6.5 NC Nurse Aide Registry, Licensure, and CNA II

These NC-specific rules show up on the NNAAP exam through scenario items ("In North Carolina, when must a nurse aide be re-listed?") and on the job through registry checks, hiring decisions, and disciplinary actions. Knowing the difference between the NA I Registry, the CNA II credential, and the abuse reporting statutes can protect your license for the rest of your career.

The NC Nurse Aide I Registry

• Maintained by: NC Department of Health and Human Services (DHHS), Division of Health Service Regulation (DHSR), Health Care Personnel Registry Section.
• Authority: NC General Statute §131E-255 and §131E-256 (Health Care Personnel Registry); federal authority is OBRA 1987 / 42 CFR §483.156.
• Listing validity: 24 months from the date of the last paid nursing-related work for a state-approved employer.
• Listed information includes: the aide's full name, registry number, date of listing, last employer, and any substantiated findings of abuse, neglect, or misappropriation of resident property.
• Public verification: Employers and the public can verify a nurse aide's status on the NC DHSR online Health Care Personnel Registry. Nursing facilities are required by federal law to check the registry before hiring.

Renewing your listing

If the aide does not meet the 8-hour requirement within 24 months, the listing becomes expired. To get back on the registry, the aide generally must retake the NNAAP (written and skills) — sometimes after retraining. Plan ahead; do not let the listing lapse.

Out-of-state reciprocity

NC accepts a nurse aide from another state's registry when all of the following are true:

1. The aide is currently in good standing on that state's registry (active listing, no findings).
2. The aide completed a training program of at least 75 hours equivalent to NC's program.
3. The aide passed an exam equivalent to the NNAAP (written/oral and skills).
4. There are no substantiated findings of abuse, neglect, or misappropriation of property.

The aide submits a reciprocity application to the NC DHSR Health Care Personnel Registry Section. Confirm the current application packet and any temporary work authorization rules with DHSR before relying on reciprocity to start a new job.

Abuse, Neglect, and Misappropriation Findings

Under NC GS §131E-256(d), when an investigation by the NC DHSR substantiates a finding of resident abuse, neglect, or misappropriation of property, the finding is permanently annotated on the Health Care Personnel Registry. A nursing facility may not employ a person with such a finding. In practice this is a career-ending finding — there is no expungement for substantiated abuse.

How the process works

1. Report — Anyone (CNA, family, resident, ombudsman) reports a suspected incident to the facility administrator and to NC DHSR.
2. Facility investigation — The facility must investigate within five working days and submit a report.
3. DHSR investigation — DHSR may also investigate independently.
4. Notice and hearing — The accused aide is notified and has the right to a hearing.
5. Finding — If substantiated, the finding is added to the registry and remains.

The practical lesson for the CNA: document carefully, report promptly, and never retaliate, restrain, scold, or strike a resident — even once, even when provoked.

Mandatory Abuse Reporting in NC

Every NC citizen is a mandatory reporter for child abuse (§7B-301) and adult abuse, neglect, or exploitation involving a disabled or elder adult (§108A-102). The CNA does not have to prove abuse — only have a reasonable suspicion. Reporting in good faith is legally protected; the reporter's identity is kept confidential by DSS to the extent the law allows.

NC CNA II

NC CNA II is a separate, optional credential for nurse aides who want a broader scope of practice. It is listed and regulated by the NC Board of Nursing (not DHSR), under 21 NCAC 36 .0403.

Eligibility (verify against current NC Board of Nursing rules)

• Hold an active, unrestricted NC Nurse Aide I listing on the DHSR registry.
• Complete a Board-approved CNA II training program (typically at least 100 additional contact hours beyond NA I) or be a nursing student who has completed equivalent coursework.
• Demonstrate competency on the expanded skills list.
• Apply to the NC Board of Nursing for CNA II listing.

Expanded scope: typical CNA II skills

The NC Board of Nursing publishes the full CNA II skills list; always check the current list before performing a skill new to you. Skills commonly added at CNA II include:

• Tracheostomy care (suctioning and cleaning of an established trach)
• Ostomy care (colostomy, ileostomy)
• Sterile dressing changes
• Urinary catheter insertion and irrigation (sterile technique)
• Nasogastric tube feedings and tube care (insertion remains a nurse function)
• Intravenous fluid monitoring (not initiation)
• Oral and nasopharyngeal suctioning of a stable patient
• Specimen collection beyond basic urine/stool (e.g., sterile specimens)
• Administration of certain treatments delegated by an RN per the NC Board of Nursing CNA II rules

Important: Even with CNA II, the aide works under delegation by an RN. CNAs at any level may never start an IV, push IV medications, administer most medications (some states allow medication aides — that is a different credential), perform sterile invasive procedures not on the list, or do anything outside the published scope.

Quick NC-Specific Reference

Master this table — it is the highest-yield NC-specific content on the NNAAP and on every NC nursing-facility orientation.