Enable TNAs to become CNAs

John P. Reinhart

On April 7, 2022, the Centers for Medicare & Medicaid Services announced that the waiver option that created clinical care roles known as Temporary Nurse Aides (TNAs) and Personal Care Aides (PCAs) ) will expire federally on June 6, 2022.

Individual national regulations may vary. TNAs and PCAs have until October 6, 2022, unless amended at the individual state level, to complete all required training and pass their respective state proficiency test. Nearly 300,000 students in May 2022 have taken the American Health Care Association’s TNA course, indicating that there is significant interest in clinical careers.

Recruiting, developing, and retaining quality, health-focused caregivers remain top priorities for qualified nursing and long-term care providers. In my November 2021 editorial, I suggested creative strategies that could be adopted by federal and state governing entities that would expand opportunities for those seeking a clinical career as a CNA. These ideas are still relevant and should be considered for inclusion in future regulations.

This article outlines the steps for providers to create a pathway for TNAs and PCAs to transition to fully licensed/certified caregivers.

  1. Know your state’s specific regulations for licensing and certification of health care aides

States that recognize and endorse the use of TNAs and PCAs

  • States that have granted TNAs and PCAs modified training requirements
  • States That Require TNAs and PCAs to Complete a Traditional, Approved Nurse Aide Training Program (NATP)
  • States That Allow Candidates to Challenge the Licensing Test Without Taking a Formal Nursing Aide Training Course

States that have not approved the use of TNAs and PCAs

  • Applicants must complete a Traditional and Approved Nursing Aide Training Program (NATP)
  • Programs must incorporate an approved training program for health care aides
  • Facilities must apply and be approved to become an NATP clinical site
  • Instructor must submit credentials and be state approved

For unanswered questions, I recommend contacting the organization that maintains the health care aide registry for your state.

  1. Understand the components of pre-licensing training required for TNAs/PCAs

TNAs and PCAs must have proof that they have completed the following training components in accordance with the regulations of the state in which they wish to obtain a license:

  • Proof or certificate of completion of a temporary health care aide or personal care aide training course that incorporates the minimum number of hours required for all compulsory subjects outlined by CMS in its waiver guidelines. The free AHCA TNA course offers 8-hour and 16-hour versions to meet state-specific requirements.
  • Lab and job skills training is usually conducted at their employment facility and led by a state-licensed RN instructor.
  • Check documentation demonstrating competency by a state-licensed nurse for all required skills.
  • Documentation of their hours of field work experience issued under the supervision of a state-licensed nurse.
  • Documentation of completion of additional training requirements based on each state’s mandates. Many of them focus on theoretical training and not on skills, so they could be offered online.
  1. Assess options for vendors to sponsor TNAs/PCAs to complete all required training
  • Online hybrid model for an approved nurse aide training program – the clinical skills and laboratory portions of the course are delivered in-person and on-site with preceptors. The theoretical part of the course is delivered online 24 hours a day, 7 days a week.
  • In-person model for an approved nurse aide training program – clinical skills and theoretical components are delivered in-person on a schedule at a provider’s facility or at a community college.
  • TNA to CNA Bridge Course Model – applicable in states that have changed the nursing aide training requirements for TNAs and PCAs. The course is delivered in person or online focusing only on the theoretical components. This allows flexibility to reduce mandatory training hours while giving students full access to all course materials. State license/certification proficiency tests are not changed or reduced; therefore, it is important to understand all topics. Providing credit for the TNA and PCA basic training course along with field work experience can also lower the price of the course.
  • TNA to CNA Test Prep Model – an affordable study guide format that equips TNAs and PCAs with essential materials and links to skill checklists. This service is a subscription model with unlimited access, which can be useful in states that are experiencing delays in the availability of test center appointments. This option is also viable in challenge states and those where no additional formal training is required to prepare TNAs and PCAs to pass the licensing test.

Times of significant challenge like what we have all experienced during this recent pandemic can also stimulate an environment of fresh thinking and creative approaches. Through collaboration, cooperation and innovation, we have a real opportunity to build on a tradition of ensuring caregivers meet quality training requirements. We are blessed every day to have the opportunity to dialogue with compassionate and committed leaders from the American Health Care Association, AHCA state affiliates, state regulators, healthcare facilities and especially healthcare heroes pursuing careers in helping who train with our solutions.

John P. Reinhart, CPA, MBA, is a serial entrepreneur and innovator specializing in digital health and age technology. John is co-founder and president of Academic platforms. Academic Platforms is the exclusive partner of the American Health Care Association for providing online clinical education focused on nurse aides and CNA pre-licensure training at cnaonline.com. He is also Executive-in-Residence at the National Institute on Aging, part of the National Institutes of Health.

The opinions expressed in McKnight Long Term Care News guest submissions are those of the author and not necessarily those of McKnight Long Term Care News or its editors.

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