The Skills Evaluation

South Carolina - National Nurse Aide Assessment Program (NNAAP)

What To Expect

The Skills Evaluation is set up to resemble an actual care-giving situation. The Skills Evaluation area will look similar to your work setting. It will have all the equipment necessary to perform the assigned skills. The Skills Evaluation will be administered by a Nurse Aide Evaluator. Before your skills evaluation begins, the evaluator will show you where equipment is located and answer questions about operating the equipment. Please arrive 30 minutes early. Test times are approximate. Please plan to spend the day.

Who will act as a Client?

The part of the “client” will be played by a candidate who volunteers to act as a weakened elderly person. While you perform the skills, speak to the candidate volunteer as you would speak to an actual client in a nurse aide work setting. You are encouraged to speak to the 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 candidate volunteer for another nurse aide’s Skills Evaluation and play the role of a nursing home patient (client). The evaluator will give you verbal instructions that will describe how you should act in performing the role of the client.

Candidate Dress Requirements

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 your 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 of 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 in order for you to pass the skill. If you leave out a Critical Element Step or do not perform a Critical Element Step properly, you will not pass the skill. However, if you perform only the Critical Element Step correctly in a skill, you do not automatically pass that skill. You must also correctly demonstrate 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, and there will always be and one (1) measurement skill (blood pressure, pulse, respiration, urinary output, or weight). The remaining three (3) skills are randomly chosen from the complete set of skills listings on pages 11 to 17 of this handbook. You are strongly encouraged to 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 will not have to redo the entire skill, just the steps you wish to correct. There are, however, some exceptions to this rule. If you fail to put on gloves or take them off when it is required to do so and the evaluator reminds you to do so, for infection control purposes, then you will not receive credit for attempting to correct this step. If you wish to correct an order-dependent step (a step stating that an action should be performed before or after another step) and you fail to say when the corrected step should be performed, you will not receive credit for the correction.

Once you begin a new skill, you may not go back to correct a previous skill. 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 regarding measurement skills).

You will be asked to decontaminate your hands (with hand sanitizer) before proceeding from skills performed on a live client to skills that are not. This is for infection control purposes and will not affect the results of your evaluation.

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 advise you that you have 5 minutes left.

When you have completed your skills evaluation, the evaluator will direct you to wash your hands. Although this will not effect your examination results, for the purposes of infection control, you must wash your hands.

Recording a Measurement

The NNAAP Skills Evaluation requires every candidate to 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, or record, 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 labeled Candidate Results.

On the following page is a copy of the recording sheet that will be used during the skills exam. The candidate must record his/ her 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 Blood Pressure
Measures and Records Weight of Ambulatory Client
Measures and Records Urinary Output
Counts and Records Radial Pulse
Counts and Records Respirations

Tips for the Skills Evaluation

You will be expected to perform the skills as you would in a nursing home setting. When water is required, you must use running water. All candidates will be required to perform the Hand Hygiene skill. The Nurse Aide Evaluator will inform you after you have washed your hands for the first time that you should just tell him or her when you would wash your hands during your performance of the rest of the skills, rather than actually washing them for each skill. For all steps other than hand washing, you must actually perform the skill in order to receive credit. You may not simply tell the evaluator what you would do for simulating a step. For example, you may not simply tell the evaluator that you would wash the client. You must actually demonstrate washing the client. You may not simply tell the evaluator that you would feed the client. You must actually demonstrate feeding the client.
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 site. A sample of the Recording Sheet is shown on page 25 of this handbook. You are encouraged to become familiar with the Recording Sheet before your scheduled test date.
You must know how to operate both a standing and a nondigital 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 site (e.g., 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.