PURPOSE: This rule requires hospitals to have a personnel training policy that requires unlicensed health care personnel who provide direct patient care under the delegation and supervision of a registered nurse to complete the Unlicensed Assistive Personnel (UAP) Training Program, which shall be used to prepare individuals for employment in hospitals. This program shall be designed to teach the knowledge and skills that will qualify students to perform uncomplicated nursing procedures and assist in direct patient care.

1. (1) Definitions Relating to this Rule.

   1. (A) Acute care unit—an area of a hospital that provides care primarily for patients with acute diseases or conditions. This does not include care provided in a long-term care unit such as a skilled nursing, intermediate care and residential care units. 19 CSR 30-20
   2. (B) Unlicensed Assistive Personnel (UAP)—unlicensed health care personnel who provide direct patient care twenty-five percent (25%) or more of the time, under the delegation and supervision of a registered nurse. Individuals who provide a specific job function such as, but not limited to, phlebotomist, radiology technician or patient transporter are not included in this definition.

2. (2) The hospital training policy for UAPs shall include the following minimum standards:

   1. (A) The curriculum of the UAP Program shall consist of a standard plan of instruction to include:

      1. 1. A minimum of seventy-five (75)

hours of classroom instruction.

1. 2. Computer or paper-based learning

modules that provide documentation of completion may be substituted for up to sixty (60) hours of classroom time.

1. 3. A minimum of one hundred (100)

hours of clinical practicum.

1. 4. Curriculum content of the program

shall include procedures and instructions on basic nursing skills including but not limited to the areas of:

1. A. The Role of the UAP (ethics, law,

team member communication, observation, reporting, documentation, medical terminology);

1. B. Patient/Client Rights (Health

Insurance Portability and Accountability Act (HIPAA), privacy, confidentiality, advanced directives, abuse and neglect, age specific care, cultural diversity, pain management, restraint-free care, end-of-life care, death and dying, do not resuscitate (DNR) orders, postmortem care);

1. C. Vital Signs;
2. D. Basic Human Needs (age specific

cognitive/psychological/social needs, activities of daily living, ambulation, positioning, personal care, elimination and toileting, nutrition, hydration, feeding, bed making);

1. E. Infection Control (universal pre-

cautions, blood-borne pathogens, safe needle devices, aseptic technique, hand washing, gloving, isolation);

1. F. Skin Care (wound care, pressure

ulcers and prevention); and

1. G. Safety (cardiopulmonary resusci-

tation (CPR), allergies, fall prevention, environmental safety issues, fire/electrical, hazardous materials transportation safety information (HAZMAT), emergency procedures, body mechanics).

1. 5. The clinical practicum of one hundred

1. (100) hours shall start after the student has enrolled and started the course curriculum. SENIOR SERVICES

   1. 6. Skill validation and knowledge verifi-

cation is to be used to determine student competence.

1. 7. Annual in-service training also shall

occur as required under 19 CSR 30- 20.021(3)(L)6. and 7. and (5)(B)4.

1. (3) The hospital training policy for UAPs shall begin three (3) months after the effective date of this rule. UAP training shall be completed within ninety (90) days of employment for any individual who is hired as a UAP. UAPs from staffing agencies shall comply with this regulation. A UAP shall not work in direct patient care, except as part of their supervised practicum, until the entire UAP training requirements have been met. Hospitals shall not be required to meet the UAP training requirements if an employee demonstrates competency in the content areas required by this rule; in the duties specific to their job and the patient population assigned and:

   1. (A) Is enrolled in a professional or practical nursing education program and has or will complete within ninety (90) days a fundamentals of nursing course; or
   2. (B) Was a professional nursing or practical nursing licensure candidate who failed to pass the state licensure examinations in the past three (3) years; or
   3. (C) Is certified as a nursing assistant as defined in section 198.082, RSMo; or
   4. (D) Has documented experience as a nurse assistant, emergency medical technician or surgical technician in the past three (3) years; or
   5. (E) Has proof of completion of UAP training program in Missouri or another state which meets the requirements of this rule within the last three (3) years; or
   6. (F) Has completed a professional or licensed practical nursing program outside the United States and is awaiting the licensure examination in this country.

2. (4) The hospital training policy for UAPs shall meet the following faculty qualifications and responsibilities:

   1. (A) A registered nurse shall be designated as the course coordinator and shall be responsible for all aspects of the course, and must supervise all classroom and clinical instruction;
   2. (B) Instructors shall hold a current license or temporary permit to practice as a registered nurse in Missouri and have a minimum of two (2) years of nursing experience in an acute care, long-term care or ambulatory surgery facility within the prior five (5) years, or an experience as a clinical faculty member in a nursing program within the prior five (5) years. An instructor’s nursing license shall not be under current disciplinary action;
   3. (C) A clinical supervisor’s or preceptor’s nursing license shall not be under current disciplinary action or investigation; and
   4. (D) UAPs who have satisfied the training requirements of this rule and Licensed Practical Nurses may assist with the clinical practicum under the direction of the course coordinator.

3. (5) A hospital or ambulatory surgical center that provides training for UAPs shall meet the following training site requirements:

   1. (A) Provide designated space sufficient to accommodate the classroom teaching portion of the course or have a written agreement with another acute care hospital, an area vocational-technical school, a high school offering a health service occupation program, a community college or a provider agency to provide the classroom portion of the course;
   2. (B) Provide on-the-job clinical practicum or have a written agreement with one (1) or more hospitals or ambulatory surgical centers in their vicinity to do so;
   3. (C) Assess and review the program and outcomes of any training provided by another facility to ensure that all of the requirements of this rule have been met;
   4. (D) Maintain, either electronically or on paper in the employee’s personnel file, records of course completion and competency for a minimum of three (3) years. Records shall be signed and dated by the course coordinator and each of the instructors and clinical supervisors verifying classroom time, clinical time and competency for each student; and
   5. (E) Provide a signed copy of the course completion and competency record to the student, that includes the elements in subsection (5)(D) of this rule.

AUTHORITY: section 197.287, RSMo 2000.* Original rule filed Jan. 31, 2008, effective Sept. 30, 2008. *Original authority: 197.287, RSMo 2000.