To become eligible for the Nurse Assistant Training Program, you must do the following:
Date Completed
Item
1.
Read this brochure completely. Enrollment in HS 70 is on a first come first
admitted basis of those students completing and submitting all requirements.
Students who submit the requirements after the course is filled will be placed
on a waiting list. Space is not guaranteed for those on the waiting list.
Completed applications will be accepted beginning May 19, 2009
_____________ 2.
Individuals who have never attended San Joaquin Delta college and those
students who have not attended for more than one semester must apply online
for admissions to the College before enrolling in classes. Online applications
may be completed in the E Services Lab, located in
Goleman, Room 128 or by accessing the Delta College Web site at
www.deltacollege.edu. A registration appointment is required to use the STAR
system and online registration except during open enrollment and after the
term has begun.
3.
Have fingerprinting completed at one of the sites provided on the Live Scan
Information Sheet (Appendix F). The Live Scan Form included with this
information packet must be utilized. Fingerprint fee of $47 to be paid to the site.
4.
Make an appointment to see your doctor or go to San Joaquin County Health
office located at 1601 E. Hazelton Ave., (209) 468-3830.
5.
Get a physical and have your health examiner complete the Pre-Entrance
Medical Record (Appendix A) in full. Make sure the health examiner answers
all questions on the Pre-Entrance Medical Form. Health examiner cannot be
related to applicant.
6.
Have the immunization form (Appendix B) completed by a licensed Health Care
Provider. The following are required:
A. Complete TB testing and submit results on the form provided.
B. Hepatitis B – you must document proof of receiving at least the first
immunization on the form provided. If the series has been completed
you must provide proof of a positive titre.
7.
Complete Malpractice Liability Insurance Application (Appendix C). Attach
$20.50 check or money order made payable to: Nurses Service Organization (credit
card payment also available). Mail the form and payment by certified mail.
Submit a copy of completed application and the certified mailing receipt to the
Nursing & Health Sciences Office.
8.
Complete the Application for Nurse Assistant Certification
DO NOT MAIL, submit to the Nursing & Health Sciences Office.
9.
Make copies of all completed forms and retain for your
records!
10.
Provide the Nursing & Health Sciences Office, Locke 213 with
the following beginning on May 19, 2009.: Retain copies for your records.
A. Original completed Pre-Entrance Medical Record
B. Original completed Immunization Record
C. Proof of mailing NSO insurance: certified receipt and copy of application.
D. “Requesting Agency” copy of the Live Scan Form
- Page 1 -
E.
F.
Completed Application for Nurse Assistant Certification
Bring your original social security card and California Drivers License or
California ID to the Nursing & Health Sciences Office.
11.
After all of the above items are completed, obtain the course code from the
Nursing & Health Sciences Office, Locke 213.
12.
Register for course.
13.
Purchase textbooks and required supplies before first day of class.
14.
Student identification badges will be done as a class
unit probably on the first day of class.
15.
Uniforms will be needed by the first day classes are scheduled for the hospital.
- Page 2 -
Introduction
The Nurse Assistant Training Program at San Joaquin Delta College is designed to qualify the student for
state certification. Preparation includes classroom instruction and supervised clinical training within the
guidelines set by the State Department of Health Services.
The Certified Nurse Assistant (CNA) is eligible for immediate employment in any acute care or skilled
nursing facility. The CNA performs tasks under the supervision of a licensed nurse that are supportive
and complimentary to nursing practice.
The nursing faculty at San Joaquin Delta College subscribes to career mobility and educational
articulation. Credit options for previous learning are available to CNAs who plan to expand there
professional goals toward the Vocational Nursing, Psychiatric Nursing, and the Registered Nursing
programs.
Upon satisfactory completion of the Nurse Assistant Training Program, students are eligible to take the
state examination for certification as a Certified Nurse Assistant (CNA).
Program Requirements
To enroll in the Nurse Assistant Training Program, you must do the following:
1.
If you are not currently a San Joaquin Delta College student, contact the Admissions Office in
Holt 101A, (209) 954-5614. You will need to complete an Application for Admission and will
need to have a "Registration Appointment" for the semester you intend to enroll.
2.
Complete the clinical requirements listed below. We will be accepting completed requirement
packets for the Spring Nurse Assistant Training class beginning May 19, 2009. You must submit
all required documents to the Nursing & Health Sciences Office, Locke 213. All necessary forms
are included in this packet. Enrollment in HS 70 is on a first come first admitted basis of those
students completing and submitting all requirements. Students who submit the requirements
after the course is filled will be placed on a waiting list. Space is not guaranteed for those on
the waiting list.
*Keep a duplicate copy of all material prior to submitting the originals to the Nursing &
Health Sciences Office, Locke 213. The Office will not make copies for you.
a. Pre-Entrance Medical Record. (See Appendix A) – Submit original completed, signed form.
b. Immunization Record. (See Appendix B) – Submit original completed, signed form.
c. Professional Liability Insurance. (See Appendix C) – Mail completed application with
payment to NSO by Certified Mail. Submit copies of the completed application and Certified
Mailing Receipt.
d. "Requesting Agency" copy of completed Live Scan fingerprinting form.
e. Completed Application for Nurse Assistant Certification.
3.
f. Students are required to show original social security card before course code is given.
If there is space available in the course, you will be given a course code number so you can
register for HS 70, Nurse Assistant Training after you have turned in all required documents.
- Page 3 -
Completed application packets will not be accepted until May 19, 2009. Only fully completed
packets will be accepted.
4.
5.
Register for HS 70 as soon as possible after receiving the course code. If you are not enrolled in
Delta College, you must submit an application to Admissions and Records, Holt 101A, and
request a registration appointment for the Summer 09 semester.
Purchase the following books from the San Joaquin Delta College Bookstore:
a.
"Nurse Assistant Student Handbook" and read thoroughly prior to the first class meeting.
Bring the handbook to the first day of class.
b.
"Mosby's Textbook for Nursing Assistants", Sorrentino.
c.
"HS 70, Nurse Assistant Training Curriculum Manual."
Optional: "Nursing Assistant Review for Competency", Sorrentino
6.
Student Identification badges will be done a class unit probably
the first day of class.
7.
Attend class as scheduled. All enrolled students are to report to L313 on the first day of class,
Tuesday, June 16, 2009. Bring all required textbooks and the Nurse Assistant Program Student
Handbook to class the first day. A calendar of dates and times for this course are in the packet.
Medical Records
The Pre-Entrance Medical Record form must be filled out and signed by a Health Examiner (See
Appendix A). The selection of an examiner is at the discretion of the student and may be a physician,
physician's assistant or a nurse practitioner. The examiner may not be a relative of the applicant!
Physical examinations are also given at the local Health District. This physical examination must be
completed within six months of entrance into the program. Be sure all lines are completed.
The Immunization Record (Appendix B) form must be completed and signed by a physician, physician's
assistant, a nurse practitioner, Registered Nurse, or Vocational Nurse. Forms signed by medical
assistants are not acceptable. Be sure to carefully follow all instructions for completion of the form. You
may receive your immunizations at any of the San Joaquin County Local Health District Clinics. (For fee
schedule, see Appendix D). All immunizations and testing must be documented on the form provided.
Tuberculosis (TB) skin test is mandatory unless contraindicated. A chest x-ray is needed if skin test is
positive. If a chest x-ray is performed, a copy of the report must be submitted to the Nursing &
Health Sciences Office, Locke 213.
The Immunization Record form includes a listing of the necessary tests and vaccinations required.
All vaccination series must be started prior to the first class meeting. Request that Public Health
Services mail your test results to: Nursing & Health Sciences Office, San Joaquin Delta College, 5151
Pacific Ave, Locke 213, Stockton, CA 92507. All needed diagnostic testing must be completed prior
to the first day of class.
- Page 4 -
Student Nurse Professional Liability Insurance
Malpractice is defined as "the negligent act of a person with specialized training and education." The
affiliating hospitals and San Joaquin Delta College are not held responsible for the negligent act(s) of
student nurses. All students enrolled in the San Joaquin Delta College Nursing Assistant Program must
carry current liability insurance. You may contact an agent of your choice or you may use one of the
Nurse Service Organization Application (See Appendix C). If you have any questions regarding which
malpractice insurance coverage you need, contact the insurance carrier. If you choose Nurse Service
Organization (NSO), you must mail (certified) the application and $20 premium by credit card, check, or
money order. Submit proof of certified mail and copy of application to the Nursing & Health Sciences
Office, Locke 213.
•
If you currently have professional liability insurance coverage, you may provide a copy of
your insurance policy. The policy must include student Nurse Assistant coverage.
Liability insurance coverage is one of the clinical requirements and students will not be allowed to
enroll in the course if verification of liability insurance or proof of completed Application for Student
Nurse Professional Liability Insurance and certified receipt is not presented to the Nursing Office.
State Certification
Students planning to enroll in HS 70, Nurse Assistant Training, must be fingerprinted prior to being
allowed to enroll in the course. The Live Scan Form required for this process is included with this
information packet. They must also complete a Department of Health Services Application for Nurse
Assistant Certification.
•
Appendix F lists the local agencies that perform Live Scan services and the pertinent
information for the agencies. You will be required to pay the $47 Department of Justice
fingerprint fee .
•
Submit to the Nursing & Health Sciences Office, Locke 213:
1) "Requesting Agency" copy of the completed and signed Live Scan Form,
2) Completed Department of Health Services Application for Nurse Assistant
Certification.
•
Fingerprinting, fees, and application are requirements which must be met
prior to enrollment in the course.
Reporting Prior Convictions or Disciplinary Action
The Nurse Assistant Initial Application form includes information regarding prior convictions.
Individuals who have been convicted of a penal code violation (see Appendix E) will be subject to
automatic denial of certification. All other convictions (other than minor traffic violations) not listed
on the attached form are subject to review by the California Department of Health Services.
- Page 5 -
The following are policies of the State Department of Health Services:
1.
Nurse Assistant students who have a problem caused by alcoholism, drug abuse or emotional
illness, should be informed that these conditions, if left unattended, could lead to disciplinary
action and may prevent a student from being certified.
2.
Failure to report prior conviction(s) or disciplinary action is considered falsification of application
and is grounds for denial of certification. The reporting of prior convictions, other than minor
traffic violations, is required by law. All disciplinary action against an applicant for the state
certification examination must be reported to the Department of Health Services.
Any prior conviction or disciplinary action against you must be reported to the Department of Health
Services prior to registering for the training program. Reporting of prior conviction(s) or disciplinary
action, other than minor traffic violations, is required by law for public safety purposes. Since it takes
eight to ten weeks to process such reports, it is important to request clearance before the start of the
training program.
The Department of Health Services has a registry that lists all individuals with prior convictions.
Students who are not cleared by the State Registry are not allowed to apply for the State Certification
Exam. See Appendix E for list of convictions, which constitute automatic denial of certification as a
Nurse Assistant.
Clearances take eight to ten weeks. Once a clearance has been completed, the "Application for Nurse
Assistant Certification" form will be returned to Delta College. If you are not cleared, the application is
not returned, but a letter will be sent to you stating why the State cannot clear you for certification.
The clearance letter is a very important piece of paper - keep it in a safe place! When you complete the
training program you will need to send a copy of your clearance when you apply to take the state
certification test. You will also need to provide the Nursing & Health Sciences Office, Locke 213, with a
copy of this clearance to be placed in your student file.
Falsification of the application is grounds for denial or revocation of certification. If you have any
questions regarding this procedure, you are urged to contact the Department of Health Services,
Licensing and Certification at (916) 327-2445.
Uniform and Accessories
1.
Uniforms/Shoes: In all clinical settings, students must dress in a professional manner.
a.
Uniforms will be required. Purchase either:
Females: Light Blue Scrub Top and Pants or Light Blue Scrub Dress
Males: Light Blue Scrub Top and Pants
SOLID COLORS ONLY. NO PRINTS WILL BE ALLOWED.
Uniforms will be needed the first day classes are scheduled for the hospital.
b.
Light blue uniform warm up jackets may be worn in the clinical area. Warm up jackets must be
standard uniform design.
- Page 6 -
c.
The following items of clothing are considered inappropriate in any clinic area:
1.
2.
3.
4.
5.
6.
7.
2.
Sport jeans, blue jeans and/or denim jeans of any color.
Leggings, capris, pedal pushers and/or mid-calf fitted pants, shorts, skirts and culottes.
Torn or unkempt clothing.
Sweats, sweatshirts, T-shirts.
Unkempt, unsafe, or inappropriate footwear including thongs, wooden clogs or footwear
which make loud sounds.
Short, tight, low-cut or suggestive clothing.
Patient gowns/robes or surgical scrubwear.
Accessories:
a. Each student must have a watch with a "second" indicator.
b. Ball point pen with black ink (medium point).
c. Stethoscope with bell and diaphragm (seek instructor guidance before purchasing).
d. Optional: Kelly clamp and bandage scissors.
The following is a list of some of the uniform shops that carry the uniforms for our programs. This list is
for information only and should not be considered as a recommendation or endorsement of any specific
merchant.
Fashion Health Care Apparel
305 E. Yosemite Avenue
Manteca, CA (209) 239-2254
Life Uniform and Show Shop
304 Lincoln Center
Stockton, CA (209) 951-2222
Uniformity
531 West Lodi Avenue
Lodi, CA (209) 369-7343
Student Identification Badge
Badges must be obtained from the Student Government Office, Shima Center, Room 101, and the class
will go as a unit the first day of class. The fee for each badge is $8.00 (the exact fee must be paid in cash at
the college bookstore before you obtain the badge). Be sure to let them know you are entering the Nurse
Assistant Program. Because of safety and confidentiality issues, no Nursing Assistant student will be
allowed in the clinical area without their Student Identification Badge. The badges are to be worn on the left
side of the uniform.
- Page 7 -
Appendix A
San Joaquin Delta College
Family, Consumer & Health Sciences Division
5151 Pacific Avenue
Stockton, CA 95207
Pre-Entrance Medical Record
Student Name:
Date of Birth:
(Last Name)
(First Name)
(Middle Initial)
MEDICAL HISTORY: (To be filled out by applicant before physical exam)
Family history: (Circle disorders requiring a YES answer)
Cancer, Diabetes, High blood pressure, Tuberculosis
Explain YES answers
Applicant's history: (Circle YES answers): Emotional instability, chronic headaches, mental disorders, seizures,
heart disease, high blood pressure, tuberculosis, asthma, shortness of breath, chronic cough, irregular menstrual
cycles, serious allergies, drug allergies, broken bones, back injury, venereal disease, any other serious illness, injuries
or deformities, hospitalized for any reason.
Explain YES answers
Do you have any handicap(s) that may interfere with your student duties?
Are you currently taking any medications or drugs?
If yes, list name and reason
Date of last physical exam
Date of last dental exam
SIGNATURE OF APPLICANT
PHYSICAL EXAM: All spaces must be filled and all questions answered — LEAVE NOTHING BLANK
Height
Weight
Thyroid
Vision: OD
Glucose
Skin
Recommend Eye Exam?
B.P.
Pulse
OS
HEENT
Urine: SpGr:
Heart
Lungs
Condition of teeth
Protein
Abdomen
Neuro
Recommend dental exam?
Posture/spine & extremities
* Any handicaps which may interfere with fully carrying out duties of a nursing assistant?
* Upon reviewing the medical history and physical, does the student have any health condition that would
create a hazard to himself, fellow hospital employees, patients and/or visitors?
* Please summarize important findings:
Name/Title of Health Examiner: (Printed Name/Title)
(Signature)
Office Address:
_______________ Telephone:
City, State & Zip Code:
_____________ Date:
ALL STARRED (*) QUESTIONS MUST BE ANSWERED. ** - Please see back of page for additional criteria.
February 2009
PHYSICAL QUALIFICATIONS FOR NURSE ASSISTANT TRAINING
STUDENTS
All Nurse Assistant training students must be able to demonstrate the following to
successfully meet clinical objectives:
1.
2.
Transfer of adult patients from bed or gurney to chair or wheelchair.
Lift at least 25 pounds.
3.
4.
5.
Auscultate lung, heart, and bowel sounds with use of a stethoscope.
Verbally communicate with patients.
Ability to see drug labels and complete visual assessments of patients.
February 2009
Appendix D
Immunization Clinic Schedules for Various Health Clinics Throughout
San Joaquin County
Location
Times
Days
Stockton:
1601 E Hazelton Avenue, 468-3830
Immunizations
Health Exams
Tuberculosis Clinic
1-4:00pm
Tuesday
10-1:00pm
Wednesday
8-11:00pm
Thursday
Monday, Wednesday,Thursday&Friday a.m.
Tuesday a.m. & Wednesday p.m.
APPT
Lodi:
300 W. Oak Street, 331-7303
Immunizations
TB Test Reading/Appts
Health Examinations
8:30-11:30am
& 1-4:00pm
2-4:00pm
8:30-11:00pm
Monday
Thursday APPT
Manteca:
124 Sycamore Street, 823-7104
Immunizations
TB Test Readings/Appts.
Health Examinations
1-4:00pm
9-11:30am
& 1-4:00pm
2-4:00pm
9-11am
1st,2nd&4th Wednesday
3rd Wednesday
Friday
1st,2nd&4th Wednesday
(Except 3rd Wednesday)APPT
Tracy
205 West 9th St., 831-5930
Immunizations
TB Test Reading/Appts
Health Examinations
8:30-11:30am
2-4:00pm
1-4:00pm
Tuesday(except 3rd )
Thursday
2nd Tuesday
APPT
Routine physical examinations are given, by appointment only, at the San Joaquin County Public Health Service.
For an appointment, phone (209) 468-3830.
Fees for Immunizations:
T.B. Skin (PPD)
$20.00
Hepatitis "B" Titre
$23.40
Hepatitis "B" Series
$40.00
Note: If a Private Doctor does your physical and wants you to have any blood drawn at this clinic, a
referral is needed.
Prices quoted above are for immunizations and tests provided by the San Joaquin County Public
Health Services (468-3830). Prices will differ for services rendered by other agencies. The above
information is current as of December 2008. It is highly recommended that you call the facility to see if
any changes have been made.
February 2009
Fingerprinting Hours and Locations
Location
Appendix F
Hours
Fee
By Appointment ONLY
Monday – Friday
8:15 A.M. to 4:30 P.M.
$15.00 plus DOJ fee of $32.00
Check or money order only
Walk-In Only
Mon/Wed/Fri 9:00 A.M to 4:00 P.M.
CLOSED 12:00 NOON TO 1:00 P.M.
$17.00 plus DOJ fee of $32.00
Cash or Check
San Joaquin Delta College
5151 Pacific Avenue
Stockton, CA 95207
Contact: Nancy Guerrero
(209) 954-5748
San Joaquin County
Sheriff’s Department
7000 Michael Canlis Blvd.
French Camp, CA 95231
(209) 468-4459
San Joaquin County
Office of Education
2901 Arch-Airport Road
Stockton, CA 95206
(209) 468-9145
Escalon PD
1855 Coley Avenue
Escalon, CA 95320
(209) 838-7093
Manteca PD
1001 West Center Street
Manteca, CA 95336
(209) 825-2565
By Appointment ONLY
Monday – Friday
8:30 A.M. to 4:30 P.M.
(Must be on time or
you will need to reschedule)
By Appointment ONLY
Monday, Tuesday & Thursday
9:00 A.M. to 3:00 P.M.
Walk-In Only
Mon-Thurs 3:00 P.M. to 4:45.PM
FRI 10:00 A.M. – 12:45 P.M.
.
$12.00 plus DOJ fee of $32.00
Cashiers Check or Money Order
Only Make Payable to :SJCOE
$10.00 plus DOJ fee of $32.00
Cash or Check
$20.00 plus DOJ fee of $32.00
Cash or Check
Ripon PD
259 N. Wilma
Ripon, CA 95366
8:30
(209) 599-2102
Saturday Appointments Available
Tracy PD
1000 Civic Center Drive
Tracy, CA 95376
(209) 831-4560
Tues & Thurs
A M.
– 11:30
A M. & 1:30 – 4:30 P.M
$10.00 plus DOJ fee of $32.00
Cash or Check
Walk-In
Tues & Thurs
9:00 A M. – 11:00 A M.
$10.00 plus DOJ fee of $32.00
Cash or Check
By Appointment ONLY
Tuesday’s 12:00 - 3:00
Thursday’s 1:00 – 4:00
$15.00 plus DOJ fee of $32.00
Cash or Check
Lodi PD
230 W. Elm Street
Lodi, CA 95240
Contact: Danna Schmiedt
(209) 333-6865
February 2009
February 2009