---
kind: "section"
citation: "42 C.F.R. § 483.152"
title: "42"
number: "483.152"
heading: "Requirements for approval of a nurse aide training and competency evaluation program."
url: "https://uscodex.org/cfr/42/483.152"
---

# §483.152. Requirements for approval of a nurse aide training and competency evaluation program.

- (a) For a nurse aide training and competency evaluation program to be approved by the State, it must, at a minimum—
  - (1) Consist of no less than 75 clock hours of training;
  - (2) Include at least the subjects specified in [paragraph (b)](#b) of this section;
  - (3) **Include at least 16 hours of supervised practical training.** Supervised practical training means training in a laboratory or other setting in which the trainee demonstrates knowledge while performing tasks on an individual under the direct supervision of a registered nurse or a licensed practical nurse;
  - (4) **Ensure that—**
    - (i) Students do not perform any services for which they have not trained and been found proficient by the instructor; and
    - (ii) Students who are providing services to residents are under the general supervision of a licensed nurse or a registered nurse;
  - (5) Meet the following requirements for instructors who train nurse aides;
    - (i) The training of nurse aides must be performed by or under the general supervision of a registered nurse who possesses a minimum of 2 years of nursing experience, at least 1 year of which must be in the provision of long term care facility services;
    - (ii) Instructors must have completed a course in teaching adults or have experience in teaching adults or supervising nurse aides;
    - (iii) In a facility-based program, the training of nurse aides may be performed under the general supervision of the director of nursing for the facility who is prohibited from performing the actual training; and
    - (iv) Other personnel from the health professions may supplement the instructor, including, but not limited to, registered nurses, licensed practical/vocational nurses, pharmacists, dietitians, social workers, sanitarians, fire safety experts, nursing home administrators, gerontologists, psychologists, physical and occupational therapists, activities specialists, speech/language/hearing therapists, and resident rights experts. Supplemental personnel must have at least 1 year of experience in their fields;
  - (6) Contain competency evaluation procedures specified in [§ 483.154](/cfr/42/483.154.md).
- (b) The curriculum of the nurse aide training program must include—
  - (1) At least a total of 16 hours of training in the following areas prior to any direct contact with a resident:
    - (i) Communication and interpersonal skills;
    - (ii) Infection control;
    - (iii) Safety/emergency procedures, including the Heimlich maneuver;
    - (iv) Promoting residents' independence; and
    - (v) **Respecting residents' rights.**
  - (2) Basic nursing skills;
    - (i) Taking and recording vital signs;
    - (ii) Measuring and recording height and weight;
    - (iii) Caring for the residents' environment;
    - (iv) Recognizing abnormal changes in body functioning and the importance of reporting such changes to a supervisor; and
    - (v) **Caring for residents when death is imminent.**
  - (3) **Personal care skills, including, but not limited to—**
    - (i) Bathing;
    - (ii) Grooming, including mouth care;
    - (iii) Dressing;
    - (iv) Toileting;
    - (v) Assisting with eating and hydration;
    - (vi) Proper feeding techniques;
    - (vii) Skin care; and
    - (viii) **Transfers, positioning, and turning.**
  - (4) **Mental health and social service needs—**
    - (i) Modifying aide's behavior in response to residents' behavior;
    - (ii) Awareness of developmental tasks associated with the aging process;
    - (iii) How to respond to resident behavior;
    - (iv) Allowing the resident to make personal choices, providing and reinforcing other behavior consistent with the resident's dignity; and
    - (v) **Using the resident's family as a source of emotional support.**
  - (5) **Care of cognitively impaired residents—**
    - (i) Techniques for addressing the unique needs and behaviors of individual with dementia (Alzheimer's and others);
    - (ii) Communicating with cognitively impaired residents;
    - (iii) Understanding the behavior of cognitively impaired residents;
    - (iv) Appropriate responses to the behavior of cognitively impaired residents; and
    - (v) **Methods of reducing the effects of cognitive impairments.**
  - (6) **Basic restorative services—**
    - (i) Training the resident in self care according to the resident's abilities;
    - (ii) Use of assistive devices in transferring, ambulation, eating, and dressing;
    - (iii) Maintenance of range of motion;
    - (iv) Proper turning and positioning in bed and chair;
    - (v) Bowel and bladder training; and
    - (vi) **Care and use of prosthetic and orthotic devices.**
  - (7) **Residents' Rights.**
    - (i) Providing privacy and maintenance of confidentiality;
    - (ii) Promoting the residents' right to make personal choices to accommodate their needs;
    - (iii) Giving assistance in resolving grievances and disputes;
    - (iv) Providing needed assistance in getting to and participating in resident and family groups and other activities;
    - (v) Maintaining care and security of residents' personal possessions;
    - (vi) Promoting the resident's right to be free from abuse, mistreatment, and neglect and the need to report any instances of such treatment to appropriate facility staff;
    - (vii) **Avoiding the need for restraints in accordance with current professional standards.**
- (c) **Prohibition of charges.**
  - (1) No nurse aide who is employed by, or who has received an offer of employment from, a facility on the date on which the aide begins a nurse aide training and competency evaluation program may be charged for any portion of the program (including any fees for textbooks or other required course materials).
  - (2) If an individual who is not employed, or does not have an offer to be employed, as a nurse aide becomes employed by, or receives an offer of employment from, a facility not later than 12 months after completing a nurse aide training and competency evaluation program, the State must provide for the reimbursement of costs incurred in completing the program on a pro rata basis during the period in which the individual is employed as a nurse aide.

## Notes

### Source

Source: 56 FR 48919, Sept. 26, 1991, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302, 1320a-7, 1395i, 1395hh and 1396r.