The Skill Evaluation

South California - National Nurse Aide Assessment Program (NNAAP)

What to Expect Settings

The Skills Evaluation is set up to look like an actual care-giving situation. The Skills Evaluation area will look like your work setting. It will have all the equipment needed to perform the assigned skills. The Skills Evaluation will be given by a Nurse Aide Evaluator. Before your Skills Evaluation begins, the evaluator will show you where equipment is and answer questions about using the equipment.

Who Will Act as a Patient/Resident

The part of the “patient/resident” will be played by a candidate who volunteers to act as a weakened elderly person. While you perform the skills, speak to the patient/resident candidate volunteer as you would speak to an actual patient/resident in a nurse assistant work setting. You are encouraged to speak to the patient/resident candidate volunteer not only because it is part of quality care, but also because it will help you to relax as you perform the skills. Please note, you may not receive help from anyone during the Skills Evaluation, and the candidate and the client must speak to one another in English so that the evaluator can understand and correctly score the evaluation. If either candidate gives help or receives help during the test, or the client and candidate are communicating in a language other than English, the test will be stopped.

Candidate Volunteer Requirements

You will need to act as a patient/resident candidate volunteer for another nurse assistant’s Skills Evaluation and play the role of a nursing home patient/resident. The evaluator will give you verbal instructions that will describe how you should act in performing the role of the patient/resident.

You must wear flat, slip-on, non-skid shoes; a loose-fitting top with short sleeves that can be rolled up to the shoulder, or tank top; and loose-fitting pants that can be rolled up. You will be required to put a gown on over clothing. In no case may candidates remove clothing down to undergarments.

Prior to beginning the exam, you should inform the evaluator of any food or latex allergy or sensitivity to skin soaps or lotion. Any limitations to range of motion must also be communicated to the evaluator prior to the start of the skills examination. For infection control purposes, you should not come to the test site with open areas/sores on the skin. Candidates with any open areas or sores on their skin should reschedule their skills test to a later date after their skin fully heals.

The Tasks

The NNAAP Skills List contains all the skills that you may be asked to demonstrate during the Skills Evaluation. Each skill represents a task that you will be asked to perform in your job and has been broken down into a series of steps.

A step that is highlighted in bold type is called a Critical Element Step. Critical Element Steps are important steps that must be performed correctly for you to pass the skill. If you leave out a Critical Element Step or do not perform a Critical Element Step correctly, you will not pass the skill. However, if you perform only the Critical Element Step correctly, you do not automatically pass that skill. You must also correctly perform enough steps to meet the passing standard (or cut score) for each skill.

Before your Skills Evaluation begins, the Nurse Aide Evaluator will give you an instruction card that will list the five (5) skills selected for you to perform. Handwashing will always be one of the skills to be performed. The remaining four (4) skills are randomly chosen from the skills listings on this handbook. You should perform the skills in the order they are listed on the instruction card.

If you make a mistake, say so, and you will be instructed to tell the evaluator which step(s) is to be corrected and then to perform the step(s). You do not want to do the entire skill, just the steps you want to correct. There are some exceptions to this rule. If you do not put on gloves or take them off when required, and the evaluator reminds you to do that, then you will not get credit for trying to correct this step.
If you want to correct a step that must be done in order — a step that must be performed before or after another step — and you forget to say when the corrected step should be performed, you will not get credit for the correction.
Once you begin a new skill, you cannot go back to correct the skill that came before it.
The Nurse Aide Evaluator will not answer questions during the Skills Evaluation and will not tell you whether you performed a skill correctly. You may not receive help from anyone during the Skills Evaluation. If you do have any questions, please ask them before the Skills Evaluation begins.
One (1) of the four (4) randomly selected skills will include a measurement skill (see the section below, Recording A Measurement, for more information on measurement skills).
You must successfully complete five (5) out of the five (5) skills in the skill form to pass the Skills Evaluation. You will have thirty (30) minutes to demonstrate all five (5) skills. When twenty-five (25) minutes have elapsed the Nurse Aide Evaluator will tell you that you have five (5) minutes left.
When you have finished your Skills Evaluation, the evaluator will tell you to wash your hands. This will not affect your score, but you must wash your hands as a hygiene measure.

Recording a Measurement

For your Skills Evaluation, you must perform one measurement skill, such as blood pressure, radial pulse, respirations, urine output or weight. You will be given a special form, called a Recording Sheet for Measurement Skills, to write down the measurement. For example, if performing the Measures and Records Blood Pressure skill, you will write the complete systolic and diastolic pressures of your blood pressure reading in a box labelled candidate results.

On the following page is a copy of the recording sheet that will be used during the skills exam. You must record your results in the Candidate Results box on this sheet. This sheet will be used to record the results of the following measurement skills:

Measures and Records Electronic Blood Pressure
Measures and Records Weight of Ambulatory Client
Measures and Records Urinary Output
Counts and Records Radial Pulse
Counts and Records Respiration

A close-up of a test form

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Tips for the Skills Evaluation

You will be expected to perform the skills just like you would in a nursing home setting. When water is required, you must use running water. You will be required to perform the Hand Hygiene skill.
For your skills evaluation, you do not have to wash your hands for each skill. You can just tell the evaluator “Now I would wash my hands.” You do not have to wash them each time if you tell the evaluator when you would wash them if this were a real situation.
For all steps other than handwashing, you should perform the skill to get credit. You cannot tell the evaluator what you would do for simulating a step. You must do the step.
After you have introduced yourself to the client for the first time, it is not necessary for you to introduce yourself each time you begin a new skill.
To receive full credit for a measurement skill, you must accurately make the required measurement and then write that measurement on the Recording Sheet for Measurement Skills. The evaluator will provide the Recording Sheet to you at the test center. A sample of the Recording Sheet is shown on Figure2 Recording sheet for measurement skill. It’s best for you to become familiar with the Recording Sheet before your scheduled test date.
You must know how to use both a standing and a non-digital bathroom scale and must know how to set both types of scales to zero.
You may not bring any of your own equipment to the test center (like a transfer/gait belt).
It is important for you to place the call signal within the client’s reach whenever you leave the client.
Where the word “client” appears, it refers to the person receiving care.