NURSE AIDE TRAINING SUMMARY (NATS)
NURSING FUNDAMENTALS 7243 – NC PUBLIC HIGH SCHOOLS
2013-2014
Student ____________________________________ School ______________________
This document will be handled frequently and must be kept on file for three years in a locked cabinet or locked office,
it is suggested that the NATS be printed on card stock paper.
PREREQUISITES SATISFIED
NATS - PART 1
Date of successful completion of AHSI or MSI or HSI
Date of successful completion for Health Science II -7242
Date Healthcare Provider Basic Life Support completed
NATS - PART 2
(semester / school year)
(semester / school year)
(must be current)



SKILLS PROFICIENCY – TRAINING LAB
Directions
•
Student must demonstrate, and then teacher must document skill proficiency in ALL curriculum
skills PRIOR TO DIRECT RESIDENT CONTACT.
•
Approved teacher must enter the date in column “A” and enter approved teacher initials in
column “B” for each skill as evidence of student proficiency in the training lab. Use black ink
only. Do not draw a line down through the columns.
•
Skills marked with an asterisk  must be taught. However, individual student proficiency
check is NOT required. Teacher must enter the word “taught” and the date in column “A” and
place approved teacher’s initials in column “B.”
•
This is a legal document and must be stored securely in the student’s individual file for a
minimum of three years. *Change effective school year 11-12.
A
DATE STUDENT
DEMONSTRATED
COMPETENCE
B
APPROVED
TEACHER’S
INITIALS
UNIT A - NURSE AIDE WORKPLACE FUNDAMENTALS
1.03A
1.03B
3.01A
3.01B
3.01C
SKILL
SKILL
SKILL
SKILL
SKILL
Restraint Alternative - Apply Electric Alert Device
Apply Restraints
Wash Hands
Handrub (hand hygiene)
Don and remove complete PPE
Dispose of equipment from resident unit with transmission based
3.01D SKILL
precautions
Collect specimen from resident under disease transmission based
3.01E SKILL
precautions
3.02A SKILL
Perform relief of choking (assure CURRENT competence)
UNIT B - NURSE AIDE RESIDENT CARE SKILLS
4.01A SKILL
Take oral temperature with non-mercury glass thermometer
4.01B SKILL
Take axillary temperature with non-mercury glass thermometer
4.01C SKILL
Take rectal temperature with non-mercury glass thermometer
4.01D SKILL
Take oral temperature with electronic thermometer
4.01E SKILL
Take temperature with tympanic thermometer
4.01F SKILL
Count and record radial pulse
4.01G SKILL
Count and record apical pulse
4.01H SKILL
Count and record respirations
4.01 I SKILL
Measure and record blood pressure - Manual BP cuff
Retain all parts of the Nurse Aide Training Summary (NATS) in the student’s individual file for a minimum of three years. This is a legal
document and should be stored in a locked file cabinet ready for nurse aide training program review at any time.
1
Student Name:
4.01J SKILL
4.01K SKILL
4.02A SKILL
4.02B SKILL
4.02C SKILL
4.02D SKILL
4.02E SKILL
4.02F SKILL
4.02G SKILL
4.02H SKILL
5.01A SKILL
5.01AA SKILL
5.01B SKILL
5.01C SKILL
5.01D SKILL
5.01E SKILL
5.01F SKILL 
5.01G SKILL
5.01H SKILL
5.01I SKILL
5.01J SKILL
5.01K SKILL
5.01L SKILL
5.01M SKILL
5.01N SKILL
5.02A SKILL
5.02B SKILL
5.02C SKILL
5.02D SKILL
5.03A SKILL
5.03B SKILL
5.03C SKILL
6.01A SKILL
6.01B SKILL
6.01C SKILL
6.01D SKILL
6.02A SKILL
6.02B SKILL
6.02C SKILL
6.02D SKILL
6.02E SKILL
6.02F SKILL
6.02G SKILL
6.02H SKILL
6.02I SKILL
6.02J SKILL
6.02K SKILL
Initials
Measure and record combined vital signs
Measure and record height and weight
Ambulation with cane or walker
Use mechanical resident lift
Range of Motion
Ambulation with transfer (gait) belt
Transfer from bed to chair / wheelchair
Transfer from bed to stretcher
Assist resident to cough and deep breath
Apply and remove anti-embolic stockings (TEDs)
Assist and provide when needed, resident mouth care
Mouth Care using a MOUTH CARE PLAN
Denture care
Mouth care for unconscious resident
Fingernail care
Foot care
Shaving a resident
Provide hair care
Shampoo resident’s hair in bed
Dressing and undressing the resident
Complete bed bath
Partial bed bath
Tub bath or shower
Perineal care
Giving a back rub
Move resident up in bed with and without turn sheet
Position resident on side
Apply non-sterile dressing
Apply warm and cold applications
Make a closed (unoccupied) bed
Opening a closed bed
Make an occupied bed
Provide fresh drinking water
Measure and record intake and output
Assist with dining
Serve supplemental nourishment
Assist to bathroom (BR)
Assist to bedside commode (BSC)
Assist resident with use of bedpan
Apply adult brief
Administer cleansing enema
Collect fecal (stool) specimen
Assist with urinal
Provide catheter care
Empty urinary drainage catheter bag
Collect routine urine specimen
Apply condom catheter
Approved Teacher’s Name
Initials
Approved Teacher’s Name
I CERTIFY THAT ALL NURSE AIDE I CURRICULUM SKILLS REQUIRING STUDENT PROFICIENCY
CHECKS WERE COMPLETED AND DOCUMENTED PRIOR TO DIRECT PATIENT CONTACT.
Retain all parts of the Nurse Aide Training Summary (NATS) in the student’s individual file for a minimum of three years. This is a legal
document and should be stored in a locked file cabinet ready for nurse aide training program review at any time.
2
NATS - PART 3
SKILLS PROFICIENCY – C L I N I C A L
Student must demonstrate the ability to transfer NA I skill proficiency from the training lab to direct resident care in a long
term care setting. DHSR/CARE requirement - July 2006.
APPROVED RN TEACHER MUST SUPERVISE WHEN CLINICAL
PROFICIENCY IS BEING DETERMINED.
A
B
DATE STUDENT
DEMONSTRATED
COMPETENCE
APPROVED
TEACHER’S
INITIALS
MUST PERFORM AT LEAST (15) OF THE FOLLOWING SKILLS IN LTC CLINICAL SETTING
1
2
3
4
5
6
7
8
9
10*
11
12
13
14
15
16
17
18
19
21
22
23
24
25
Initials
Restraint Alternative - Apply Electric Alert Device
Hand hygiene – washing and hand rub
Don and remove complete PPE
Measure and record combined vital signs
Measure and record height and weight (balance scale)
Range of Motion
Ambulation with transfer belt, ambulation with cane or walker
Transfer from bed to chair / wheelchair
Apply and remove anti-embolic stockings (TEDs)
Provide mouth care for resident with a Mouth Care Plan
Denture care
Mouth care for unconscious resident
Fingernail care
Foot care
Dressing and undressing the resident
Complete bed bath or partial bed bath
Perineal care
Move resident up in bed with and without turn sheet, position
resident on side
Make an occupied bed
Assist with dining (resident who cannot feed self) and measuring
intake and output
Assist with us of bathroom, bedside commode (BSC), bedpan,
and urinal and measuring and recording urinary output
Change adult brief
Provide catheter care and empty urinary drainage catheter bag
Collect routine urine specimen
Approved Teacher’s Name
Initials Approved Teacher’s Name
NOTES:
Retain all parts of the Nurse Aide Training Summary (NATS) in the student’s individual file for a minimum of three years. This is a legal
document and should be stored in a locked file cabinet ready for nurse aide training program review at any time.
3
NATS - PART 4
CLINICAL TIME REQUIREMENT
Successfully completed 40 hours of supervised long term care or long term type care, performing hands on NAI
skills personal care skills to residents or completion of clinical option 2,3, or 4.
Date Clinical Time Complete:
Number of Clinical Hours:
NATS - PART 5
NURSE AIDE I TRAINING COMPLETION
Training is complete and candidate is eligible to receive a certificate of NAI training completion, and eligible to register
for the NNAAP™ examination and as an E1 when the student has:
NATS
Part 1
NATS
Part 2
NATS
Part 3
NATS
Part 4
NATS
Part 5
1.
2.
3.
4.
Satisfied course prerequisites

Demonstrated competence in ALL curriculum skills in the training lab prior to clinical

Demonstration of ability to transfer skill competence in a real long term care resident
care setting as required by DHSR/CARE
Met clinical experience time requirement

Completed Nurse Aide Training (READ NOTES BELOW)


1. The teacher does NOT have to wait until EOC exams are administered to complete the
certificate of completion and guide candidates to apply for registry by NNAAP
competency evaluation.
2. When NATS Part 1,2,3,4 listed above are totally completed and the student is “for sure”
on track to pass Nursing Fundamentals with a 75 or better, the candidate may receive
the certificate of completion apply to take the NNAAP exam as an E1. Some teachers
may desire to prepare the certificate of completion when training is complete and hold
onto it until the last day of school.
3. The date on the Training Completion Certificate is the date all requirements for
nurse aide training are complete. It does not need to be the last day of school.
Prepare certificate of completion. Enter date of NAT completion here:______________
Have certificate of completion notarized. Your signature is what is being notarized.
Give ORIGINAL, notarized certificate of NA I training completion to the student.
Attach a photocopy of the original certificate of completion to this NATS.
NATS - PART 6
NURSING FUNDAMENTALS COURSE GRADE
Nursing Fundamentals 7243 Final Grade:
_______________________________
Notes/Comments:
NATS - PART 7 PHOTOCOPY OF CERTIFICATE OF NAI TRAINING COMPLETION
PLACE A PHOTO COPY OF THE CERTIFICATE OF COMPLETION BEHIND THIS
PAGE. THE CERTIFICATE OF COMPLETION COPY BECOMES NATS PART 7
Retain all parts of the Nurse Aide Training Summary (NATS) in the student’s individual file for a minimum of three years. This is a legal
document and should be stored in a locked file cabinet ready for nurse aide training program review at any time.
4