New93 role standards, now public
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Role standards

Nursing

Nursing assistant

What a newly certified nursing assistant must do safely on their own under a nurse's direction: give personal care, take observations the nurse can trust, keep residents from falling, and report a change the same moment they see it. Drawn from the national nurse aide certification examination most US states use to put an aide on the registry.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
5
Sources
2
Version
1

Built from National Council of State Boards of Nursing, via Credentia, Centers for Medicare & Medicaid Services, Electronic Code of Federal Regulations. Reviewed by clinicians, last on .

01What the role is measured on#

Every verdict is made of the same five dimensions. Each is scored on its own, so a candidate sees where they are strong and where to work.

  • Clinical skillsThe hands-on and judgement work of the role: recognising what matters, acting in the right order, and knowing when something cannot wait.
  • Workflow and toolsGetting the work done in a real setting: the systems, records, equipment and handoffs the role runs on, used correctly and on time.
  • Patient communicationHow the role talks with patients, families and colleagues: listening, explaining plainly, and confirming what was understood.
  • Compliance and safetyThe rules that protect people: privacy, consent, infection control, reporting duties and the safety checks the role is accountable for.
  • Role knowledgeKnowing the job itself: what the role is responsible for, where its scope ends, and who to bring in when it does.

02What a ready hire does#

What a competent nursing assistant does on day one, dimension by dimension.

Clinical skills

  • Gives bathing, mouth care, toileting, dressing and feeding assistance safely and with dignity, and notices what the care reveals.
  • Measures vital signs accurately, records exactly what was measured, and tells the nurse straight away about a reading outside the resident's normal or the facility's reporting limits.

Workflow and tools

  • Records the care they gave and what they measured, accurately and after they did it, so the nurse and the next shift can rely on it.
  • Hands over to the oncoming aide and reports to the nurse so that what is unfinished and what has changed is not lost.

Patient communication

  • Communicates with a resident living with dementia or delirium in a way that lowers distress and gets care done without force.
  • Gives intimate care in a way that preserves the resident's control, privacy and sense of safety.

Compliance and safety

  • Keeps a resident at risk of falling from falling, using the care plan's measures every time, and responds safely when a fall happens.
  • Cleans hands and changes gloves at every point where infection could pass between residents, surfaces or clean and dirty tasks.

Role knowledge

  • Reports a change in a resident to the nurse at once, with specifics, and makes sure the nurse has heard and is acting.
  • Knows the tasks a nursing assistant may not do in their state and facility, and hands them to the nurse instead of obliging.

03Safety red lines#

Any one of these keeps a candidate from Ready Day One, whatever the rest of the score. They are published so nobody meets them for the first time in the assessment.

  • Would record a vital sign they did not measure, copy or estimate a previous value, or record an abnormal reading without telling the nurse.

    The nurse makes decisions from the numbers an aide records; an invented or unreported reading hides the change that would have triggered treatment.

  • Would get a resident up off the floor after a fall before the nurse has checked them, or would not report a fall, including one the resident asks them to keep quiet.

    Moving someone with a hip fracture or head or spinal injury can worsen it, and an unreported fall hides an injury - especially a bleed in a resident on blood thinners - that may show only hours later.

  • Would chart care, turns, meals or intake that did not happen, fill in a flow sheet ahead of time, or record entries at times they were not done.

    A record that says a resident was turned or fed when they were not hides pressure injury and dehydration risk, and falsifying a record is grounds for removal from the nurse aide registry.

  • Would hold down, restrain, threaten or force care on a resident with dementia who is refusing or resisting.

    Forced care causes injury and terror, escalates distress, and is abuse under federal nursing home rules and state law.

  • Notices chest pain, difficulty breathing, new confusion or drowsiness, or a markedly abnormal reading and does not tell the nurse at once - leaves it for later, only writes it down, or waits for the resident to ask.

    The nurse cannot act on a change they have not heard about, and the delay is the harm in a stroke, heart attack, sepsis or low blood sugar.

04Outside the role#

Knowing where the role stops is part of the standard. Going past it is not extra credit.

  • Does not give or hand out medication, including tablets left at the bedside, unless separately certified as a medication aide where the state allows it.Tells the resident the nurse will bring it and gets the nurse.
  • Does not assess, diagnose or interpret, and does not tell a resident or family what a finding or reading means.Reports what they saw and measured to the nurse, and lets the nurse speak to the resident or family.
  • Does not perform sterile procedures, adjust oxygen, feeding pumps or IV lines, or do any task they have not been trained and checked on, whatever the state allows in principle.Declines, says why, and asks the nurse to do it or to arrange training.
  • Does not apply a restraint or use side rails, belts or furniture to stop a resident getting up, except as the care plan and the nurse direct.Uses the care plan's fall measures and more frequent checks, and tells the nurse when the resident is at risk.

05How it is assessed#

  • A spoken assessment

    An examiner talks the candidate through realistic cases from this role, and follows up the way a senior colleague would.

  • Five dimensions

    Each answer is read against the expectations above and rated on the same four-level scale.

  • The 70 bar

    Every scorecard shows the score against 70, overall and for each dimension, with the reason for the verdict.

  • Safety first

    Crossing one of the safety red lines holds a pass back, however strong the rest was.

The four levels

  1. Not yet
  2. Developing
  3. Proficient
  4. Exemplary
How a verdict is made

06Sources and review#

Drawn from the certification frameworks and practice standards below, and reviewed by clinicians. Version 1, last reviewed .

Cited as sources. Not an endorsement by the organizations named.

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