the frequency of classes that are offered; or
(d) Any other conditions deemed necessary by the Board to assure that the program meets the regulatory requirements of this chapter.
9425.8 Training program deficiencies sufficient to warrant withdrawal of approval shall include, but are not limited to:
(a) Continued failure to fully implement the District-approved curriculum for
the training program;
(b) Continued failure to maintain an adequate number of instructors with required qualifications;
(c) Continued failure of trainees to demonstrate adequate competencies upon employment;
(d) Continued failure to adhere to the training program’s stated objectives, and policies; or
(e) Continued failure to maintain adequate resources, facilities, and services required to meet training objectives.
9425.9 The Board may consider reinstatement or approval of a training program upon submission of satisfactory evidence that the program meets the standards set forth in this chapter.
9425.10 The Board may investigate complaints made against a program and may conduct hearings in connection with such complaints.
9425.11 Any Board action for suspension or withdrawal of a training program’s approval shall take place only upon notice to the program and the opportunity for a hearing in accordance with D.C. Official Code § 3-1205.14 (2012 Supp.).
9426 RESERVED
9427 DIALYSIS TECHNICIAN TRAINING PROGRAM
9427.1 The training program shall prepare the DT to perform Board approved core skills and the role-specific skills listed in §9415.
9427.2 The training program for a DT shall include a minimum of one hundred sixty two (162) hours of didactic instruction skills lab, and a minimum of two hundred and forty (240) hours of instruction in a clinical setting.
9427.3 Each training program’s curriculum shall prepare trainees to practice as required in § 9415 prior to any direct contact with a client.
9427.4 Each training program shall report to the Board for approval of any proposed change in its curriculum prior to the implementation of the change.
9427.5 Each training program shall provide trainees with information on the policies governing admission, retention, dismissal, and the course requirements of the training program in writing.
9427.6 Each training program shall require testing and vaccination of applicants for communicable disease prior to admission.
9427.7 Each training program shall have a sufficient number of qualified instructors to meet the purposes and objectives of the program.
9427.8 The training program shall be coordinated by a registered nurse with:
(a) A current, unencumbered District of Columbia license;
(b) At least two (2) years of experience as a registered nurse; and
(c) Clinical experience in the practice setting that he or she is coordinating.
9427.9 The program coordinator’s responsibilities shall include, but not be limited to:
(a) Ensuring that the curriculum is coordinated and implemented in accordance with this chapter;
(b) Establishing job descriptions stating the responsibilities of the instructors;
(c) Ensuring that each instructor meets the qualifications specified in this chapter;
(d) Ensuring that each student is properly supervised during the student’s clinical experience; and
(e) Ensuring that each clinical preceptor evaluates the student’s performance and provides the evaluation results to the clinical instructor.
9427.10 The training for DTs shall be performed by a registered nurse licensed in the District of Columbia who has a minimum of two (2) years of current clinical experience as a renal dialysis nurse.
9427.11 A licensed, qualified health professional as listed in D.C. Official Code § 3-1201.02 (2012 Supp.) who has a minimum of two (2) years of experience may participate in DT training in non-client care related content.
9427.12 The following conditions shall be met when clinical preceptors are used:
(a) The criteria for selecting a clinical preceptor shall be in writing and shall include the following:
(1) The method of selecting clinical preceptors;
(2) The plans for orientation of clinical preceptors;
(3) The clinical objectives or outcomes of the preceptorship; and
(4) A system for monitoring and evaluating the preceptor’s learning experiences.
9427.13 There shall be a written agreement between the preceptor and the training program specifying the following:
(a) The clinical objectives or outcomes; and
(b) The system used for monitoring and evaluating the trainee’s learning experiences.
9427.14 The clinical instructor shall:
(a) Retain responsibility for the trainee’s learning experiences and meet periodically with the clinical preceptor and the trainee to monitor and evaluate the trainee’s learning experiences; and
(b) Be readily available, either directly or by a communication device, when preceptors are in the clinical area.
9427.15 The clinical preceptor shall have:
(a) A minimum of two (2) years of experience as a licensed nurse or certified DT;
(b) Experience providing direct client care during the five (5) years immediately preceding the date of the written agreement between the preceptor and the training program;
(c) A philosophy of health care congruent with that of the dialysis technician program; and
(d) Current knowledge of practice at the DT level.
9427.16 Each clinical instructor and preceptor shall be licensed or certified in the District of Columbia.
9427.17 Clinical instruction shall be offered in a facility that provides dialysis services.
9427.18 The ratio of clinical instructors to trainees in clinical areas involving direct care of clients shall:
(a) Be based upon the client acuity level, skill level of the trainee, and the clinical setting; and
(b) Not exceed one (1) instructor or preceptor to two (2) trainees.
9427.19 Each clinical instructor and preceptor’s qualifications shall be documented in the official records of the program and shall be available for review by the Board.
9427.20 Each clinical instructor shall be responsible for:
(a) Assisting in the development, implementation, and evaluation of the objectives of the training program;
(b) Helping to implement and evaluate the curriculum;
(c) Facilitating preceptor participation in the program and evaluating the progress and retention of preceptors in the program;
(d) Giving guidance to preceptors;
(e) Evaluating preceptor achievement in the program;
(f) Providing for preceptor and peer evaluation of his or her teaching effectiveness; and
(g) Participating in continuing nursing education programs to improve his or her competence in areas of responsibilities.
9428 MINIMUM QUALIFITICATIONS FOR DIALYSIS TECHNICIAN TRAINEES
9428.1 Each trainee shall be a high school graduate or have completed a graduate
equivalency diploma program.
9428.2 Each trainee shall be required to take a pre-admission examination to assess
reading, writing, and math skills prior to enrollment in a training program.
9429 RESERVED
9430 CLOSING OF EDUCATION AND TRAINING PROGRAMS
9430.1 Each DT training program that voluntarily closes shall:
(a) As early as possible, notify the Board, in writing, of the intended closing, stating the reason(s) for and planned date of the intended closing;
(b) Continue the training program until the committed class scheduled for currently enrolled trainees is completed; and
(c) Notify the Board of the final closing date at least thirty (30) days before the final closing.
9430.2 If the Board denies or withdraws approval of a training program, the institution shall:
(a) Close the program on the date provided by the Board;
(b) Submit to the Board a list of all program graduates and all current trainees transferred to approved programs and dates of transfer; and
(c) Comply with the requirements of all applicable rules and notify the Board that the requirements have been fulfilled.
9431 RECORDS RETENTION
9431.1 Each DT training program shall maintain an accurate and appropriate system of record keeping.
9431.2 Each DT training program shall ensure that administrative and personnel records are protected against loss, destruction, and unauthorized review.
9431.3 A record for each trainee shall be maintained by the facility and shall include the trainee’s evaluation and health information.
9431.4 Each instructor’s personnel records shall be maintained by the facility and shall include application data, qualifications, and position description.
9431.5 All records shall be maintained by the DT training program for a minimum of five (5) years.
9432 RESOURCES, FACILITIES, AND SERVICES
9432.1 Each DT training program shall maintain resources, facilities, and services which are adequate to accommodate the training program. The resources, facilities, and services shall include, but are not limited to:
(a) Adequate temperature controls in each training facility;
(b) Clean and safe conditions of the facility’s premises;
(c) Adequate space to accommodate faculty;
(d) Adequate lighting in each facility; and
(e) Sufficient and adequate equipment for the program’s needs, including audio-visual equipment and equipment needed for simulating client care.
9432.2 Each classroom, conference room, laboratory, and office shall be adequate to meet the needs of the DT training program.
9432.3 Each cooperative agreement between a DT training program and a facility shall be in writing. The training program shall maintain a copy of the agreement in its records.
9499 DEFINITIONS
9499.1 As used in this chapter, the following terms shall have the meanings
ascribed:
Abuse – Any willful or reckless act or omission by a DT that causes or is likely to cause or contribute to, or which caused or is likely to have caused or contributed to, physical or emotional injury, death, or financial exploitation of a client.
Activities of daily living - Self-care activities which a person performs independently, when able, to sustain personal needs or to participate in society.
Applicant - A person applying for a registration to practice as a DT.
Board - The Board of Nursing, established by § 204, D.C. Law 6-99, D.C. Official Code § 3-1202.04 (1985).
Boundary violation: Non-therapeutic relationships that are formed between a
DT and a client in which the DT derives a benefit at the client’s expense.
Clinical - Faculty planned and guided learning activities designed to assist preceptors in meeting course objectives and to apply nursing knowledge and skills in the direct care of clients, including clinical conferences and planned learning activities in acute care facilities, and other community resources. Clinical shall not include skills lab activities.
Clinical preceptor - An individual meeting the requirements of this chapter that is an employee of a clinical agency who works with a trainee in a clinical setting to facilitate student learning in a manner specified in a signed written agreement between the agency and the educational institution.
Clinical preceptorship - An organized system of clinical experiences which allows a DT trainee to be paired with a clinical preceptor for the purpose of attaining specific learning objectives.
Conditional approval - The approval status that is granted for a time period, specified by the Board, to a DT training program to correct deficiencies when the program has failed to meet or maintain the requirements and standards of this chapter.
Direct supervision - Supervision in which the supervisor is physically present and accessible in the immediate client area and is available to intervene if necessary.
Endorsement - The process of issuing a certification to a DT applicant who is registered by a state board and recognized by the Board as a qualified professional according to standards that were the substantial equivalent at the time of the certification to the standards for that profession set forth in this chapter and who has continually remained in good standing with the Board from the date of certification until the date of certification in the District.
Immediate supervision - Supervision in which the supervisor is on the premises and within vocal communication, either directly or by communication device.
In-service – Learning experiences provided in the work setting for the purpose of assisting staff members in performing their assigned functions in that particular agency or institution; and consists of activities intended to assist the DT to acquire, maintain, or increase competence in fulfilling the assigned responsibilities specific to the expectations of the employer.
Neglect –Any act or omission by a home health aide which causes or is likely to cause or contribute to, or which caused or is likely to have caused or contributed to the injury, death, or financial explotation of a consumer.
Reinstatement –Reissuance of an expired DT registration.
9499.2 The definitions in § 4099 of chapter 40 of this title are incorporated by reference into, and are applicable to, this chapter.
Chapter 95 (Medication Aide-Certified) is added to read as follows:
CHAPTER 95 MEDICATION AIDE-CERTIFIED
9500 GENERAL PROVISIONS
9501 CERTIFICATION
9502 TERM OF CERTIFICATION
9503 CRIMINAL BACKGROUND CHECK
9504 APPLICATION FOR CERTIFICATION
9505 CERTIFICATION BY EXAMINATION
9506 CERTIFIED MEDICATION AIDE ENDORSEMENT
9507 RENEWAL OF CERTIFICATION
9508 INACTIVE STATUS; REACTIVATION OF CERTIFICATION
9510 RESERVED
9511 RESERVED
9512 RESERVED
9513 ASSIGNMENT AND DELEGATION OF NURSING CARE TASKS TO MEDICATION AIDES
9514 RESERVED
9515 MEDICATION AIDE TASKS
9516 REPORTING REQUIREMENTS
9517 DISCIPLINE
9518 RESERVED
9519 RESERVED
9520 STANDARDS FOR MEDICATION AIDE TRAINING PROGRAMS
9521 SUPERVISED PRACTICE OF MEDICATION AIDE TRAINEES
9522 RESERVED
9523 RESERVED
9524 MEDICATION AIDE PROGRAM APPROVAL PROCEDURES
9525 PERIODIC REVIEW OF APPROVED PROGRAMS
9526 RESERVED
9527 MEDICATION AIDE TRAINING PROGRAM
9528 MIMIMUM QUALIFACATIONS FOR MEDICATION AIDE TRAINEES
9529 RESERVED
9530 CLOSING OF EDUCATION AND TRAINING PROGRAMS
9531 RECORDS RETENTION
9532 RESOURCES, FACILITIES, AND SERVICES
9599 DEFINITIONS
9500 GENERAL PROVISIONS
9500.1 This chapter applies to applicants for, and holders of, a certification to practice as a medication aide.
9500.2 Chapter 40 (Health Occupations: General Rules) and 41 (Health Occupations: Administrative Procedures) of this title shall supplement this chapter.
9501 CERTIFICATION
9501.1 No person shall practice as a medication aide in the District of Columbia without first being certified by the Board of Nursing (Board).
9502 TERM OF CERTIFICATION
9502.1 Subject to § 9501.1, a medication aide certification issued pursuant to this chapter shall expire at 11:59 on October 30 of each odd-numbered year for medication aides.
9502.2 The Director may modify the renewal system pursuant to § 4006.3 of chapter 40 of this title and may modify the date on which a certification expires.
9503 CRIMINAL BACKGROUND CHECK
9503.1 A person applying for certification as a medication aide shall undergo a criminal background check (CBC) prior to issuance of the certification.
9503.2 After issuance of an initial certification, the applicant shall undergo an additional CBC every four (4) years or as determined by the Department of Health.
9503.3 The applicant shall pay a fee for the CBC.
9503.4 The Board shall receive and review the results of a CBC of a person if, within the seven (7) years preceding the CBC, the person has been convicted in the District of Columbia, or in any state or territory of the United States where the person has worked or resided, of any of the following offenses or their equivalent:
(a) Murder, attempted murder, or manslaughter;
(b) Arson;
(c) Assault, battery, assault and battery, assault with a dangerous weapon, mayhem or threats to do bodily harm;
(d) Burglary;
(e) Robbery;
(f) Kidnapping;
(g) Theft, fraud, forgery, extortion or blackmail;
(h) Illegal use or possession of a firearm;
(i) Trespass or injury to property;
(j) Rape, sexual assault, sexual battery, or sexual abuse;
(k) Child abuse or cruelty to children;
(l) Adult abuse, neglect or exploitation; or
(m) Unlawful distribution or possession with intent to distribute, of a controlled substance.
9504 APPLICATION FOR CERTIFICATION
9504.1 Persons applying for certification as a medication aide shall:
(a) Be at least eighteen (18) years of age;
(b) Provide evidence of having completed an approved medication aide course;
(d) Meet the requirements of § 9503;
(d) Submit a completed application to the Board;
(e) Submit any other documents that may be required by the Board; and
(f) Pay all required fees.
9504.2 An application that remains incomplete for ninety (90) days or more from the date of submission shall be considered abandoned, and closed by the Board. The applicant shall thereafter be required to reapply, comply with the current requirements for licensure, and pay the required fees.
9505 CERTIFICATION BY EXAMINATION
To qualify for certification by examination a medication aide applicant shall pass the National Council of Boards of Nursing’s (NCSBN) Medication Aide Certification Exam (MACE); and
9505.1 To apply for authorization to take a medication aide examination an applicant
shall provide proof of successful completion within the past six (6) month of a
medication aide course with standards determined by the Board to be comparative to the standards in the District of Columbia.
9505.3 Applicants shall take the certification examination not later than ninety (90) days following submission of the application. The Board may, in its discretion, grant an extension of the time requirement if the applicant’s failure to sit for the examination was for good cause. As used in this section “good cause” includes the following:
(a) Serious and protracted illness of the applicant; or
(b) The death or serious and protracted illness of a member of the applicant’s
immediate family.
9505.4 To request special accommodations for an examination, an applicant shall
submit in writing, the following information:
(a) A letter from the appropriate health professional which confirms the
disability and provides information describing the accommodations required; and
(b) A letter from the candidate’s education program, indicating what
modifications were granted by the program.
9505.5 If an applicant has not taken or passed the MACE for more than one (1) year after the date the applicant becomes eligible to apply to take the examination, the applicant shall provide evidence of completion of a new training program.
9505.6 Persons completing course work which includes medication administration and pharmacology from a registered nurse or practical nurse program may request a waiver from the medication aide examination and shall comply with § 9504.1.
9506 CERTIFIED MEDICATION AIDE ENDORSEMENT
9506.1 An applicant for (MA-C) endorsement shall submit proof of:
(a) Having completed a comparable medication aide course in another
jurisdiction;
(b) Current certification, registration or licensure as a certified medication aide or its equivalent;
(c) Having passed the MACE or other medication aide examination
accepted by the Board; and
(d) Having met the requirements of § 9504.
9507 RENEWAL OF CERTIFICATION
9507.1 Renewal applicants shall provide verification of completion of twelve (12) hours per year, twenty-four (24) hours total of in-service training or continuing education.
9507.2 Pursuant to § 9507.1 six (6) of the twenty four (24) in-service or continuing education hours shall include pharmacology or medication administration.
9507.3 A minimum of two (2) hours of in-service or continuing education shall include any Board mandated topics.
9507.4 MA-Cs who have another active District of Columbia certification as nursing assistive personnel (NAP) may apply continuing education hours to all NAP renewal requirements.
9507.5 Applications will be subject to audit to assure compliance with the above requirements.
9508 INACTIVE STATUS; REACTIVATION OF CERTIFICATION
9509 REINSTATEMENT OF EXPIRED CERTIFICATION
(a) Having a current certification in another jurisdiction approved by the Board; or
(b) Having practiced for a minimum of one hundred (100) hours within the last twenty-four (24) months under the supervision of a licensed nurse.
9510 RESERVED
9511 RESERVED
9512 RESERVED
9513 ASSIGNMENT AND DELEGATION OF NURSING CARE TASKS TO MEDICATION AIDES
9513.1 A licensed nurse may delegate a task to an MA-C if the task is appropriate to the level of knowledge and skill of the MA-C and is within the scope of authorized tasks of an MA-C.
9513.2 MA-C’s shall not practice independently but shall work under the supervision of a licensed nurse.
9513.3 The delegation shall comply with the standards for delegation listed in 17 DCMR §§ 5400 and 5500.
9513.4 Nursing care tasks that may be delegated shall be determined by:
(a) The knowledge and skills of the MA-C;
(b) Verification of the clinical competence of the MA-C by the employing agency;
(c) The stability of the client’s condition, including factors such as predictability, absence of risk of complication, and rate of change; and
(d) The variables in each health care setting which include, but are not limited to:
(1) The accessible resources and established policies, procedures, practices, and channels of communication that lend support to the type of nursing tasks being delegated to the MA-C;
(2) The complexity and frequency of care needed by a given client population; and
(3) The accessibility of a licensed nurse.
9513.4 The MA-C shall not perform a task involving the administration of medication if:
(a) The medication administration requires a calculation of the dosage of the
medication or the conversion of the dosage;
(b) The supervising nurse is unavailable either in person or by telephone to monitor the progress of the client and the effect on the client of a medication;
(c) The client is not stable or has changing health care needs; or
(d) The MA-C has not been prepared by training to perform the
delegated task.
9513.5 The MA-C shall immediately inform the delegating nurse if the MA-C is unable to perform a delegated task.
9514 RESERVED
9515 MEDICATION AIDE TASKS
9515.1 Under the supervision of a licensed nurse the MA-C may perform the following tasks:
(a) Perform personal care including bathing, grooming, and assistance with toileting or bedpan use;
(b) Assist the client with transfer, ambulation, and exercise as prescribed;
(c) Observe, record, and report the client’s physical condition, behavior, or appearance;
(d) Assist with eating;
(e) Measure and record height and weight;
(f) Implement universal precautions to assure infection control;
(g) Perform tasks related to keeping the client’s living area in a condition that promotes the client’s health and comfort;
(h) Assist the client with activities that are directly supportive of skilled therapy services; and
(i) Communicate with clients who have cognitive impairment, sensory deficits or impairments, communication limitations, agitation or combativeness
9515.2 In addition to the tasks in § 9515.1, under the supervision of a licensed nurse the MA-C may perform the following tasks:
(a) Administering medication in emergency or life-threatening circumstances
(b) Conducting a fingerstick blood glucose test with a physician’s, nurse
practitioner’s or physician assistant’s order which shall indicate:
(1) The daily frequency for finger sticks;
(2) The normal blood sugar range;
(3) The values outside the range that requires notification to the nurse;
and
(4) The parameters for when to contact emergency services.
(c) Reporting of symptoms or side effects;
(d) Administering unit dose insulin;
(e) Administering oral medications;
(f) Administering medication via eye, ear, or nose;
(g) Administering of medication via suppository;
(h) Administering topical medications and medicated shampoos;
(i) Reporting of symptoms or side effects; and
(j) Documenting medication administration or omissions on medication administration record
9516 REPORTING REQUIREMENTS
9516.1 Based on agency or facility policies, the MA-C shall document in the medication record, ordered medications that have been administered, withheld, or omitted.
9516.2 The MA-C shall:
(a) Report the following to the supervising nurse:
(1) Signs or symptoms that appear life threatening;
(2) Events that appear health threatening; and
(3) Medications that produce no results or undesirable effects as reported by the client.
(b) Notify a nurse prior to the administration of prescribed PRN (as needed)
medications;
(c) Be personally responsible and accountable for all actions taken when
implementing delegated tasks;
(d) Comply with laws, policies and procedures applicable to the setting in
which the MA-C is administering medication; and
(e) Performs tasks only in situations where licensed nurse
supervision is available.
9517 DISCIPLINE
9517.1 The Board may revoke, suspend, or deny registration of any MA-C who is convicted during a period of time in which he or she is registered, of any of the crimes listed in § 9417.2 or any act specified in D.C. Official Code § 3-1205.14 (2012 Supp.).
9517.2 In addition to any other disciplinary action it may take, the Board may impose a civil penalty of not more than five thousand dollars ($5,000) per violation or file a letter of concern if the Board believes there is insufficient evidence to support direct action against the MA-C.
9517.3 Grounds for discipline of an MA-C include, but are not limited to:
(a) Substance abuse or other chemical dependency;
(b) Client abandonment;
(c) Fraud or deceit, which may include but is not limited to:
(1) Filing false credentials;
(2) Falsely representing facts on an application for initial certification, reinstatement or renew; or
(3) Giving or receiving assistance in taking the competency evaluation;
(d) Client neglect, abuse or misappropriation of funds;
(e) Boundary violations;
(f) Unsafe client care;
(g) Performing acts beyond the DT’s range of functions or beyond those tasks delegated;
(h) Misappropriating or misusing property;
(i) Criminal conviction;
(j) Failure to conform to acceptable standards of practice as a dialysis technician;
(k) Putting clients at risk of harm; or
(l) Violating the privacy or failing to maintain the confidentiality of client information;
9517.4 The Board shall maintain records of disciplinary actions.
9517.5 MA-C’s who are unable to perform their duties due to drug or alcohol dependency or mental illness may utilize the services offered under the Nurse’s Rehabilitation Program pursuant to D.C. Official Code §3-1251.01, et seq.
9518 RESERVED
9519 RESERVED
9520 STANDARDS FOR MEDICATION AIDE TRAINING PROGRAMS
9520.1 Each institution authorized to provide MA-C training shall be approved by the Board.
9520.2 The following types of institutions may apply for approval to provide MA-C training:
(a) Private, degree-granting educational institutions operating or incorporated in the District of Columbia which are licensed by the Education Licensure Commission pursuant to the Educational Institution Licensure Act of 1976( D.C. Law 1-104; D.C. Official Code § 38-1601, et seq. (2012));
(b) Private, non-degree, post-secondary schools operating in the District of Columbia which are licensed by the Education Licensure Commission;
(c) District public universities or colleges; and
(d) Health care facilities licensed and operating in the District of Columbia, that have not received any adverse actions during the preceding two (2) years.
9520.3 The Board shall consider any one of the following as an adverse action which would preclude a health care facility from providing MA:
(a) A facility's participation in the Medicaid or Medicare Program has been terminated, restricted or revoked;
(b) A facility, other than a new facility, has received a provisional or restricted license; or
(c) A facility has been given a provider agreement of less than one (1) year.
9520.4 All MA training programs shall have adequate faculty and clinical facilities to provide supervised clinical experience with early, realistic exposure to job requirements. The clinical experience shall include exposure to the full range of skills needed in the workplace.
9521 SUPERVISED PRACTICE OF MEDICATION AIDE TRAINEES
9521.1 A trainee may practice only in accordance with the Act and this chapter.
9521.2 A trainee who is fulfilling educational requirements under this chapter may engage in supervised practice without a District of Columbia certification.
9521.3 All supervised practice of a trainee shall take place under the general or immediate supervision of a licensed nurse or other appropriate health professional.
9521.4 A trainee shall identify himself or herself as a trainee before practicing.
9521.5 A trainee shall not receive compensation of any nature, directly or indirectly, from a client or client’s family member.
9521.6 The Board may deny an application for certification by, or take other disciplinary action against, a trainee who is found to have violated the Act or this chapter. The Board may, in addition to any other disciplinary actions permitted by the Act, revoke, suspend, or restrict the privilege of the trainee.
9522 RESERVED
9523 RESERVED
9524 MEDICATION AIDE PROGRAM APPROVAL PROCEDURES
9524.1 Each institution applying for approval to provide training shall do the following:
(a) Submit to the Board a statement of intent to establish a training program; and
(b) Submit to the Board an application for approval which contains the following information:
(1) A statement of purpose;
(2) A statement of need for the training program in the District
of Columbia;
(3) A description of the proposed program's potential effect on existing MA training programs in the area;
(4) A description of the organizational structure of the institution showing the relationship of the proposed training program within the organization;
(5) Evidence of financial resources, adequate planning, implementation, and continuation of the program;
(6) The number of full-time equivalent (FTE) budgeted instructor positions;
(7) The number of budgeted instructor positions;
(8) Evidence of the availability of adequate clinical facilities;
(9) A description of the anticipated trainee population, including admission criteria along with a copy of the admissions exam;
(10) A tentative time schedule for planning and initiating the program; and
(11) A fee schedule; and
(c) Submit the application fee.
9524.2 After reviewing the application, based on the applicant’s compliance with §§ 9527 and 9532, a decision shall be made to:
(a) Approve the application;
(b) Defer approval if additional information is needed; or
(c) Deny approval of the application.
9524.3 If an application approval has been granted, a site visit shall be conducted by the Board in conjunction with the Education Licensure Commission staff to
determine the program’s compliance with § 9527 and the program’s ability to meet criteria set forth in §§ 9531 and 9532.
9524.4 After reviewing the site visit report, the Board shall vote to approve, deny, or defer program approval for resource, facility, or service concerns.
9524.5 A training program shall not admit trainees to the program before the program has been approved by the Board.
9525 PERIODIC REVIEW OF APPROVED PROGRAMS
9525.1 Programs approved by the Board to train the MA shall submit to the Board an annual report in accordance with procedures established by the Board.
9525.2 The Board shall re-evaluate the MA training programs once a year.
9525.3 The Board shall make unannounced visits to review and assess each nursing assistive personnel training program to ensure that the program is in compliance with §§ 9522 and 9523.
9525.4 The Board shall assess each training program on the basis of visits to the facility, the progress of the training program, and any other information deemed appropriate by the Board.
9525.5 Each training program shall ensure that at least seventy-five percent (75%) of first time candidates from its program shall achieve a passing score on the District's approved competency evaluation.
9525.6 The Board shall withdraw approval of a training program if:
(a) It determines that the program is not in compliance with standards set forth in §§ 9522 and 9523.
(b) The program does not permit unannounced survey visits; or
(c) The educational institution loses its licensure.
9525.7 If the training program does not meet the requirements for approval, the Board may grant conditional approval pending correction of the deficiencies.
9525.8 The training program deficiencies sufficient to warrant withdrawal of approval shall include, but are not limited to the following:
(a) Failure to effectively utilize the District's approved curriculum for the training program;
(b) Failure to maintain an adequate number of instructors with required qualifications;
(c) Failure to meet the seventy five percent (75%) passing rate of the District's approved competency evaluation for a period of two (2) years or more;
(d) Failure of trainees to demonstrate minimal competencies upon employment;
(e) Failure to adhere to training program's stated objectives, and policies; and
(f) Failure to maintain adequate resources, facilities, and services required to meet training objectives.
9525.9 The Board may consider reinstatement or approval of training upon submission of satisfactory evidence that the program meets the standards set forth in this chapter.
9525.10 The Board may investigate complaints made against a program and may conduct hearings in connection with such complaints.
9525.11 Any Board action for suspension or withdrawal of a training program’s approval shall only take place after notice to the program and the opportunity for a hearing in accordance with D.C. Official Code §
3-1205.14 (2012 Supp.).
9526 RESERVED
9527 MEDICATION AIDE TRAINING PROGRAM
9527.1 The MA training program shall prepare the MA to provide core care skills and specific role skills as listed in § 9415.
9527.2 Training programs for Board approved MA model curriculum shall provide a minimum of:
(a) One hundred forty (140) training hours for MAs;
(b) Fifty (50) training hours for home health aides or certified nurse
assistants;
(c) Eighty (80) training hours for direct support professionals; or
9527.3 Each training program shall have a sufficient number of qualified instructors to meet the purposes and objectives of the program.
9527.4 The training program shall be coordinated by a licensed nurse who has:
(a) A current, unencumbered District of Columbia license; and
(b) At least two (2) years of full-time or full-time equivalent clinical experience as a licensed nurse.
9527.5 The program coordinator’s responsibilities shall include, but not be limited to:
(a) Ensuring that the curriculum is coordinated and implemented in accordance with the chapter;
(b) Establishing job descriptions indicating the responsibilities of the instructors;
(c) Ensuring that each instructor meets the qualifications as specified in this chapter;
(d) Ensuring that each MA trainee is properly supervised during the clinical experience; and
(e) Ensuring that each clinical preceptor evaluates the MA trainee’s performance and provides the evaluation results to clinical instructor.
9527.7 (a) The criteria for selecting a clinical preceptor shall be in writing and shall include the following:
(1) The method of selecting clinical preceptors;
(2) The plans for orientation of clinical preceptors;
(3) The clinical objectives or outcomes of the preceptorship; and
(4) A system for monitoring and evaluating the trainee’s learning experiences.
(b) The instructor shall:
(1) Retain responsibility for the trainee’s learning experiences
and meet periodically with the clinical preceptor and the trainee to monitor and evaluate the trainee’s learning
experiences; and
(2) Be readily available, either directly or by a communication device, when preceptors are in the clinical area.
9527.8 The clinical preceptor shall meet the following minimum qualifications:
(a) Have a current license in good standing, in the jurisdiction in which he or she is providing the preceptorship; and
(b) Have a minimum of two (2) years of experience as a licensed nurse providing direct patient care, during the five (5) years immediately preceding the date of the written agreement.
9527.9 The ratio of preceptor to trainees in a clinical setting shall not exceed one (1) preceptor to one (1) trainee.
9527.10 The ratio of instructors to trainees in clinical areas involving direct care of clients shall be based upon the client acuity level, the skill level of the trainee, and the clinical setting.
9527.11 The ratio of instructor to trainees in a skills lab shall not exceed one (1) instructor to eight (8) trainees.
9527.13 The ratio of instructor to trainees in a clinical setting shall not exceed one (1) instructor to two (2) trainees during medication administration.
9527.14 Each instructor's qualifications shall be documented in the official records of the program and available for review by the Board.
9527.15 Each instructor shall be responsible for doing the following:
(a) Assisting in the development, implementation, and evaluation of the purpose, philosophy, and objective of the training program;
(b) Helping to implement and evaluate the curriculum;
(c) Facilitating preceptor participation in the program and evaluating the progress and retention of preceptors in the program;
(d) Giving guidance to preceptors;
(e) Evaluating preceptor achievement in the program;
(f) Providing for preceptor and peer evaluation of his or her teaching effectiveness; and
(g) Participating in continuing nursing education programs to improve his or her competence in areas of responsibilities.
9527.16 Each training program shall provide trainees with information on the policies governing admission, retention, dismissal, and the course requirements of the training program in writing.
9527.17 Each training program shall test and vaccinate applicants for communicable disease prior to admission.
9528 MINIMUM QUALIFICATIONS FOR MEDICATION AIDE TRAINEE
9528.1 Each trainee shall be a high school graduate or have completed a graduate equivalency diploma program.
9528.2 Each trainee shall be required to take a pre-admission examination to assess reading, writing and math skills prior to enrollment in a training program.
9529 RESERVED
9530 CLOSING OF EDUCATION AND TRAINING PROGRAMS
9530.1 Each MA program that voluntarily closes shall:
(a) Notify the Board, in writing, as early as possible, of the intended closing, stating the reason(s) and planned date of the intended closing;
(b) Continue the training program until the committed class scheduled for currently enrolled trainees is completed; and
(c) Notify the Board of the final closing date at least thirty (30) days before the final closing.
9530.2 If the Board denies or withdraws approval of a training program, the institution shall:
(a) Close the program on the date provided by the Board;
(b) Submit to the Board a list of all program graduates and all current
trainees transferred to approved programs and dates of transfer; and
(c) Comply with the requirements of all applicable rules and notify the Board that the requirements have been fulfilled.
9531 RECORDS RETENTION
9531.1 Each MA training program shall maintain an accurate and appropriate system of record keeping.
9531.2 Each training program shall ensure that administrative and personnel records are protected against loss, destruction, and unauthorized review.
9531.3 A record for each trainee shall be maintained by the facility and shall include the trainee’s evaluation and health information.
9531.4 Each instructor’s personnel records shall be maintained by the facility and shall include application data, qualifications, and position description.
9531.5 All records shall be maintained by the training program for a minimum of five (5) years.
9532 RESOURCES, FACILITIES, AND SERVICES
9532.1 Each MA training program shall maintain resources, facilities, and services which are adequate to accommodate the training program. The resources, facilities, and services shall have at a minimum, the following:
(a) Adequate temperature controls in each training facility;
(b) Clean and safe conditions of the facility’s premises;
(c) Adequate space to accommodate faculty;
(d) Adequate lighting in each facility; and
(e) Sufficient and adequate equipment for the program’s needs, including audio-visual equipment and equipment needed for simulating client care.
9532.2 Each classroom, conference room, laboratory, and office shall be adequate to meet the needs of the training program.
9532.3 Each cooperative agreement between a training program and an agency shall be in writing. The training program shall maintain a copy of the agreement in its records.
9599 DEFINITIONS
9599.1 As used in this chapter, the following terms have the meanings ascribed:
Administer The direct application of medication to the human body whether by ingestion, inhalation, insertion, sublingual, or topical means or an injection of epipen or equivalent injection system for emergency purposes only.
Applicant –A person applying for certification as a trained medication employee under this chapter.Boundary violation: Non-therapeutic relationships that are formed between a MA-C and a client in which the MA-C derives a benefit at the client’s expense.
Board –The Board of Nursing as established by section 204 of the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986, D.C. Law 6-99; D.C. Code § 3-1202.04 (1985).
Clinical - Faculty planned and guided learning activities designed to assist preceptors in meeting course objectives and to apply nursing knowledge and skills in the direct care of clients, including clinical conferences and planned learning activities in acute care facilities, and other community resources. Clinical shall not include skills lab activities.
Continuing education –Systematic learning experiences designed to augment the knowledge, skills, and attitudes of the medication aide.
Delegation –The transference from the licensed nurse to another individual within the scope of his or her practice, the authority to act on behalf of the licensed nurse in the performance of a nursing intervention, while the licensed nurse retains accountability and responsibility for the delegated act.
Direct support professional - Any person employed by, under contract with, sub-contracted with, through a provider Medicaid Agreement, or serving in a volunteer capacity with, or for a public or private agency that provides services and supports to, or for individuals with intellectual and developmental disabilities.
Direct supervision – Ssupervision in which the supervising nurse is available to the medication aide on the premises and within vocal communication either directly or by a communication device.
Facilities –An assisted living residence, District of Columbia schools, and homes for persons with physical or intellectual disabilities, skilled home care agencies, or other facilities authorized by the Board.
Fingerstick –Sticking of the finger to get a blood sample to use in a glucometer to measure the amount of glucose in blood.
General supervision –Supervision in which the supervising nurse is available to the trained certified medication aide for consultation either in person or by a communication device, but need not be physically present on the premises at the time the actions are performed.Glucometer –A machine that measures the amount of glucose in the blood.
In-service –Activities intended to assist the MA-C in acquiring, maintaining, or increasing competence in fulfilling the assigned responsibilities specific to the expectations of the employer.Licensed practitioner –An individual licensed to practice a health occupation in the District of Columbia.
Medication –A controlled or non-controlled substance or treatment regarded as effective in bringing about recovery, restoration of health, alleviation of pain or symptoms of an illness, or the normal functioning of the body.
Chapter 96 (Certified Nurse Assistants and Patient Care Technicians) is added to read as follows:
CHAPTER 96 CERTIFIED NURSE ASSISTANTS AND PATIENT CARE
TECHNICIANS
9600 GENERAL PROVISIONS
9601 NURSE ASSISTANT AND PATIENT CARE TECHNICIAN
CERTIFICATION
9602 TERM OF CERTIFICATION
9603 CRIMINAL BACKGROUND CHECK
9604 APPLICATION FOR CERTIFICATION
9605 CERTIFICATION BY EXAMINATION
9606 CERTIFICATION BY ENDORSEMENT
9607 RENEWAL OF CERTIFICATION
9608 INACTIVE STATUS; REACTIVATION OF CERTIFICATION
9609 REINSTATEMENT OF EXPIRED CERTIFICATION
9610 RESERVED
9611 RESERVED
9612 RESERVED
9613 ASSIGNMENT AND DELEGATION OF NURSING CARE TASKS TO CERTIFIED NURSE ASSISTANTS
9614 RESERVED
9615 CERTIFIED NURSE ASSISTANT TASKS
9616 PATIENT CARE TECHNICIAN TASKS
9617 DISCIPLINE
9618 RESERVED
9619 RESERVED
9620 STANDARDS FOR TRAINING PROGRAMS
9621 SUPERVISED PRACTICE OF TRAINEES
9622 RESERVED
9623 RESERVED
9624 TRAINING PROGRAM APPROVAL PROCEDURES
9625 PERIODIC REVIEW OF APPROVED PROGRAMS
9626 RESERVED
9627 TRAINING PROGRAM REQUIREMENTS
9628 MINIMUM QUALIFICATIONS FOR NURSE ASSISTANT TRAINEES
9629 RESERVED
9630 CLOSING OF EDUCATION AND TRAINING PROGRAMS
9631 RECORDS RETENTION
9632 RESOURCE, FACILITIES, AND SERVICES
9699 DEFINITIONS
9600 GENERAL PROVISIONS
9600.1 This chapter applies to applicants for and holders of, a certification to practice as a certified nurse assistant (CNA) or patient care technician (PCT).
9600.2 This chapter shall apply to persons working under the supervision of a licensed nurse, or other licensed health care professional, regardless of title, who perform duties as specified in this chapter.
9600.3 Chapters 40 (Health Occupations: General Rules) and 41 (Health Occupations: Administrative Procedures) of this title shall supplement this chapter.
9601 NURSE ASSISTANT AND PATIENT CARE TECHNICIAN CERTIFICATION
9601.1 No person shall practice as a CNA or PCT in the District of Columbia without first being certified by the Board of Nursing (Board).
9602 TERM OF CERTIFICATION
9602.1 Subject to § 9601.1, a certification issued pursuant to this chapter shall expire at 11:59 p.m. of October 30 of each odd-numbered year.
9602.2 The Director may modify the renewal system pursuant to § 4006.3 of chapter 40 of this title and may modify the date on which a certification expires.
9603 CRIMINAL BACKGROUND CHECK
9603.1 A person applying for certification as a nurse assistant shall undergo a criminal background check (CBC) prior to issuance of the certification.
9603.2 After issuance of an initial certification, the applicant shall undergo an additional CBC every four (4) years or as determined by the Department of
Health.
9603.3 The applicant shall pay a fee for the CBC.
9603.4 The Board shall receive and review the results of a CBC of a person if, within the seven (7) years preceding the CBC, the person has been convicted in the District of Columbia, or in any state or territory of the United States where the person has worked or resided, of any of the following offenses or their equivalent:
(a) Murder, attempted murder, or manslaughter;
(b) Arson;
(c) Assault, battery, assault and battery, assault with a dangerous weapon, mayhem or threats to do bodily harm;
(d) Burglary;
(e) Robbery;
(f) Kidnapping;
(g) Theft, fraud, forgery, extortion or blackmail;
(h) Illegal use or possession of a firearm;
(i) Trespass or injury to property;
(j) Rape, sexual assault, sexual battery, or sexual abuse;
(k) Child abuse or cruelty to children;
(l) Adult abuse, neglect or exploitation; or
(m) Unlawful distribution or possession with intent to distribute, of a controlled substance.
9604 APPLICATION FOR CERTIFICATION
9604.1 A person applying for certification as a CNA shall:
(a) Be at least eighteen (18) years of age;
(b) Submit evidence of having successfully completed an approved national nurse aide exam;
(c) Meet the requirements of § 9603;
(d) Submit a completed application to the Board;
(e) Submit any other documents that may be required by the Board; and
(f) Pay all required fees.
9604.2 An applicant for certification as a PCT shall submit evidence of:
(a) Certification as a CNA;
(b) Successful completion of a Board-approved patient care technician
program;
(c) Completion of a Board-approved registered nursing “Fundamentals of Nursing” course with a minimum of forty (40) hours of clinical experience within the last thirty-six (36) months from the date of an application for certification; and
(d) Having practiced as a hospital corpsman within the last thirty-six (36)
months.
9604.3 The Board shall waive the training requirements for any person currently
practicing as a PCT provided that the applicant demonstrates, to the satisfaction of the Board, that he or she has been performing the functions of a PCT or a full-time or substantially full-time (a minimum of five hundred (500) hours per year) basis provided that the patient care technician complies with the following:
(a) Has completed a Board approved patient care training program;
(b) Has provided a statement from a supervising nurse or health care
professional, indicating the applicant’s continued competence to provide care;
(c) Has submitted a letter from an employer certifying the applicant’s ability to perform skills as listed in § 9616; and
(d) Has submitted an application no later than one hundred eighty days (180) after these regulations are published as Final Rulemaking.
9605 CERTIFICATION BY EXAMINATION
9605.1 To qualify for nurse assistant certification by examination, an applicant shall provide proof of one (1) of the following:
(a) Successful completion of a nurse assistant program, within the past twenty-four (24) months, approved by the Board or by a nursing board in the United States with standards determined by the Board to be substantially equivalent to the standards in the District of Columbia;
(b) Successful completion of a practical nursing or registered nursing “Fundamentals of Nursing” course with a clinical component in the United States within the last thirty-six (36) months from the date of an application for certification; or
(c) Receipt of a Commission on Graduates of Foreign Nursing Schools certificate, received within the last thirty-six (36) months from the date of an application for certification, indicating education as a registered nurse (RN) or licensed practical nurse (LPN) outside the United States.
9605.2 If an applicant has not taken or passed the nurse aide certification exam for more
than one (1) year after the date the applicant becomes eligible to apply to sit for examination, the applicant shall provide evidence of completion of a new training program.
9606 CERTIFICATION BY ENDORSEMENT
9606.1 An applicant for endorsement as a CNA shall provide proof of the following:
(a) Having obtained a current certification as a CNA or similar title and
duties; and
(b) Having met the requirements of § 9604.
9606.2 An applicant for endorsement as a patient care technician shall provide proof of the following:
(a) Current certification as a PCT or similar title and duties; or
(c) Current certification as a CNA and verification from supervising licensed
nurse or employer certifying the applicant’s ability to perform skills listed in § 9616.
9607 RENEWAL OF CERTIFICATION
9607.1 An applicant for renewal shall provide evidence of:
(a) Completion of twenty-four (24) hours of continuing education or in-service training in the area of health or nursing needs of an assigned client population, to include a minimum of two (2) hours of any Board mandated topics; and
(b) Completion of CBC as required.
9607.2 Applicants who have another active District of Columbia certification as
nursing assistive personnel (NAP) may apply continuing education hours to CNA renewal requirements.
9607.3 Applications will be subject to audit to assure compliance with the above requirements.
9608 INACTIVE STATUS; REACTIVATION OF CERTIFICATION
9609 REINSTATEMENT OF EXPIRED CERTIFICATION
(a) Receipt of current certification in another jurisdiction approved by the Board; or
(b) Having practiced for a minimum of one hundred (100) hours within the last twenty-four (24) months under the supervision of a licensed nurse or other licensed health professional deemed appropriate by the Board.
9610 RESERVED
9611 RESERVED
9612 RESERVED
9613 ASSIGNMENT AND DELEGATION OF NURSING CARE TASKS
9613.1 A licensed nurse or health care professional may assign or delegate tasks to a CNA or PCT that are among the authorized tasks listed in §§ 9615.1 or 9616.2.
9613.2 A CNA or PCT shall not practice independently but shall work under the immediate supervision of a licensed nurse or other licensed health care professional.
9613.3 The delegation shall comply with the standards for delegation listed in 17 DCMR §§ 5400 and 5500.
9613.4 Nursing care tasks that may be delegated shall depend upon:
(a) The knowledge and skills of the CNA or PCT;
(b) Verification of the clinical competence of the CNA or PCT by the employing agency;
(c) The stability of the client’s condition, including factors such as predictability, absence of risk of complication, and rate of change in health status; and
(d) The variables in each health care setting which include, but are not limited to:
(1) The accessible resources and established policies, procedures, practices, and channels of communication that lend support to the type of nursing tasks being delegated;
(2) The complexity and frequency of care needed by a given client population; and
(3) The accessibility of a licensed nurse.
9613.4 Nursing tasks that inherently involve on-going assessment, interpretation, or decision making that cannot be logically separated from one or more procedures shall not be delegated to the certified nurse assistant or patient care technician.
9614 RESERVED
9615 CERTIFIED NURSE ASSISTANT TASKS
9615.1 Under the supervision of a licensed nurse or health professional a CNA may perform the following tasks:
(a) Provide effective communication and interpersonal skills;
(b) Maintain infection control;
(c) Provide safety and emergency procedures;
(d) Promote resident’s independence;
(e) Recognize and report abuse;
(f) Basic nursing skills which include:
(1) Taking and recording vital signs;
(2) Measuring and recording height and weight;
(3) Observing and reporting pain;
(4) Recognizing abnormal signs and symptoms of common diseases and conditions;
(5) Applying clean bandages; and
(6) Assisting with admitting, transferring, or discharging patients.
(g) Personal care skills, including but not limited to:
(1) Bathing, skin care and dressing;
(2) Oral and denture care;
(3) Shampoo and hair care;
(4) Fingernail care;
(5) Toileting, perineal and ostomy care; and
(6) Feeding and hydration, including proper feeding techniques and use of assistive devices in feeding.
(h) Mental health and social welfare care such as:
(1) Responding appropriately to behavior;
(2) Providing care sensitive to religion, national origin, gender identity, and sexual orientation; and
(3) Providing care to dying patients.
(i) Basic restorative services such as:
(1) Transferring, ambulation, eating, and dressing;
(2) Range of motion exercises;
(3) Proper turning and positioning in bed and chair;
(4) Bowel and bladder training;
(5) Care and use of prosthetic and orthotic devices; and
(j) Protect patient’s rights such as:
(1) Providing privacy and maintaining confidentiality;
(2) Promoting the resident's rights to make personal choices to accommodate his or her needs;
(3) Giving assistance in resolving grievances and disputes;
(4) Providing needed assistance in getting to and participating in resident and family groups and other activities;
(5) Maintaining care and security of a resident's personal possessions;
(6) Providing care which ensures that the resident is free from abuse, mistreatment, and neglect and the need to report any such instance to appropriate facility staff; and
(7) Maintaining the resident's environment and care to avoid the need for restraints.
9616 PATIENT CARE TECHNICIAN TASKS
9616.1 Under the supervision of a licensed nurse or health professional a PCT may perform the following tasks in addition to the tasks specified in § 9615:
(a) Monitoring the administration of oxygen equipment by observing settings, tubing and equipment;
(b) Setting-up intravenous (IV) equipment and discontinue peripheral IV catheter (this shall not include insertion of a peripheral IV catheter or administration or discontinuation of IV fluids.);
(c) Performing elimination procedures, including enemas, fleets and soap suds enemas;
(d) Performing electrocardiograms;
(e) Carrying out blood glucose test;
(f) Collecting specimens;
(g) Assisting patients in using incentive spirometer;
(h) Performing phlebotomy; and
(i) Mounting a pulse oximeter.
9617 DISCIPLINE
9617.1 The Board may revoke, suspend, or deny registration of any DT who is convicted during a period of registration, of any of the crimes listed in §
9417.2 or convicted of any act specified in D.C. Official Code § 3-1205.14 (2012 [cpe2] Supp.).
9617.2 In addition to any other disciplinary action it may take, the Board may impose a civil penalty of not more than five thousand dollars ($5,000) per violation or file a letter of concern if the Board believes there is insufficient evidence to support direct action against a CNA or PCT.
9617.3 Grounds for denial, suspension, revocation or other discipline of CNA OR PCT include evidence of the inability to function with reasonable skill and safety for the following reasons and conviction of any additional acts as specified in D.C. Official Code § 3-1205.14:
(a) Substance abuse or other chemical dependency;
(b) Client or patient abandonment;
(c) Fraud or deceit, which may include but is not limited to:
(1) Filing false credentials;
(2) Falsely representing facts on an application for initial certification, reinstatement or renew; or
(3) Giving or receiving assistance in taking the competency evaluation;
(d) Client or patient neglect, abuse or misappropriation of funds;
(e) Boundary violations;
(f) Unsafe client care;
(g) Performing acts beyond the certified nurse assistant or patient care technician’s range of functions or beyond those tasks delegated;
(h) Misappropriation or misuse of property;
(i) Criminal conviction;
(j) Failure to conform to acceptable standards of practice as a dialysis technician;
(k) Putting clients or patients at risk of harm; or
(l) Violating the privacy or failing to maintain the confidentiality of client information;
9617.4 CNAs or PCTs who are unable to perform their duties due to drug or alcohol dependency or mental illness may utilize the services offered under the Nurse’s Rehabilitation Program pursuant to D.C. Official Code §3-1251.01, et seq.
9618 RESERVED
9619 RESERVED
9620 STANDARDS FOR TRAINING PROGRAMS
9620.1 The following types of institutions may apply for certificate of approval to provide CNA or PCT training:
(a) Private, degree-granting educational institutions operating or incorporated in the District of Columbia;
(b) Private, non-degree post-secondary schools operating in the District of Columbia which are licensed by the Education Licensure Commission;
(c) District public schools (for nurse assistants only);
(d) District public universities or colleges; and
(e) Nursing facilities licensed and operating in the District of Columbia
that have received no adverse actions during the preceding two (2) years.
9620.2 The Board of Nursing shall consider any one of the following as an adverse action which would preclude a facility from providing training:
(a) A facility's participation in the Medicaid or Medicare program has been terminated, restricted or revoked;
(b) A facility, other than a new facility, has received a provisional or restricted license; or
(c) A facility has been given a provider agreement of less than one (1) year.
9621 SUPERVISED PRACTICE OF TRAINEES
9621.1 A trainee may practice only in accordance with the Act and this chapter.
9621.2 A trainee who is fulfilling educational requirements of this chapter may engage in supervised practice without a District of Columbia certification.
9621.3 All supervised practice of a trainee shall take place under the general or immediate supervision of a licensed nurse or other appropriate health professional.
9621.4 A trainee shall identify himself or herself as a trainee before practicing.
9621.5 A trainee shall not receive compensation of any nature, directly or indirectly, from a client or client’s family member.
9621.6 The nurse supervising the trainee shall be responsible for all practice by a trainee during the period of supervision and may be subject to disciplinary action for violations of the District of Columbia Health Occupations Revision Act of 1985, effective March 15, 1986 (Act) (D.C. Law 6-99; D.C. Official Code §§ 3-1203.01, et seq. (2007 Repl. & 2012 Supp.)) or this chapter by the trainee.
9621.7 The Board may deny an application for certification by, or take other disciplinary action against, a trainee who is found to have violated the Act or this chapter. The Board may, in addition to any other disciplinary actions permitted by the Act, revoke, suspend, or restrict the privilege of the trainee.
9622 RESERVED
9623 RESERVED
9624 TRAINING PROGRAM APPROVAL PROCEDURES
9624.1 Each institution applying for a certificate of approval to provide nurse assistant training shall do the following:
(a) Submit to the Board of Nursing, at least ninety (90) days in advance of the scheduled starting date, a statement of intent to establish a nurse assistant training program; and
(b) Submit an application which contains the following:
(1) A statement of purpose;
(2) A statement of need for the training program in the District of Columbia;
(3) A description of the proposed program's potential effect on existing nurse assistant training programs in the area;
(4) A description of the organizational structure of the institution showing the relationship of the proposed training program within the organization;
(5) Evidence of financial resources adequate for planning, implementation, and continuation of the program;
(6) Evidence of Licensure status of the proposed training facility;
(7) A list of available qualified instructors;
(8) The number of budgeted instructor positions;
(9) Signed agreements with clinical facilities which meet the educational needs of the training program;
(10) The anticipated trainee population and tentative time schedule for planning and initiating the program; and
(11) Fee schedules.
9624.2 After reviewing the application, based on the applicant’s compliance with §§ 9627 and 9632, a decision shall be made to:
(a) Approve the application;
(b) Defer approval if additional information is needed; or
(c) Deny approval of the application.
9624.3 If an application approval has been granted, a site visit shall be conducted by the Board staff to determine the program’s compliance with § 9627 and the program’s ability to meet criteria set forth in §§ 9631 and 9632.
9624.4 After reviewing the site visit report, the Board shall vote to approve, deny, or defer program approval for resource, facility, or service concerns.
9624.5 A training program shall not admit trainees to the program before the program has been approved by the Board.
9625 PERIODIC REVIEW OF APPROVED PROGRAMS
9625.1 Programs approved by the Board to train nursing assistant shall submit to the Board an annual report in accordance with procedures established by the Board.
9625.2 The Board shall re-evaluate nursing assistant training programs once a year.
9625.3 The Board shall make unannounced visits to review and assess each NAP training program to ensure that the program is in compliance with §§ 9621 and 9624.
9625.4 The Board shall assess each training program on the basis of visits to the facility, the progress of the training program, and any other information deemed appropriate by the Board.
9625.5 Each training program shall ensure that at least seventy-five percent (75%) of first time candidates shall achieve a passing score on the District's approved competency evaluation.
9625.6 The Board shall withdraw approval of a training program if:
(a) It determines that the program is not in compliance with standards set forth in §§ 9621 and 9624;
(b) The program does not permit unannounced survey visits; or
(c) The education institution loses its licensure.
9625.7 If the training program does not meet the requirements for approval, the Board may grant conditional approval pending correction of the deficiencies.
9625.8 The training program deficiencies sufficient to warrant withdrawal of approval shall include, but are not limited to the following:
(a) Failure to effectively utilize the District's approved curriculum for the training program;
(b) Failure to maintain an adequate number of instructors with required qualifications;
(c) Failure to meet the seventy five percent (75%) passing rate on the District's approved competency evaluation for a period of two (2) years or more;
(d) Failure of trainees to demonstrate minimal competencies upon employment;
(e) Failure to adhere to training program's stated objectives, and policies; and
(f) Failure to maintain adequate resources, facilities, and services required to meet training objectives.
9625.9 The Board may consider reinstatement or approval of training upon submission of satisfactory evidence that the program meets the standards set forth in this chapter.
9625.10 The Board may investigate complaints made against a program and may conduct hearings in connection with such complaints.
9625.11 Any Board action for suspension or withdrawal of a training program’s approval shall take place only upon notice to the program and the opportunity for a hearing in accordance with D.C. Official Code § 3-1205.14 (2012 Supp.).
9626 RESERVED
9627 TRAINING PROGRAM REQUIREMENTS
9627.1 The nursing assistant training programs shall provide core skills and specific skills as specified in § 9615 and shall provide a minimum of one hundred twenty- five (125) hours of training, eighty- five (85) hours of didactic and forty (40) hours in the clinical setting.
9627.2 Patient care technician training shall provide skills as specified in § 9616 and shall include fifty (50 hours of didactic and clinical consisting of thirty-four (34) hours of classroom and laboratory, and sixteen (16) hours of clinical.
9627.3 Each training program shall have a sufficient number of qualified instructors to meet the purposes and objectives of the program.
9627.4 The training program shall be coordinated by a licensed nurse with:
(a) A current, unencumbered District of Columbia license; and
(b) At least two (2) years of full-time or full-time equivalent experience as a
licensed nurse with clinical experience in the clinical practice setting he or she is responsible for coordinating;
9627.5 The program coordinator’s responsibilities shall include, but not be limited to:
(a) Ensuring that the curriculum is coordinated and implemented in accordance with the chapter;
(b) Establishing job descriptions indicating the responsibilities of the instructors;
(c) Ensuring that each instructor meets the qualifications as specified in this chapter;
(d) Ensuring that each trainee is properly supervised during the trainee’s clinical experience; and
(e) Ensuring that each clinical preceptor evaluates the MA trainee’s performance and provides the evaluation results to clinical instructor.
9627.6 (a) The criteria for selecting a clinical preceptor shall be in writing and shall include the following:
(1) The method of selecting clinical preceptors;
(2) The plans for orientation of clinical preceptors;
(3) The clinical objectives or outcomes of the preceptorship; and
(4) A system for monitoring and evaluating the preceptor’s learning experiences.
(b) The instructor shall:
(1) Retain responsibility for the trainee’s learning experiences and meet periodically with the clinical preceptor and the trainee to monitor and evaluate the trainee’s learning experiences; and
(2) Be readily available, either directly or by a communication device, when preceptors are in the clinical area.
9627.7 The clinical preceptor shall meet the following minimum qualifications:
(a) He or she shall be currently licensed or registered in good standing, in the jurisdiction in which he or she is providing the preceptorship, at or above the level for which the preceptor is preparing; and
(b) He or she shall have a minimum of two (2) years of experience as a licensed nurse providing direct patient care, during the five (5) years immediately preceding the date of the written agreement.
9627.8 The ratio of preceptor to trainees in a clinical setting shall not exceed one (1) preceptor to two (2) trainees.
9627.9 Each instructor shall be, where applicable, licensed, registered, or certified in his or her profession in the District of Columbia.
9627.10 The ratio of instructors to trainees in clinical areas involving direct care of clients shall be based upon client acuity level, skill level of the trainee, and the clinical setting.
9627.11 The ratio of instructor to trainees in a clinical skills lab shall not exceed one (1) instructor to eight (8) trainees.
9627.12 The ratio of instructor to trainees in a clinical setting shall not exceed one (1) instructor to eight (8) trainees
9627.13 Each instructor's qualifications shall be documented in the official records of the program and available for review by the Board.
9627.14 Each instructor shall be responsible for doing the following:
(a) Assisting in the development, implementation, and evaluation of the purpose, philosophy, and objective of the training program;
(b) Helping to implement and evaluate the curriculum;
(c) Facilitating preceptor participation in the program and evaluating the progress and retention of preceptors in the program;
(d) Giving guidance to preceptors;
(e) Evaluating preceptor achievement in the program;
(f) Providing for preceptor and peer evaluation of his or her teaching effectiveness; and
(g) Participating in continuing nursing education programs to improve his or her competence in areas of responsibilities.
9627.15 Each training program shall provide trainees with information on the policies governing admission, retention, dismissal, and the course requirements of the training program in writing.
9627.16 Each training program shall test and vaccinate applicants for communicable disease prior to admission.
9628 MINIMUM QUALIFICATIONS FOR NURSE ASSISTANT TRAINEES
9628.1 Each trainee shall be a high school graduate or possess a graduate equivalency diploma.
9628.2 Each trainee shall be required to take a pre-admission examination to assess reading, writing and math skills prior to enrollment in a training program.
9629 RESERVED
9630 CLOSING OF EDUCATION AND TRAINING PROGRAMS
9630.1 Each nurse assistant program that voluntarily closes shall:
(a) As early as possible, notify the Board, in writing, of the intended closing, stating the reason(s) and planned date of the intended closing;
(b) Continue the training program until the committed class scheduled for currently enrolled trainees is completed;
(c) Notify the Board of the final closing date at least thirty (30) days before the final closing.
9630.2 If the Board denies or withdraws approval of a training program, the institution shall:
(a) Close the program on the date provided by the Board;
(b) Submit to the Board a list of all program graduates and all current trainees transferred to approved programs and dates of transfer;
(c) Comply with the requirements of all applicable rules and notify the Board that the requirements have been fulfilled.
9631 RECORDS RETENTION
9631.1 Each nurse assistant training program shall maintain an accurate and appropriate system of record keeping.
9631.2 Each training program shall ensure that administrative and personnel records are protected against loss, destruction, and unauthorized review.
9631.3 A record for each trainee shall be maintained by the facility and shall include the trainee’s evaluation and health information.
9631.4 Each instructor’s personnel records shall be maintained by the facility and shall include application data, qualifications, and position description.
9631.5 All records shall be maintained by the training program for a minimum of five (5) years.
9632 RESOURCES, FACILITIES, AND SERVICES
9632.1 Each nurse assistant training program shall maintain resources, facilities, and services which are adequate to accommodate the training program. The resources, facilities, and services shall include, but are not limited to:
(a) Adequate temperature controls in each training facility;
(b) Clean and safe conditions of the facility’s premises;
(c) Adequate space to accommodate faculty;
(d) Adequate lighting in each facility; and
(e) Sufficient and adequate equipment for the program’s needs, including audio-visual equipment and equipment needed for simulating client care.
9632.2 Each classroom, conference room, laboratory, and office shall be adequate to meet the needs of the training program.
9632.3 Each cooperative agreement between a training program and an agency shall be in writing. The training program shall maintain a copy of the agreement in its records.
9699 DEFINITIONS
9699.1 When used in this chapter, the following terms shall have the meaning ascribed below:
Abuse –The infliction of physical or mental harm on a nursing home resident.
Boundary violation - Non-therapeutic relationships that are formed between a CNA or PCT and a client in which the CNA or PCT derives a benefit at the client’s expense.
Certified nurse assistant –An individual, who as a result of training and demonstrated competencies, provides nursing or nursing related services to residents in a nursing facility. This definition does not include an individual who volunteers to provide such services without pay, but does include individuals who are hired by residents and their families to provide care to residents in a nursing facility and includes nurse aides supplied by an agency as well as those actually employed by the facility.
Clinical Faculty planned and guided learning activities designed to assist preceptors in meeting course objectives and to apply nursing knowledge and skills in the direct care of clients, including clinical conferences and planned learning activities in acute care facilities, and other community resources. Clinical shall not include skills lab activities.
Department –The Department of Health.
Director –The Director of the Department of Health, or his or her designee.
District – The District of Columbia.
Facility –A licensed nursing home in the District of Columbia.
Misappropriation – means to appropriate wrongfully or dishonestly to one's own an item or money belonging to a nursing home resident.
Neglect –To fail to carry out or perform, or to be remiss in the care or treatment of a nursing home resident.
Nursing assistive personnel –An individual, other than a licensed nurse, who has received appropriate training or instruction to function in a complementary or assistant role to a licensed nurse, in providing direct patient care or in carrying out common nursing tasks. The term includes, but is not limited to, nursing students, graduate nurses, home health aides, personal care aides, medication aides, DTs, certified nurse assistants, or others as specified by the Board of Nursing.
Nursing home administrator – A licensed person responsible for planning, organizing, directing, and controlling the operation of a nursing
facility licensed in the District of Columbia.
Pass rate –A percentage of first time candidates who receive a passing score on the competency evaluation.
Patient care technician – Any unlicensed personnel working in a health care setting, regardless of title, to whom nursing tasks specified in this chapter, are delegated.
All persons desiring to comment on the subject matter of this proposed rulemaking should file comments in writing not later than thirty (30) days after the date of publication of this notice in the D.C. Register. Comments should be sent to the Department of Health, Office of the General Counsel, 899 North Capitol Street, N.E., 4th Floor, Washington, D.C. 20002. Copies of the proposed rules may be obtained from the Department at the same address during the hours of 9:00 a.m. and 5:00 p.m., Monday through Friday, excluding holidays. In addition, comments may be forwarded via e-mail to Van.Brathwaite@dc.gov.
