Wisconsin Legislature: DHS 129.07(2)(a)1.

(e) Rights of clients.

1. The program shall provide instruction on the principles of and requirements relating to clients’ rights. The nurse aide shall demonstrate an understanding of all of the following obligations:

a. Providing privacy for clients in treatment, living arrangements and personal care needs.

b. Maintaining the confidentiality of client health and personal records.

c. Allowing clients to make personal choices to accommodate the clients’ needs.

d. Providing help clients need in getting to and participating in activities, including client and family group meetings.

e. Maintaining the personal possessions of clients in good and secure condition.

f. Interacting with clients without abusing or neglecting the clients.

g. Interacting with clients without misappropriating the clients’ property.

h. Immediately reporting to appropriate facility or agency staff every instance of abuse or neglect of a client or misappropriation of a client’s property as defined in s. DHS 13.03 (1), (12), and (14).

2. The nurse aide shall demonstrate behavior that recognizes that clients have rights and that the aide respects those rights. The nurse aide shall do all of the following:

a. Demonstrate respect and concern for each client’s rights, preferences and awareness of age, color, disability, family status, financial status, gender, marital status, race, sexual orientation, and ethnic, cultural, social, generational and religious differences.

b. Show respect for cultural, ethnic and religious food preferences.

c. Recognize what constitutes abuse of clients and demonstrate an understanding of how to interact with clients without abusing them or without appearing to abuse them.

d. Demonstrate prevention and intervention skills with combative clients that balance appropriate client care with a need to minimize the potential for injury to the aide and others.

e. Recognize the role of state and federal regulatory agencies in licensing or otherwise approving providers and in investigating complaints of abuse of client property.

f. Demonstrate an understanding of the process by which a client or staff member may file a complaint on behalf of a client and seek redress for a perceived violation of client rights.

g. Recognize the role of client advocacy groups as client resources.

h. Demonstrate awareness of how to file a complaint with the department regarding operations within the provider setting.

(f) Dementias. The program shall include instruction about dementia and specific techniques for meeting the basic needs of clients with dementia. The nurse aide shall demonstrate an understanding of all of the following:

1. The nature of dementia, including the cause, course and symptoms of the impairment. The effects that brain changes have on the person’s moods, abilities and functioning.

2. The effects on the client of staff verbal and nonverbal communication with the client and means of modifying these communications and approaches to facilitate effective interaction between clients and staff.

3. The feeding and fluid intake problems associated with dementia and the specialized techniques for addressing those problems.

4. The effect of the environment on clients with dementia and the appropriate environmental stimuli to use with those clients to reduce stress and maximize normal functioning and how to incorporate strategies that preserve function and prevent excess disability.

5. Possible causes of dementia related symptomatic behavior changes, specifically focusing on understanding behavior as an attempt to communicate unmet needs and then how to address the unmet need including an understanding of how pain impacts behavior.

6. Ways to help the person with dementia continue meaningful involvement in his or her day, the importance of structure and routine and the incorporation of the person’s life story and past interests, routines, tastes, values and background.

7. The stress involved for the client, family and nurse aide in caring for a client with dementia and techniques for coping with this stress and ways to address the person with dementia’s core needs of having self-esteem boosted, being useful, giving and receiving love, and caring for self and others.

(2) program operation.

(a) Class setting.

1. Programs shall ensure that classrooms and lab facilities are adequate to meet the needs of the program, based on the number of students enrolled and how the classroom space is used. Programs shall ensure that classroom and skills labs have adequate temperature controls, clean and safe conditions, adequate space to accommodate students, adequate lighting, and all training equipment needed, including audiovisual equipment and any equipment needed for simulating resident care. Lab equipment shall be in the skill lab at all times necessary for demonstration, practice, and student demonstration. Any area designated as a classroom or lab in a facility-based program shall be an area that is not designated for resident care.

2. The program shall have qualified faculty members for both the classroom and the skills portion of the program.

3. The program shall have reasonable accommodations for students and prospective students with disabilities.

(b) Program standards for training programs.

1. A training program shall include at least 75 training hours as required under 42 CFR 483.152 (a). At least 16 of those 75 training hours must be in a clinical experience in a clinical setting as required under 42 CFR 483.152 (a) and approved by the department. The first 16 hours of training shall be provided in a classroom setting before a student has direct contact with clients. Tours of a facility, including observations of clients and day-to-day facility activities, may be incorporated into the classroom hours. Competency evaluation under s. DHS 129.08 and provider orientation may not be counted toward meeting the 75-hour minimum requirement.

2. The program shall cover all of the following during the first 16 hours of classroom training:

a. Communication and interpersonal skills.

b. Infection control.

c. Safety and emergency procedures.

d. Promoting residents’ independence.

e. Residents’ rights.

3. A health care provider may employ a student as a nurse aide after the student has completed 16 hours of classroom training in the topics in subd. 2., and if the student is a full-time permanent employee, and is enrolled in an approved training program. The training program shall provide the health care provider with verification that the program has provided the instruction specified in subd. 2.

4. The program shall provide notification to students sponsored by Medicaid-certified nursing facilities that the students are not responsible for any costs associated with training, including deposits for textbooks or supplies used.

(c) Clinical setting. Before a student performs any client-related services, the RN primary instructor shall determine that the student has been trained and found proficient in providing those services. The training program shall ensure all of the following:

1. Access to a clinical setting approved by the department that is adequate to meet the needs of the program.

a. Clinical settings shall be in compliance with state and federal law. The program designee or primary instructor and the health care provider with whom the program has contracted are responsible for verifying that the clinical facility is in compliance with state and federal law. This verification shall be documented in the program’s files and shall be available during the evaluation process.

b. The agreement between the program and the clinical setting shall be reviewed and renewed annually by the department and upon any change of facility or school administration. A copy of the agreement shall be submitted to the department.

c. During classroom and lab instructions, students shall be oriented to the various forms used to document resident information. Instructors shall supervise documentation on the appropriate flow sheets and forms during the clinical rotation.

d. Before a student begins a clinical rotation, the primary instructor shall evaluate and document that the student successfully demonstrated the ability to perform a skill.

e. Students may not give hands-on care to a resident who is not assigned to the student unless the student is under the direct supervision of the primary instructor.

f. Students who are under the general supervision of the primary instructor may be paired, during the student’s clinical rotation, with nurse aides who are employed by the health care provider.

g. Students shall maintain safe practices, infection control and respect resident rights at all times.

h. Students shall demonstrate knowledge regarding their assigned residents’ diagnoses and identified needs.

i. Students and instructors shall wear clothing that is in compliance with program policy and that is appropriate for performing resident care. The clothing shall include a nametag that designates the name of the nurse aide training program and the person’s status as a student or instructor.

j. The scheduled clinical hours shall provide experiences that meet expected outcomes outlined in the program curriculum.

k. The length of the clinical day may not exceed 8 hours.

L. A health care facility may serve as the site of clinical instruction for up to 2 nurse aide training programs at the same time, except that the department may decide to allow more than 2 programs at a single health care facility on a case-by-case basis in conjunction with the facility’s administrative staff.

m. The program shall not be used as a substitute for staff orientation or staff education programs.

2. An adequate number of primary instructors in the clinical setting to provide safe and effective supervision and assistance of students.

a. Primary instructors shall not function in another role while supervising students in the clinical setting.

b. A ratio of 6 to 8 students per instructor is considered to be adequate in most circumstances.

c. The primary instructor shall evaluate and document that a student demonstrated successfully the ability to perform a skill before the student begins a clinical rotation.

d. The primary instructor shall make all student clinical assignments with the approval of the health care provider. The instructor shall complete a review of each resident’s chart to retrieve pertinent information needed by the students to provide the required cares. Care plan information shall be reviewed at the beginning of each clinical experience and shall include new orders or changes in each resident’s status.

e. A student’s assignment shall be shared with the clinical setting to which the student is assigned before the student arrives at the clinical setting.

f. Each student shall be given an individual assignment. More than 2 students shall not be assigned to the same resident at the same time.

g. Clinical assignments shall include all of the following:

i. Care of clients with varied levels of care needs.

ii. The opportunity to be evaluated on organizational skills and time management.

h. The RN primary instructor is responsible for supervising the clinical performance of each LPN program trainer.

(d) Nursing home-based program. Training of nurse aides may be performed under the general supervision of the director of nursing for a facility; however, the director of nursing may not act as the primary instructor or as a program trainer. Primary instructors shall not be involved in more than one role while supervising students in the clinical area.

(e) Expectations and records.

1. The training program shall maintain a list of the required skills and competencies that a student will complete by the end of the training program.

2. On the list of skills, the primary instructor shall verify, by initialing and dating each individual skill, that the student has satisfactorily performed that skill. When a student has satisfactorily completed all required skills and competencies and attained the necessary knowledge, as well as achieved the stated course completion criteria, the trainee qualifies to enter a competency evaluation program.

3. The primary instructor shall provide a copy of the student’s performance record to the student at the conclusion of the student’s training.

(f) Record retention. The training program shall retain all records required by this section for a period of at least 3 years after a student completes the training program.

History: CR 08-042: cr. register November 2008 No. 635, eff. 12-1-08; correction in (1) (e) 1. h. made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635; renumbering in (2) (c) 2. g. made under s. 13.92 (4) (b) 1., Stats., Register November 2008 No. 635; CR 16-088: am. (1) (intro.), cr. (1m), am. (2) (b) (title), 1., cr. (2) (bm), am. (2) (d), (e) 1. Register September 2017 No. 741, eff. 10-1-17; correction in (1m), (2) (b) made under s. 35.17, Stats., Register September 2017 No. 741; 2019 Wis. Act 1: am. (1) (a) 1. b. Register May 2019 No. 761, eff. 6-1-19; CR 20-068: am. (2) (a) 3. Register December 2021 No. 792, eff. 1-1-22; CR 21-087: r. and recr. (1) (title), (intro.), r. (1m), r. and recr. (2) (b) (title), 1., r. (2) (bm) Register June 2022 No. 798, eff. 7-1-22.

DHS 129.08 Standards for nurse aide competency evaluation programs.

(1) Examiner qualifications. The examiner conducting the clinical competency program of a student shall be an RN with at least one year experience caring for the elderly or chronically ill of any age.

(2) Written or oral evaluation component.

(a) The RN examiner will give each student instructions for the written or oral evaluation component. After the student’s written or oral evaluation has begun, the RN may designate another person to proctor the written or oral evaluation.

(b) The competency evaluation program shall develop a pool of test questions that addresses all 6 content areas and their components under s. DHS 129.07 (1). The test questions shall include enough questions to form 3 separate and complete examinations.

(c) The competency evaluation program shall develop written and oral examinations from the pool of test questions. The content of the written and oral examinations shall reflect the content and emphasis of the training program approved by the department.

(d) The competency evaluation program shall provide students with written and oral examinations in English. If the student will be working in a provider setting in which the predominant language is other than English, the program may not refuse to test in the language that is predominant in that work setting.

(e) The competency evaluation program may develop an oral examination for nurse aides with limited literacy skills. To do so, the program shall adapt the written examination for oral testing. The oral examination shall cover the same subject areas included in the original written examination adapted for oral testing, and shall include a component to determine the aide’s ability to read basic, objective, job-related information, such as reading a client’s name band or a client’s flow sheet.

(f) A minimum of 50 written or oral questions shall be asked in each examination. The questions shall cover at least the 6 care areas under s. DHS 129.07 (1) and shall be selected randomly from the following areas:

1. A minimum of 4 questions in the area of interpersonal communication and social interaction.

2. A minimum of 7 questions in the area of basic nursing skills. Of these 7 questions, at least one question shall address each of the following areas:

a. Observation, reporting and documentation of changes in client status and services furnished.

b. Recognizing and reporting change of client condition and status to supervisor.

c. Knowledge of emergency procedures.