Student Forms & Program Procedures

Pre-Program Admission Checklist

Classroom Documents

 Nursing Assistant Skill Proficiency Performance List (NAPP)

 FLU Waiver Form – CNA Program Only

 Intake/Output Worksheet

Forms for Minors (under age 18)

Instructions & Forms Packet for Underage Students 

Optional FERPA Release Form 

Minor Student Background Exemption Form


 CNA Program Procedures

List of Procedures & Form Link

Click the down arrow near each procedure to view/read the detailed procedure.

Click the red box below to view/download the acknowledgement form.

 Acknowledgement of CNA Procedures FOrm

1.  Clinical Expectations & Scheduling

EXPECTATIONS

Students are expected to be at assigned clinical sites on time and prepared to care for patients/clients.  Students are expected to be dressed according to the Dixie State University Department of Nursing Uniform Dress Code.  A student who is unprepared for clinical may be deemed unsafe and may be sent home and subject to disciplinary actions (see General Student Nurse Handbook).

Preparation for clinical includes, but is not limited to:

  • Being on time
  • Having at least 4 hours minimum of rest prior to clinical
  • Proper uniform and badge
  • Fit for Study (see General Nursing Student Handbook)
  • Pre-Clinical Compliance (see course syllabus and/or Canvas)
  • Further requirements as listed in course syllabus
  • No students may leave the clinical site building for any reason during clinical shifts

Arrangements have been made to use area agencies for student learning.  These agencies have been used in the past and have provided a quality opportunity. However, changes may occur as the agencies grow, patient acuity changes, and other needs and new opportunities arise.  Learning experiences may not necessarily take place Monday through Friday from 8am-5pm.  Contract lists are on file with the nursing department.

 

SCHEDULING

Students will sign up for clinical shifts (NURS 1007) on pre-determined days with specific times and locations. Students are required to complete 24 hours of clinical in conjunction with taking the CNA class (NURS 1005).

The last day to change any clinical date is the DSU Drop for Non-Payment date which is the first Friday of each semester (see academic calendar). Prior to scheduling, students should ensure the dates and times will work for their needs because there will be no switching of clinical due to personal reasons after the non-payment drop date. Students who cannot attend all the scheduled clinical days or are unable to find a clinical to switch to should drop the CNA course before the drop date.

Clinical scheduling is done through an online scheduling website. Information on clinical scheduling will be posted in Canvas. Rotations are subject to clinical site and instructor availability. Changes do occur.

By scheduling a clinical, students agree to the following:

  • I understand that I must attend all of my scheduled clinical dates and that I am responsible to make up any missed time.
  • I understand that I must schedule my clinical shifts using the directions posted in Canvas.
  • I understand that I cannot change my clinical rotation dates after the DSU Drop Date.
2.  Uniform Code 

Each student is expected to abide by the Dixie State University Department of Nursing Uniform Code and conform to all agency codes where Dixie State University students participate in clinical activity. (Reasonable accommodations will be considered by the Nursing Department Chair if any of the requirements conflict with religious beliefs.)

Dixie State University Department of Nursing Uniform Code will be in accordance with all clinical facilities.

General Grooming

  1. Avoid using strong scented lotions, perfumes, or colognes as some people may have adverse reactions.
  2. No chewing gum in the clinical setting.
  3. Discriminating and/or distracting tattoos (students may be asked to cover any tattoo while in the clinical setting).
  4. No smoking during clinical shifts

Hair

  1. Clean & neatly combed with NO extreme styles, outrageous hair ornaments, ribbons, or colored scarves.
  2. Hair, long or short, must be controlled so it will NOT fall in the face of the student.  Hair should never obstruct vision or require pushing aside.
  3. Neatly trimmed male facial hair is acceptable. No extreme side burns or beards.

Uniform 

  1. Program specific scrubs are required at all clinical experiences and labs.  Mandatory Dixie State University CNA Program badges are required for nursing student identification.  Students not wearing their identification badge will be asked to leave their clinical assignment until they have their badges. There will be a charge for replacement badges.
  2. Uniforms are to be clean and wrinkle-free. Uniform pant hems must not touch/drag on floor. Uniform pants must be properly hemmed, not rolled up. Properly maintain and mend the uniform as needed (use thread rather than safety pins and/or tape)
  3. NO PATIENT GOWNS may be worn for a student uniform.
  4. When in a clinical facility for pre-assessments, student must wear clinical uniform or lab coat and name-tag.
  5. Wear appropriate uniforms in special care areas (When in OR wear the scrubs given to you).
  6. Approved uniform includes:
    1. Program approved scrubs (details in syllabus)
    2. Solid color white, red or navy blue sweater or scrub jacket, if desired.  No hoodies.
    3. White, red, or navy blue T-shirt may be worn underneath the uniform if desired. It must be tucked in with no lace or patterns showing.
    4. Appropriate underclothing not visible through or around uniform.  Must have a modest and non-revealing appearance.
    5. Clean socks with no runs, snags or holes.
    6. Shoes:
      1. Medical, professional footwear or athletic shoes.
      2. Condition and care of shoes: no cracks; no rundown heels
      3. Leather intact, and shoes and laces cleaned daily. No clogs without backs or other similar type shoes. Open-toed shoes not allowed.

Acceptable Jewelry

  1. Wedding and engagement rings. (Rings with large settings are not advised.)
  2. Watch with a second hand.  Band should be as simple as possible.
  3. Small earring posts may be worn in pierced ears only.  Maximum of two posts per ear.  No loop earrings.  NO other visible body pierced jewelry.
  4. No chains, bracelets, or ankle bracelets.

Make-up

  1. Should be conservative and natural looking.

Fingernails

  1. One-quarter (1/4) inch in length beyond end of finger, clean and manicured.
  2. Natural color polish, clear or neutral in good repair/condition
  3. Artificial nails or tips are not allowed.

Lab & Classroom Attire

  1. Uniform scrubs OR street clothes with white lab coat (long or short sleeved) are required for all labs.
  2. You are expected to behave professionally and dress in appropriate street clothes for classroom and open lab practice.
3.  Honor Code
  1.   I COMMIT MYSELF TO ACTING HONESTLY, RESPONSIBLY, AND ABOVE ALL, WITH HONOR AND     INTEGRITY IN ALL AREAS OF THE NURSING PROGRAM INCLUDING CLASSROOM, LAB, AND CLINICAL.
  2.  I AM ACCOUNTABLE FOR ALL THAT I SAY AND WRITE.
  3.  I AM RESPONSIBLE FOR THE ACADEMIC INTEGRITY OF MY WORK.
  4.  I PLEDGE THAT I WILL NOT MISREPRESENT MY WORK NOR GIVE OR RECEIVE UNAUTHORIZED AID.
  5.  I COMMIT MYSELF TO BEHAVING IN A MANNER WHICH DEMONSTRATES CONCERN FOR THE PERSONAL DIGNITY, RIGHTS, AND FREEDOMS OF ALL MEMBERS OF THE DIXIE STATE UNIVERSITY COMMUNITY.
  6.  RECOGNIZING MY RESPONSIBILITY TO PROTECT THE INTEGRITY OF THE NURSING PROFESSION, I WILL REPORT OTHER STUDENTS’ DISHONEST BEHAVIOR TO FACULTY OR THE DEAN OF HEALTH SCIENCES.
  7.  I COMMIT TO UPHOLD DIXIE STATE UNIVERSITY POLICIES ON STUDENT RIGHTS AND RESPONSIBILITIES AND THE NURSING PROGRAM INTEGRITY STATEMENT.
4.  Social Media Procedure

Online social networking sites like Facebook, Twitter, LinkedIn, and Classmates.com can be helpful to students by creating connections with classmates who share similar interests and goals, formulating study groups, and providing a way to meet and get better acquainted with others. These sites also offer students the opportunity to create an image or a profile. Profiles often contain information about the user as well as photos, blog entries, and a section dedicated to communication exchanges with friends and other users. To a certain extent, profiles reveal what students care about and provide a window into a student’s interests and lifestyle.

Purpose and Issues to Consider

The purpose of this procedure is to inform students about the appropriate use of online social networking sites as it relates to professional conduct expected of nursing students at Dixie State University (DSU). Online social networking postings in relation to students, faculty, administrators, and future employers must be evaluated in accordance with codes of conduct and standards of professional behavior expected of nursing students. Bear in mind that people have been denied employment because of information posted on social networking sites. In some cases, legal charges have been filed against a student for defamation of character and/or invasion of privacy.

 

While the DSU Department of Nursing cannot prevent reference to students, faculty, administrators, and other persons associated with the DSU Department of Nursing on social networking sites, the Department of Nursing may however, provide guidance regarding postings associated in any way with the Department of Nursing and its constituents.

Students are asked to refrain from posting insulting, disrespectful, or disparaging comments about any member of the Dixie State University campus community.

  1.  I will refrain from posting insulting, disrespectful, or disparaging comments about any member of the
    Dixie State University campus community to social media sites. I will attempt to directly resolve a
    conflict, concern, or issue with a member of the DSU community. If I am unable to resolve a conflict,
    concern, or issue directly with the individual involved, I will utilize the resources available to me
    including but not limited to the Dean of Health Sciences, Dean of Students, Health and Wellness Center
    counselors, class representative, a trusted advisor or mentor.
  2. In exchange for the educational opportunities provided to me by the clinical rotations, I agree to comply
    with all state, local, and federal requirements governing the privacy of medical information. Those
    privacy requirements have been explained to me, and I have had training in complying with these
    requirements. I agree to uphold all HIPAA and other privacy requirements during my clinical rotations.
  3. I understand that I am bound to comply with all privacy requirements when I am not at the clinical
    rotation, including in my conversations with family, friends, and peers. I will be held accountable for
    maintaining the privacy of any information I obtain, see, or am given during my clinical rotations. In
    addition, to uphold the privacy of such information, I agree to not post or discuss any clinical experience
    or information regarding my experience with the clinical agency, its staff, or its clients/patients on any
    Internet social media (Facebook, Twitter, Linkedin, email, MySpace, and any others not mentioned).
  4. I understand that administration periodically searches the Internet for breaches in its privacy policies. I
    will be prohibited from returning to the clinical site if I violate any privacy requirement in any regard.
    Such violation may also result in a delay in completing my degree requirements or in further
    disciplinary action against me by Dixie State University.
5.  PROTECTING PATIENT HEALTH INFORMATION – HIPAA

As a student of the Dixie State University CNA Program, you will have access to “Confidential Information” both in class and while at clinical. Confidential information is a valuable tool that helps in teaching skills and standards. It contains very sensitive information and is protected by law and by the facilities within which you serve. The intent of those laws and policies are to assure that this information remains confidential and is only used for the purpose in which learning will occur. All students must abide/adhere to HIPAA instructions.

Under no circumstances may confidential information be divulged to anyone except those authorized to receive information in the lines of duty. Openly discussed patient care issues in public areas outside the classroom/lab and/or facility is not appropriate. Inappropriate release of confidential information is considered a breach of confidentiality and will result in disciplinary action including possible program termination and the filing of criminal charges. All students will read and familiarize themselves with university and clinical site confidentiality policies and may be required to sign additional confidentiality agreements.

6.  Consent for Drug & Alcohol Testing

A requirement to entering a College of Health Sciences (CHS) program with a clinical component is submission to a urine drug test. The testing facility must provide results of the test directly to the CNA program. If the substance test result is positive, the program chair will follow the guidelines listed in the CHS Drug and Alcohol Testing Procedure, which may include denial of entrance to the program.

By acknowledging consent to the Drug and Alcohol Testing Procedure:

  • I authorize DSU to conduct all related alcohol and drug tests that are subject to the policy. I further authorize and give full permission to have the University and/or its personnel to send the specimen or specimens so collected to a laboratory for a screening test for the presence of any prohibited substances under the policy, and for the laboratory or other testing facility to release any and all documentation relating to such test to the University and/or to any governmental entity involved in a legal proceeding or investigation connected with the test.
  • I also authorize the release of information concerning the results of such tests to designated University personnel, its clinical partners, to any assistance program to which I may be referred, and to the appropriate licensing boards, if applicable.
  • I will hold harmless DSU, its personnel and any testing laboratory the University might use, meaning that I will not sue or hold responsible such parties for any alleged harm to me that might result from such testing, including loss of right to participating in the academic program, ineligibility to test for a certification exam, employment or any other kind of adverse action that might arise as a result of the drug or alcohol test, even if a DSU or laboratory representative makes an error in the administration or analysis of the test or the reporting of the results. I will further hold harmless DSU, its personnel and any testing laboratory the University might use for any alleged harm to me that might result from the release or use of information or documentation relating to the drug and/or alcohol test, as long as the release or use of the information is within the scope of this policy and the procedures as explained in the paragraph above.
  • I understand refusal to complete the drug and/or alcohol testing process will prohibit me from entering the desired program in the CHS at DSU as stated in the CHS Drug and Alcohol Testing Procedure.
  • I consent to urine drug and/or alcohol testing for the purpose of admission to a program with a clinical component in the College of Health Sciences at Dixie State University. I understand that this consent form remains in effect during my enrollment in a CHS program with a clinical component at DSU.
7.  Disclosure of Legal Convictions & Arrests

Students who are enrolled in the Dixie State University College of Health Sciences programs must report any arrests or legal convictions including, but not limited to, misdemeanors, felonies, sexual offender convictions or governmental sanctions.  The College of Health Sciences reserves the right to release relevant information regarding a student’s criminal history to appropriate clinical agency representatives.  Failure to report arrests or legal convictions to the Dean of Health Sciences and Department Chair within 48 hours of the arrest or conviction will result in dismissal from the program.

Students enrolled in the College of Health Sciences programs are subject to background checks prior to placement in clinical agencies and/or before enrollment in the program.  Certain arrests or convictions that could jeopardize the health and safety of patients and/or agency employees may render students ineligible for placement in a clinical agency.  Ineligibility for placement in a clinical agency will result in course failure and dismissal from the health science program.

At such time a health science student is arrested, the student has 48 hours to report this arrest to the appropriate program director and the Dean of Health Sciences.  Failure to report the arrest will result in automatic dismissal from the health science program.  Students may not report to clinical or be present in clinical agencies until the issue is resolved and a determination has been made by the Dean of Health Sciences regarding the risk to patients and/or clinical agency employees as indicated by the nature and circumstances of the arrest.  The Dean of Health Sciences will review the student’s status in the health science program. A possible outcome of the review may be the student’s inability to continue in the program.   It may be necessary to release the student’s disclosure of a legal conviction and/or arrest to an appropriate representative of the clinical agency for the sole purpose of determining eligibility to participate in clinical activities within the agency.

Students in the College of Health Sciences programs must comply with the legal, moral, and legislative standards in accordance with the Utah State Division of Professional Licensing laws and rules as well as professional and ethical codes of conduct.  A student may be denied eligibility for licensure or certification if convicted of a felony and/or certain misdemeanors.

By participating in a DSU College of Health Sciences Program, students agree to the following:

  • I understand that I have 48 hours to report any arrest, criminal conviction, or governmental sanction while enrolled in a Dixie State University Health Sciences program to the appropriate program director and the Dean of Health Sciences.
  • I understand that I will be unable to participate in clinical activities until the issue is resolved.
  • I further agree to, and hereby authorize, the release of my disclosure of a legal conviction and/or arrest to an appropriate representative of the clinical agency for the sole purpose of determining eligibility to participate in clinical activities within the agency.
  • I understand that failure to report any arrests, convictions, or governmental sanctions within 48 hours will result in my dismissal from the health science program.
  • I do hereby swear or affirm that I have read and understand the requirements of this procedure.  I will comply with the requirements of this procedure.
8.  CNA Student Code of Ethics

CODE OF ETHICS
PREAMBLE
The code of Ethics is based on the fundamental values of the Nursing Assistant (NA) profession that includes the worth, dignity and uniqueness of all persons as well as their rights and opportunities.  This Code is intended to serve as a guide to the everyday conduct of members of the Nursing Assistant profession.

The following principles should guide Nursing Assistants in their various roles and relationships. Ethical behavior results not from edict but from a personal commitment of the individual.

I.  The Nursing Assistant’s ethical responsibility to residents:  A resident is to include all individuals who receive care.
A.     Care- The NA recognizes his/her role as a caregiver, not authority figure, and focuses on the resident. The NA’s first concern is for the resident’s safety and welfare. The NA recognizes listening as a therapeutic act and projects a positive attitude in verbal and nonverbal communication (tone, volume, speed).  The NA is thorough in meeting the resident’s needs and in the delivery of care.  The NA understands and monitors the resident’s condition and reports significant changes to their team.  The NA organizes the work to insure that care plans are carried out accurately. The NA supports the resident’s efforts by offering frequent praise, by maintaining open lines of communication, and by following up on a resident’s request in a timely manner.

B.     Respect- The NA treats the resident as he/she would like to be treated regardless of illness or condition. Promoting a resident’s self-esteem is an important part of respect and is accomplished by honoring the resident’s belief system, respecting his/her life experiences, and encouraging decision making by giving choices about daily activities. The NA provides privacy and treats residents fairly without showing favoritism or being judgmental.  Respect continues after death in the care of the body and emotional support given to the family.

C.     Responsibility- The NA conducts himself/herself in a professional manner.  The NA performs at his/her level of competence, seeks clarification or helps whenever uncertain, and ensures that the resident has a safe and comfortable environment.

D.     Confidentiality- Recognizing the fragility of privacy and honoring the trust relationship of resident and caregiver, the NA ensures each resident’s dignity and privacy by following HIPAA guidelines to protect resident PHI (protected health information).  The NA should share PHI with as few individuals as needed to ensure resident’s care and discuss only as it relates to the NA’s education. NA takes all reasonable steps to make sure individuals without ‘need to know’ do not overhear conversations about PHI and do not discuss PHI in elevators or cafeteria or any social networks. NA protects computer screen, and clip boards or notes, floppy/zip/CD-ROM/PDA from loss. NA does not text or leave telephone messages of PHI. NA identifies patient by initial only, using demographic data only to identify patient’s needs to instructor. NA cannot photo duplicate documents and no notes with PHI are put in trash or recycler.

E.  Abuse- The NA does not abuse residents in any way – verbally, physically, or mentally.  Abuse includes subtle forms such as talking about residents in front of them, talking down to residents, raising the voice, or forcing residents to comply with expectations.  The NA respects the resident’s personal property, does not steal, and does not accept gratuities. The NA also reports behaviors of others that are not in the resident’s best interest.

II. The Nursing Assistant’s ethical responsibility to families, guardians, and community:
A.     Family Rights- The NA keeps family information confidential, provides privacy for families, is considerate of cultural differences, and respects decisions made by residents and families.

B.     Professional Demeanor- The NA shows concern and caring for families and visitors by speaking in a respectful and quiet tone of voice, by exercising good judgment in maintaining a supportive, professional role to the family, and by responding promptly to the needs of the families.  The NA is an ambassador to the community through honesty, competence, and provision of quality care to its members.

C.  Open Communication- The NA is friendly and compassionate to families and visitors, helping them during the admission process, encouraging them to become involved with activities and referring them to other healthcare professionals to resolve questions or problems.

III.    The Nursing Assistant’s ethical responsibility to co-workers:
A.      Attitude- The NA is positive, constructive, and professional in seeking solutions to problems.  The NA sets a positive example by being on time, being enthusiastic, being complimentary of others, and by not bringing personal problems to the work environment.  The NA gives input in an assertive but not aggressive manner.

B.     Respect- The NA treats co-workers as he/she would like to be treated. Respect is demonstrated by being sensitive, helpful, and friendly to one another, being tolerant of different personalities, being reliable, honest and trustworthy, and recognizing that respect is essential for all relationships.

C.  Teamwork- The NA recognizes himself/herself as one member in a multi-disciplinary team, all focusing its efforts on the resident.  In a spirit of teamwork, the NA is supportive, cooperative, and prompt in assisting co-workers at all times.

IV. The Nursing Assistant’s ethical responsibility to employers:
A.      Quality- The NA focuses on doing the best job possible.  This involves punctuality, attendance, thoroughness, time management, and maintaining knowledge/competency.

B.     Attitude- The NA enhances the work environment by being enthusiastic and taking pride in his/her appearance and demeanor.

C.  Respect- The NA is supportive of the organization by following policies and procedures and utilizing the chain of command. The NA views himself/herself as a representative of and promotes the organization positively.  The NA is respectful of the employer’s property. Include using supplies responsibly to avoid waste.

V.  The Nursing Assistant’s ethical responsibility to the healthcare profession:
A.      Integrity- The NA is committed to ethical behavior and practice. The NA positively promotes the Nursing Assistant profession to encourage others to see it as a rewarding career.

B.     Quality Service- The NA, in a respectful, organized, and compassionate manner promotes the caring image of the profession by working as part of the healthcare team (communicating changes, seeking consensus, consulting proper sources for solutions). The NA treats all patients equally regardless of age, race, or religion and does not perform anything beyond his /her qualifications.

C.     Professional Responsibility- The NA follows recommended healthcare practices (infection prevention practices, updated immunizations, personal cleanliness, environmental neatness, careful use of equipment, etc.). Out of respect for the profession, the NA remains in the field only if he/she feels an enthusiastic commitment.

D.  Continuing Education- The NA maintains his/her competence, growth, and adaptability through ongoing training and by keeping all certifications up to date.

VI.        The Nursing Assistant’s ethical responsibility to himself/herself:
A.      Self-Esteem- The NA is happy with and respects himself/herself.  The NA is cheerful and honest with himself/herself. The NA develops a positive attitude and lives by a moral code.  The NA keeps his/her work and social life separate.  The NA keeps physically fit through a healthy life-style, balancing rest, relaxation, recreation, and work, getting regular physical exercise, eating a balanced diet, avoiding substance abuse and making use of emotional support structures when needed.

B.     Pride- The NA takes pride in quality care and is open-minded and professional. The NA places value in the team concept.

C.     Resources and limitations- The NA is open to listening and learning to better himself/herself. The NA acknowledges his/her strengths and limitations, is willing to request help, and is able to take time off to refocus at an appropriate time.

9.  CNA & NA Student Misconduct 

Utah Office of Administrative Rules – rules.utah.gov
Utah Nurse Assistant Registry – utahcna.com

R432-45-6. Certified Nurse Aide Misconduct

The information listed below specifies what constitutes CNA misconduct. Misconduct that adversely affects the health, safety or welfare of the public may result in loss of nursing assistant certification. Abuse, neglect, and misappropriation of property fall under the misconduct rule and are considered more serious matters, and if substantiated, do result in loss of certification and possible criminal charges. CNAs with a substantiated allegation of abuse, neglect, or misappropriation of property are placed on the Abuse Registry for life or until the ruling is overturned in a court of law.

  1. CNA misconduct related to client safety and integrity includes:
    a. Leaving a nursing assistant assignment without properly notifying appropriate supervisory personnel;
    b. Failing to report information regarding incompetent, unethical or illegal practice of any health care provider to proper authorities;
    c. Failing to respect client rights and dignity regardless of social or economic status, personal attributes, or nature of health problems or disability; or
    d. Failing to report actual or suspected incidents of client abuse.
  2. Engaging in sexual misconduct related to the client or to the workplace includes:
    a. Engaging in sexual relations if the patient is receiving care from an institution or entity that employs the CNA;
    b. Engaging in sexual relations with a client for a period when a generally recognized caregiver and patient relationship exists; or
    c. Engaging in sexual relations for an extended period when a patient has reasonable cause to believe a professional relationship exists between the patients or anyone certified under the provisions of this rule (Rule R432-45).
  3. CNA misconduct related to administrative rules and state and federal law includes:
    a. Knowingly aiding, abetting or assisting an individual to violate or circumvent any rule or regulation intended to guide the conduct of health care providers;
    b. Violating the privacy rights and confidentiality of a client, unless disclosure of client information is required by law;
    c. Discriminating against a client on the basis of age, race, religion, sex, sexual preference, national origin, or disability;
    d. Abusing a client by intentionally causing physical harm or discomfort, or by striking a client, intimidating a client, threatening a client, or harassing a client;
    e. Neglecting a client by allowing a client to be injured or remain in physical pain and discomfort;
    f. Engaging in other unacceptable behavior or verbal abuse towards or in the presence of a client by using derogatory names or gestures or profane language;
    g. Using the client relationship to exploit the client by gaining property or other items of value from the client either for personal gain or sale, beyond the compensation for services;
    h. possessing, obtaining, attempting to obtain, furnishing or administering prescription or controlled drugs to any person, including oneself, except as directed by a health care professional authorized by law to prescribe drugs; or
    i. Removing or attempting to remove drugs, supplies, property, or money from the workplace without authorization.
  4. CNA misconduct related to communication includes:
    a. Inaccurate recordkeeping in client or agency records;
    b. incomplete recordkeeping regarding client care that includes failure to document care given or other information important to the client’s care or documentation which is inconsistent with the care given;
    c. falsifying a client or agency record that includes filling in someone else’s omissions, signing someone else’s name, recording care not given, or fabricating data and values;
    d. altering a client or agency record that includes changing words, letters and numbers from the original document to mislead the reader of the record, and adding to the record after the original time and date without indicating a late entry;
    e. Destroying a client or agency record;
    f. failing to maintain client records in a timely manner which accurately reflect management of client care, including failure to make a late entry within a reasonable time period; or
    g. Failing to communicate information regarding the client’s status to the supervising nurse or other appropriate person in a timely manner.
  5. CNA misconduct related to the client’s family includes:
    a. Failing to respect the rights of the client’s family regardless of social or economic status, race, religion, or national origin;
    b. Using the CNA-client relationship to exploit the family for the CNA’s personal gain or for any other reason;
    c. Stealing money, property, services, or supplies from the family; or
    d. Soliciting or borrowing money, materials or property from the family.
  6. CNA misconduct related to co-workers that includes violent, abusive, threatening, harassing, or intimidating behavior towards a co-worker, which either occurs in the presence of clients or otherwise relates to the delivery of safe care to clients.
  7. CNA misconduct related to achieving and maintaining clinical competency includes:
    a. Failing to competently perform the duties of a nursing assistant;
    b. Performing acts beyond the authorized duties for which the individual is certified; or
    c. Assuming duties and responsibilities of a nursing assistant without nursing assistant training or when competency has not been established or maintained.
  8. CNA misconduct related to impaired function includes:
    a. using drugs, alcohol or mind-altering substances to an extent or in a manner dangerous or injurious to the nursing assistant or others, or to an extent that such use impairs the ability to safely conduct the duties of a nursing assistant; or
    b. Having a physical or mental condition that makes the nursing assistant unable to safely perform the duties of a nursing assistant.
  9. CNA misconduct related to certificate violations includes:
    a. Providing, selling, applying for, or attempting to procure a certificate by willful fraud or misrepresentation;
    b. Functioning as a medication assistant without current certification as a medication assistant;
    c. Altering a certificate of completion of training or nursing assistant certification;
    d. Disclosing contents of the competency examination or soliciting, accepting or compiling information regarding the contents of the examination before, during or after its administration;
    e. Allowing another person to use one’s nursing assistant certificate for any purpose;
    f. Using another’s nursing assistant certificate for any purpose; or
    g. Representing oneself as a CNA without current, valid CNA certification.