Nurse Aide I + 4

As of January 1, 2019, the North Carolina Board of Nursing (NCBON) no longer receives notification from an agency regarding the skills selected, changed, or deleted for Nurse Aide I + 4.

The Nurse Aide I + 4 process is as follows:

1. Up to 4 Nurse Aide II skills can be selected by an agency. Note: That 1-4 skills can be selected, and only those skills can be included in the Nurse Aide I + 4 designation for the agency. All units in the agency do not have to do all selected skills, but alternative skills may not be substituted on a unit by unit basis for the selected 1-4 skills for the Nurse Aide I + 4 designation.
2. All of the skills selected for Nurse Aide I + 4 must be taught using the designated NCBON required modules. This includes fulfilling the timeframe required for each module (found at the start of each module). Each Nurse Aide must then have skill competency validated and a record of the education and skill validation using the appropriate skill competency checklist must be retained by the agency. The education and the skill validation must be done by a Registered Nurse. Note: The Registered Nurse retains the responsibility and accountability for appropriate delegation, and must be certain that the Nurse Aide has completed the education and skill competency validation and that the patient status is appropriate for the skill assignment before assigning the task even if the Nurse Aide has the Nurse Aide I + 4 designation.
3. There is no listing process for a Nurse Aide I + 4, but the Nurse Aide I must hold current Nurse Aide I listing on the DHSR Registry.
4. The Nurse Aide I + 4 skills, education and competency validation is agency specific. The Nurse Aide I is not approved for the skills at any other agency.
5. Written policies and procedures must be in place for each skill based on the NCBON Nurse Aide II Module (Developed by your agency based on module selected).
6. Formal education and competency validation of Nurse Aide II skills must be performed by a Registered Nurse with an unrestricted license to practice.
7. A record of Nurse Aide I + 4 skills, education and competency validation must be kept at said agency.
8. A Nurse Aide I is not approved for Nurse Aide II skills except the approved Nurse Aide I + 4 skills within the agency. Additional skills performance requires education and credentialing as a Nurse Aide II.
9. Although the Nurse Aide I may complete the Nurse Aide I + 4 education and competency validation of skills, the Registered Nurse is still responsible for:
   1. Making appropriate decisions related to delegation for each patient, each skill, and the aide to whom he/she is delegating.
   2. Assessing the patient and the patient's response to care, for assuring that the skill has been carried out appropriately, and for planning, modifying, and evaluating care. All judgement related to the patient care situation remains with the Registered Nurse.

You may not alter the timeframe for any of the modules if you are seeking Nurse Aide I + 4 designation or Nurse Aide II listing for the staff in your system.

If the NAI+4 process does not meet your needs, you may instead use the following document:

If you choose to use this method for delegation, note that there must be:

1. Written policies and procedures.
2. Formal education and competency validation of skills by a Registered Nurse.
3. A record of the education and skill validation must be kept.
4. The Registered Nurse must make appropriate decisions related to delegation for each patient, each skill, and the aide to whom he/she is delegating.
5. The Registered Nurse retains responsibility for assessment of the patient and the patient's response to care, for assuring that the skill has been carried out appropriately, and for planning, modifying, and evaluating care. All judgement related to the patient care situation remains with the Registered Nurse.