Nursing Assistant Program

6500 SW Pacific Blvd.

Albany, OR 97321
(541) 917-4738
nainfo@linnbenton.edu

LBCC Nursing Assistant Student Requirements

Policy & Procedures Disclosure Agreement
Policy: To inform all applicants and interested Nursing Assistant students about the following program policies: Admission
Requirements, Attendance & Refunds, Behavioral Expectations, Clinical Policies, Course Requirements & Change of Course
Policy, Criminal Background Procedure, Criminal History Requirement for Program, Dress Code, Drug Testing, Enrollment,
Attendance & Refunds, Examination Administration, and Grading.

DEFINITIONS:
1. OSBN: Oregon State Board of Nursing
2. LBCC: Linn-Benton Community College
3. Facility-based Program means an approved nursing assistant program in a licensed nursing facility.
INSTRUCTIONS: Applicants must read the following information and sign the disclosure page. The disclosure must
be attached to your application.
Program Objectives:
Upon completion of the LBCC Nursing Assistant Level 1 curriculum, the student will meet the following minimum
objectives:
1.
2.
3.
4.
5.

Practice and promote good health habits

Demonstrate an understanding of the nursing Assistant role as member of the health care team.
Develop desirable patterns of organizational skills and the execution of good work habits.
Recognize and report client/patient symptoms that deviate from normal patterns.
Recognize the mental health and social needs of the client/patient and take appropriate action to help
the client/patient meet their needs.
6. Exhibit the entry-level technical skills of bedside care including safety and infection prevention,
Selected therapeutic procedures, selected restorative procedures, and personal care skills.
List the Clients/Patients Rights and select appropriate actions that a Nursing Assistant might take to
remedy an infraction.
Program Syllabus:
The following text book will be used:
Nursing Assistant Level 1 - Classroom course: Nursing Assistant, A Nursing Process Approach, 11th Edition,
ISBN 13:9781133132370;
Nursing Assistant Level 1 - Online course: Mosby's Textbook for Nursing Assistants, 8th Edition,
ISBN-13: 978-0323080675; ISBN-10: 0323080677 and Hartman's Nursing Assistant Care: Long-Term Care, 3rd
Edition, ISBN-13: 978-1604250411; ISBN-10: 1604250410
1. In order to complete the Nursing Assistant Training program students must attend all required hours as
outlined in the Enrollment and Attendance statement.
a) In the event of an extended illness, the student must withdraw. Options for completing the course
will be discussed with the Program Director.
b) Students must pass the final examination with a score of at least 75%
c) Students must complete the Skills Check list with the instructor during the clinical experience. The
student must demonstrate safe, competent, efficient clinical practices, and be able to assume
responsibility for patient care as part of the nursing team to the satisfaction of the clinical instructor
following OSBN skill guidelines.
2. Reading assignments are given to the student at final acceptances into the program. The student is
responsible to stay current with the assignments.
3. The course schedule is provided to the student with the final acceptance into the program.

Nursing Assistant Program

6500 SW Pacific Blvd.
Albany, OR 97321
(541) 917-4738
nainfo@linnbenton.edu

LBCC Nursing Assistant Student Requirements

Policy & Procedures Disclosure Agreement

Requirements and change of course:

1. To be eligible for the Nursing Assistant course all applicants must have a high school diploma or GED.
2. Complete the College Placement test placed in Reading 80 or completed Reading 80 with C or better.
3. Complete criminal background check form 303 with the Department of Human Services with the Human
Resources through the assigned licensed nursing facility.
4. Must document a negative TB test result within twelve months.
5. All applicants will be able to turn and lift patients, hear and see patients in need; communicate with
patients, families and co-workers; take action in stressful situations and read and keep medical records.
6. Class records will be maintained at the college for 7 years. Individual student transcripts will be
maintained at the college for an indefinite time.
7. All applicants and participants will be treated equally, having program policies equally applied to all.
8. These program policies and information about any institution reimbursement requirement will be given
to Nursing Assistant and Medication Aide students on or before the first meeting of a class.
9. That for facility-based Nursing Assistant Level 1 programs, no student who is employed by, or who has
received an offer of employment from a facility on the date on which the student begins training will be
charged for any portion of the program, including any fees for textbooks or other required course
materials in accordance with 42 CFR 483.152(c)(1). All students receive the DHS reimbursement form
the first day of class.
10. The nursing assistant students will be provided with a copy of the Department of Human Services
potentially disqualifying crimes with application prior to class.
11. Nursing Assistant students will receive a copy of the program policy and procedures upon admission to
the Nursing Assistant class. Student will sign and date copy and placed as part of student record.
12. Written evaluations of program instructors and preceptors will be made at least every year. Student
contributions to this evaluation are welcome at any time.
13. A Confidentiality statement will be signed and placed in student record.
14. Must be registered at LBCC to attend class.
15. Must follow policies and procedures for course requirements, criminal background procedure, drug test,
enrollment agreement and attendance, change of course, cancellation and refunds, behavioral
expectations, dress code administration of examinations, and clinical.
16. Refer to LBCC closure information for inclement weather. This will be per instructor discretion.
17. Student will show satisfactory progress in course as documented by instructor. If student needs
assistance instructor will coach as needed and include plan of action on student progress record.
18. If student does not receive a passing grade in the class, the class may be repeated once; the student will
be required to pay current tuition. Student may withdraw the first week of class and attend subsequent
class
Criminal Background Procedure
1. The student will receive the list of Department of Human Services disqualifying crimes from
http://www.oregon.gov/dhs/chc/pages/tools.aspx prior to admission to the Nursing Assistant class. The
student will sign and date the Nursing Assistant application to indicate they received the list prior to
admission.
2. The student will receive the Oregon state Board of Nursing criminal history requirements and policies
prior to admission to the Nursing Assistant program. This is in accordance to ORS 851-061-0100. The
student will sign and date the statement they have received and understand the criminal history
requirements and policies prior to admission. This will be placed in student record.

Nursing Assistant Program

6500 SW Pacific Blvd.
Albany, OR 97321
(541) 917-4738
nainfo@linnbenton.edu

LBCC Nursing Assistant Student Requirements

Policy & Procedures Disclosure Agreement
Criminal Background Procedure (Continued)
3. These rules are to allow the candidate to determine eligibility prior to the class.
4. All applicants must complete Human Resources Form 030 through the approved licensed nursing facility
Resources department prior to class. If they have lived outside of Oregon they will be required to submit
fingerprints to Department of Human Services.
5. The applicant must receive a fit determination to participate in the classroom or clinical setting. This does
not guarantee the placement in a class. The approved facility will have final determination as to who will
be permitted to attend the class and clinical.
6. The Human Resources designee will provide the classroom instructor with a statement prior to the first
day of class that the student has had a Criminal History submitted to the criminal records department of
Department of Human Services.
7. The results of the criminal background check are confidential. The Human Resources designee will make
the final determination for eligibility for the student to attend the classroom and clinical in the Nursing
Assistant program based on the Department of Human Services Criminal History Check Rules.
8. The Nursing Assistant primary instructor will be notified that the student has received an adverse fitness
determination and referral to the Human Resources department at the designated licensed nursing
facility to provide guidelines for appeals who wish to dispute the adverse fitness determination.
9. Pursuant to ORS 678.150, the Oregon State Board of Nursing (OSBN) now requires for licensure or
certification will be required to provide fingerprints in order for the Board to conduct a national criminal
history record check.
Drug Screen.
1. Cooperating with the drug testing policies of any work experience, clinical, or cooperative teaching site is
a condition for continued enrollment in the course and/or related academic program. A student will be
required to comply with the non-LBCC instructional sites drug test policy.
2. Each student will be given a drug test prior to admittance to the Approved facility Village Nursing
Assistant class.
3. A positive drug test will disqualify students from attending the class.
4. Candidates will be notified by a designee from Human Resources at Approved facility Village.
5. The student will be notified of when to schedule the drug test and be given directions prior to the test.
The cost will be paid by the student.
6. Testing may be random and unannounced or conducted when a reasonable belief that work-behavior
may be the result of the presence of a drug.
7. The presence, as determined by the programs test procedures, of prescription or non-prescription drugs,
controlled substances, or cannabis, for other than legal and legitimate uses, may result in immediate
dismissal from the work site and disenrollment from the course and/or related academic program, if the
course is a requirement for program completion.
The student may be subject to appropriate disciplinary action for violating the Standards of Conduct as outlined
in the Students Rights and Responsibilities document. This document is available at:
http://www.linnbenton.edu/studentrights/
Enrollment and attendance.
Policy: Throughout the training, the student will meet the Oregon State Board of Nursing 155 hour attendance
requirements for the Nursing Assistant training. This includes a mandatory 80 hour classroom instruction and
approximately 10 class days and 75 hours of clinical over supervised clinical instruction. The program may
increase the hours if indicated. The schedule may change per Primary instructor discretion.

Nursing Assistant Program

6500 SW Pacific Blvd.
Albany, OR 97321
(541) 917-4738
nainfo@linnbenton.edu

LBCC Nursing Assistant Student Requirements

Policy & Procedures Disclosure Agreement
Enrollment and attendance (Continued).
1. Student will read and sign enrollment agreement. This agreement states beginning and ending dates of
course. An outline of the instructional program which student is enrolled. Fees, tuition and other
program costs itemized separately. Reference to cancellation policy for students.
2. The student must be in attendance and on-time at all scheduled classes and clinical. A class schedule is
given the first day of class.
3. Any unreported tardiness the day of class or clinical will be counted as a full day absence. Student will
have to meet with Primary instructor to determine a written, mutually agreed upon, course of action plan
will be implemented.
4. In the event of an absence due to emergency, the student must attend the makeup day for each of the
absences by attending with subsequent class depending on availability. The student will not receive a
certificate of completion until all 155 mandatory hours are met.
5. The student may not use the makeup day to fulfill daily tardiness.
6. If the student has more than one (1) excused absence during the classroom instruction and/or more than
one (1) excused absence during supervised clinical instruction the student must contact the Program
Instructor to discuss the missed hours. The decision to permit the make-up hours is at the discretion of
the Primary instructor. Primary Instructor will submit a student of concern form to Advising and
Counseling department at LBCC.
7. The Primary instructor will determine the need to withdraw from class and meet with the Dean of
student services prior to readmission to the next Nursing Assistant class.
8. All absences are required to be made up prior to completion of the course.
9. The student may withdraw from the course the first week and request to return to next class per
discretion of the Primary instructor.
10. The student has to complete the clinical portion no later than four months following the date of
completion of the classroom instruction.
Change of Course and Refunds.
1. Students currently enrolled are not required to fulfill any change of program ie: increased hours, change
of schedule, adding or dropping course requirements or change in payment methods. Any changes must
be mutually agreed upon by student and primary instructor before implemented.
2. Students are not required to pay if course is cancelled and all refunds will be made to students.
3. Students may cancel enrollment in writing three days before the first day of class. If students withdraw
from class in writing three days prior to first class all tuition will be refunded less a 10% cancellation fee.
4. The student may withdraw from class, you must go to the LBCC registration desk (or a community center)
and formally withdraw from class. Please do this as soon as you know you have changed your mind. If
you do not withdraw from class, but quit attending class, you will receive a "Y" grade which means the
amount of course work and of class participation was too insignificant to warrant assigning a grade, as
defined in the course syllabus. The "Y" grade does not affect your GPA but does show that you did not
complete the course. This is your responsibility. Please refer to the schedule of classes for more detailed
information.
5. There are no refunds after the first week of class due to costs incurred by NA program to recruit and
offer course.

Nursing Assistant Program

6500 SW Pacific Blvd.
Albany, OR 97321
(541) 917-4738
nainfo@linnbenton.edu

LBCC Nursing Assistant Student Requirements

Policy & Procedures Disclosure Agreement
Behavioral Expectations in the Nursing Assistant course.
1.
2.
3.
4.
5.
6.
7.
8.

Practice good health habits and personal hygiene

Present a professional appearance in dress.
Maintain the learning environment by arriving on time, turning off cell phones, and avoiding disruptions.
Present ideas in a constructive manner and be aware of cultural differences and help promote the
learning of fellow students.
Come to class on time and prepared to participate in classroom discussion reading assignments and
respond to in class questions. Participate in all classroom activities.
Be prepared for skills lab by reading the skills prior to class.
Adhere to policies and procedures of training program.
Show improvement throughout training.

Dress Code Expectations in the Nursing Assistant course.

1.
2.
3.
4.
5.
6.

Must be clean, neat and maintain personal hygiene.

Must wear approved scrub uniform to laboratory days at LBCC and a watch with a second hand.
Must wear LBCC student name tag at all times while in class.
Must wear gait belt in laboratory and clinical as part of uniform at all times.
Must wear closed toe shoes.
Socks must be worn

Dress Code Expectations in the Nursing Assistant course (Continued).

7.
8.
9.
10.
11.
12.

Hairstyle, nail polish, and make up should reflect a neat and professional appearance
Perfume light due to possible health hazard
Undergarments must not be visible under uniform
No dangling jewelry. Jewelry must be appropriate.
Uniforms must be clean and neat.
Potentially offensive tattoos should be covered while at work.

Examination Administration in the Nursing Assistant course.

1.
2.
3.
4.
5.
6.
7.
8.
9.

10.
11.

The quizzes will be administered per calendar schedule.

The quizzes will be given the first 15 minutes of the scheduled classes.
They will be graded and reviewed with each student confidentially.
The Mid-term will have 50 questions and will be given on the scheduled date on the class calendar. The
student will have One hour to complete.
The Final Exam will have 100 questions and 2 hours to complete on the scheduled date on calendar.
No materials will be permitted on the desk for quizzes or exams.
The mid-term is a multiple choice exam on materials covered in class up to that date.
The Final Exam will be cumulative for the entire 80 hour classroom instruction.
If a student cheats by using notes or looking at another students test they will be immediately removed
from the room and referred to the Program Director and Dean of Student Services for counsel. They will
be required to withdraw per discretion of Dean of student services.
The Final Exam will be graded on a pass or fail basis. Any student who fails final exam will not proceed to
clinical.
Students may repeat Final Exam one time by making arrangements with the Student Assessment Center
by dropping in between 9-3pm or calling 541-917-4781 at Linn Benton Community College. This must be
completed prior to the end of the class and clinical to receive the Certificate of completion.

Nursing Assistant Program

6500 SW Pacific Blvd.
Albany, OR 97321
(541) 917-4738
nainfo@linnbenton.edu

LBCC Nursing Assistant Student Requirements

Policy & Procedures Disclosure Agreement
Examination Administration in the Nursing Assistant course (Continued).
12. Any student may make an appointment at Center of Accessibility Resources who may need
accommodations or a documented at 541-917-4789.
13. If a student has a documented disability they must complete request for Accommodations form every
term.
14. Any student who may need assistance with test anxiety may call the Support Lab at LBCC at 541-9174343.
15. The student will be deferred to Support Lab and allowed to repeat Final Exam one time if they do not
pass they will not proceed to clinical and will have to repeat coursework.
Clinical Expectations Guidelines:
1. All skills on the Nursing Assistant checklist must be safely completed to pass the course. A satisfactory
competency and safety level as evaluated by the clinical instructor. Students must pass final examination
prior to clinical and progress documented in course.
2. In the clinical area, you must always use a gait belt for transfers or when assisting with mobility of
residents, a staff member (or teacher) must always be present if you are feeding a resident in the dining
room, during patient showers, and a staff member (or teacher) must be next to you each time you
transfer a resident. If a safety violation occurs, the student may be removed from the clinical area at the
discretion of the Program Director or Administrator.
3. If a student needs improvement with a skill, the problem area will be identified and
recommendations for improvement made by the instructor during conferencing with the student.
4. If resident or employee safety may be jeopardized by the students performance level, the student may
be failed in clinical, and not permitted to continue with the nursing assistant course at any time during
the course.
5. If clinical is not satisfactorily completed the student will receive a failing grade. A student receiving a
passing grade will be issued a certificate of completion.
6. One serious safety error or abandoning the duty station will result in termination of the students
registration in the class and they will not be able to complete the course.
7. No cell phones in classroom or in clinical areas.
8. Any clinical absences must be reported two hours prior to the start of shift by phone to clinical instructor.
9. One 15 minute break is allowed every four hours in the clinical setting. One 30-minute lunch is allowed
no additional breaks are authorized. Must take breaks with primary instructor.
10. Notify the clinical instructor when ready for check-off on the skills checklist. CNA are not to teach the
skills on skill checklist.
11. Students must follow facility policy and procedures. Follow the facility guidelines for charting in the
clinical experience.
12. Student must notify CNA and charge nurse when taking breaks or leaving the clinical area at end of shift.
13. Must complete mandatory 75 hour clinical hours prior to receiving certificate of completion.
Approval:
Revised:

Carolyn Pokorney RN, BSN, MNE

11/16/2014

Program Director

Date Reviewed

Carolyn Pokorney RN, BSN, MNE 10/1/10;10/2/11; 10/4/12; 11/5/14

Program Director

Nursing Assistant Program

6500 SW Pacific Blvd.
Albany, OR 97321
(541) 917-4738
nainfo@linnbenton.edu

LBCC Nursing Assistant Student Requirements

Policy & Procedures Disclosure Agreement
I certify that the information set forth by my signature in this application is true, complete, and accurate to the best of my
knowledge and that any falsified statements on this application shall be considered sufficient cause for refusal of admission
to the LBCC Nurse Assistant Program.
I understand that final acceptance into the program is dependent on completion of the following:
Passing a Criminal Background Check (non-refundable once processed), passing a Drug Screen as per the LBCC Health Services Drug
Testing Protocol, and Registering with LBCC for the Nursing Assistant Course.

If these requirements are not met by the deadline given in my acceptance letter, I understand that LBCC has the right to
drop me from the program and I am not eligible for a refund for any fees related to the class.
Reading Test
Criminal Background
CPR Certification
Gait Belt:
ONCA State Cert. Fee
OSBN Fingerprinting
Tuition Costs

$5
Costs vary
Costs vary
$16.95
$106
$52
NONE

CNA 1 Course Cost Estimates:

TB Test
Drug Screen
Uniforms & Equipment
LBCC (CLASSROOM):
Lab Fee
Text BookLBCC (Online Course):
Lab Fee
Mosby's Textbook for Nursing Astants., 8th Ed.
Hartman's Nursing Assist. Care: Long-Term Care, 3rd Ed.

$20
$36
Costs vary
$125
$85.95(new) or $59 (used)
$250
$46 (used) -64 (New)
$33 (used) -39 (New)

I further understand that I may withdraw from the course in writing three business days before the commencement of the
first day of classes or three business days before being issued access to the online didactic training. All tuition paid to the
course will be refunded, less a cancellation fee of 10 percent. If I withdraw from the class less than three business days
before the start of the course or after the start of the class, I will not be entitled to any refund of tuition. The LBCC
registration fee must be refunded through LBCC Registration Office.
The LBCC Nursing Assistant Training Program reserves the right to cancel a class. All tuition and fees received will be
refunded in full.
I may file a complaint about the LBCC Nurse Assistant Training Program with the Oregon State Board of Nursing, in writing,
either by mail or email: Oregon State Board of Nursing; 17938 SW Upper Boones Ferry Rd.; Portland, Oregon 97224-7012;
or go to www.oregon.gov/OSBN.
According to OSBN Oregon Administration Rules: For facility-based nursing assistant level 1 programs, no student who is
employed by, or who has received an offer of employment from a facility on the date on which the student begins training
will be charged for any portion of the program, including any fees for textbooks or other required course materials in
accordance with 42 CFR / 483.152(c)(1) (The LBCC Nurse Assistant Training Program is not a facility based program).
Students should save all receipts pertaining to this course for reimbursement if employed by a licensed nursing facility
within 12 months following completion of the course. The Request for Reimbursement form is available upon request.
I have received, read, and understand the Enrollment Agreement and Disclosure Statement and the program policies as follows:
Admission Requirements, Attendance & Refunds, Behavioral Expectations, Clinical Policies, Course Requirements & Change of
Course Policy, Change of Course & Refunds, Criminal Background Procedure, Criminal History Requirement for Program, Dress
Code, Drug Testing, Enrollment, Attendance & Refunds, Examination Administration, and Grading.
I have reviewed the dates and agree to be available for the entire program.
_
Applicant Signature
Date

_
Printed Name