The Role of the Nursing Assistant-Registered (NAR) In AL

WHCA has received many questions on the role of a nursing assistant-registered (NAR) in the assisted living setting. This article aims to clarify the few opportunities where proof of an active NAR is necessary to work as a caregiver.

Becoming an NAR requires nothing more than an application to Department of Health and a $85 payment. There is no training involved.  The NAR designation was originally created for skilled nursing facilities, so that nursing assistant students would fall under the Uniform Disciplinary Act while working towards their nursing assistant certification. The same holds true today.

Typically, a non-credentialed caregiver hired to work in assisted living simply enrolls in a nursing assistant or home care aide (HCA) training program, completes the training within 120 days of hire, takes the certification exams, and obtains a credential based on timelines outlined in the rules (currently 365 days from hire for HCA and 200 days from hire for NAC).  No matter the credential sought, the individual can work as a caregiver, with direct supervision, while completing their training program.

There are limited and narrow expectations for a caregiver in assisted living to carry an active NAR credential.  They might include a caregiver who:

1. Has opted for a nursing assistant training program (as opposed to an HCA training program) and the training program requires an active NAR to complete clinical requirements in the skilled nursing facility; or
2. Has completed the 75-hour HCA training program or the 85+-hour nursing assistant training program, has proof of that completion, and will be performing delegated nursing tasks while awaiting testing and credentialling by the DOH. This caregiver must also:
   1. Demonstrate proof of completion of the necessary nurse delegation course(s), and
   2. Become certified within the timeframe specified in WAC.
3. Was employed as a caregiver in a home- and community-based care setting anytime between January 1, 2011 and January 6, 2012 and completed the basic caregiver training that was required at that time (Revised Fundamentals of Caregiving) and will be performing delegated nursing tasks. This caregiver must also:
   1. Demonstrate proof of completion of the necessary nurse delegation course(s), and
   2. Not have had a lapse of more than three consecutive years of caregiving.

If/when the caregiver’s NAR is superseded by an active NAC or HCA credential, the NAR credential can lapse via nonrenewal.

For more questions about NARs in assisted living, please email [email protected] or call directly at 360.352.3304, extension 107.