5.2 North Dakota HHS Nurse Aide Registry & Licensing Rules
Key Takeaways
- The North Dakota Department of Health and Human Services (ND HHS) maintains the official Nurse Aide Registry, which tracks certification status, training compliance, renewals, and substantiated findings of resident abuse, neglect, or property misappropriation.
- Initial listing on the ND Nurse Aide Registry requires completing an approved 75-hour training program and passing both parts of the Headmaster / D&S Diversified Technologies competency exam — a 72-question knowledge exam scored at 75% or better and a manual skill test of three or four tasks — within three attempts from the date of training completion.
- Out-of-state nurse aides who hold current registry status in another state with no validated finding may be endorsed onto the North Dakota registry under N.D. Admin. Code 33-43-01-11(1)(c) without repeating training.
- North Dakota registry status is limited to twenty-four months, and N.D. Admin. Code 33-43-01-11(1)(e) requires the aide to have performed at least eight hours of nursing or nursing-related services for pay within a continuous 24-month period; no fee may be charged for initial CNA listing or renewal.
- A finding of abuse or neglect results in permanent revocation of a certified nurse aide's registration under N.D. Admin. Code 33-43-01-01(28), although an individual with a neglect finding may petition for its removal after one year under N.D. Admin. Code 33-43-01-24.
North Dakota HHS Nurse Aide Registry & Licensing Rules
In North Dakota, the practice of certified nursing assistants is governed by state and federal regulations designed to safeguard the health, safety, and rights of residents in long-term care facilities, hospitals, assisted living centers, and home health environments. The central regulatory body governing nurse aides in the state is the North Dakota Department of Health and Human Services (ND HHS), Health Facilities Division.
Every individual who provides direct nursing assistant services in a Medicare- or Medicaid-certified long-term care facility in North Dakota must be actively listed in good standing on the North Dakota Nurse Aide Registry.
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| NORTH DAKOTA NURSE AIDE REGULATORY FRAMEWORK |
| |
| [REGULATORY AUTHORITY] ---> North Dakota Dept of Health & Human Services |
| (ND HHS) - Division of Health Facilities |
| |
| [TESTING VENDOR] ---> Headmaster / D&S Diversified Technologies |
| (Administers Knowledge & Clinical Exams) |
| |
| [REGISTRY DATABASE] ---> Verifies active certification, renewals, and |
| public records of disciplinary findings |
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1. The North Dakota Nurse Aide Registry: Purpose & Public Verification
The North Dakota Nurse Aide Registry is an official, publicly accessible database containing records of all individuals who have met state and federal training and testing standards to practice as certified nurse aides.
Primary Purposes of the Registry:
- Credential Verification: Allows healthcare employers (nursing homes, hospitals, clinics, staffing agencies) and the public to verify whether an applicant possesses active, unencumbered certification.
- Public Safety & Protection: Tracks and permanently records all substantiated administrative findings of resident abuse, neglect, or misappropriation of resident property.
- Compliance Monitoring: Enforces federal OBRA mandates that prohibit Medicare- and Medicaid-certified facilities from employing any individual who has been found guilty of abusing, neglecting, or exploiting vulnerable individuals.
[!NOTE] Mandatory Pre-Employment Registry Check: Under North Dakota and federal law, healthcare facilities must conduct a formal electronic search of the North Dakota Nurse Aide Registry—as well as other state registries if the applicant previously resided outside North Dakota—before employing any individual as a nursing assistant.
2. Initial Qualification Pathways & Examination Standards
To become listed on the North Dakota Nurse Aide Registry, candidates must satisfy rigorous educational and competency benchmarks.
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| PATHWAYS TO NORTH DAKOTA CNA CERTIFICATION |
| |
| [PATHWAY 1: STANDARD STATE-APPROVED TRAINING & TESTING] |
| Complete 75-Hour Program ───> Pass Headmaster Knowledge (≥75%) ───> Active|
| & Pass the Manual Skill Test Registry
| |
| [PATHWAY 2: ENDORSEMENT / RECIPROCITY (OUT-OF-STATE NURSE AIDE)] |
| Current Registry Status in ───> No Validated Finding ─────────────> Active|
| Another State (N.D. Admin. Code 33-43-01-11(1)(c))Registry
| |
| [PATHWAY 3: REACTIVATION BY EXAM (LAPSED ND CERTIFICATION)] |
| Proof of Prior ND-Approved ───> Retake BOTH Knowledge & Skill ────> Active|
| Training + Prior ND Listing Components (nd.tmutest.com/apply/6) Registry
| |
| NOTE: The option to CHALLENGE the North Dakota CNA exam was eliminated |
| effective July 1, 2024, and is no longer an available pathway. |
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Standard Pathway: 75-Hour Training Program
Candidates must successfully complete a state-approved nurse aide training and competency evaluation program (NATCEP) consisting of a minimum of 75 total hours:
- Classroom / Theory Instruction: Covers infection control, resident rights, basic nursing principles, emergency procedures, communication, and safety. Federal law requires a minimum of 16 hours of classroom theory prior to any direct contact with residents.
- Skills Laboratory Practice: Structured hands-on demonstration and practice in a simulated clinical laboratory setting (at least 16 hours).
- Supervised Clinical Practicum: Direct hands-on care delivery to residents in an approved long-term care facility under the immediate supervision of an approved RN clinical instructor.
Headmaster / D&S Diversified Technologies Examination Standards
In North Dakota, the state competency evaluation is developed and scored by Headmaster / D&S Diversified Technologies (D&SDT-Headmaster), working under contract to ND HHS. Registration, scheduling, and results all run through the TestMaster Universe (TMU©) portal at nd.tmutest.com. The examination consists of two mandatory components, and both must be passed before ND HHS will place the candidate on the registry:
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| HEADMASTER / D&S DIVERSIFIED EXAM BREAKDOWN |
| |
| [KNOWLEDGE / AUDIO EXAM] |
| - Format: 72 Multiple-Choice Questions |
| - Delivery: ELECTRONIC ONLY via TMU(c) at every North Dakota test site |
| - Time Allowed: 90 Minutes (15-minute warning given) |
| - Passing Benchmark: MINIMUM SCORE OF 75% |
| - Audio (oral) version available; must be requested BEFORE paying the fee |
| |
| [MANUAL SKILL TEST] |
| - Format: THREE (3) or FOUR (4) randomly assigned tasks |
| - Task 1 is always one of three MANDATORY FIRST TASKS with real |
| soap-and-water hand washing embedded at the end |
| - Time Allowed: 30 Minutes (15-minute warning given) |
| - Evaluator: Approved RN Test Observer (Headmaster teams score the form) |
| - Passing Benchmark: ALL key (bold) steps performed correctly PLUS 80% |
| of the non-key steps on EACH assigned task |
| |
| [THE 3-ATTEMPT RULE] |
| - A candidate who completed approved training gets a maximum of THREE (3) |
| attempts to pass both portions, counted from the training completion |
| date. |
| - Failing three attempts at knowledge, skills, or both requires going |
| through an approved nurse aide training program again. |
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Endorsement (Reciprocity) for Out-of-State Nurse Aides
N.D. Admin. Code 33-43-01-11(1)(c) is short and specific: "Individuals who have met the requirements for registry listing as a certified nurse aide in other states, have a current registry status, and no validated finding may be endorsed onto the department's registry as a certified nurse aide." Endorsement therefore has exactly three tests:
| Endorsement Test | What ND HHS Verifies |
|---|---|
| Met another state's requirements | The applicant completed that state's approved training and competency evaluation for CNA listing (federal OBRA floor of 75 hours). |
| Current registry status | The out-of-state listing is active right now — not lapsed, expired, or inactive. |
| No validated finding | No substantiated finding of abuse, neglect, or misappropriation of resident property on any state registry. |
The application is filed with ND HHS (not with Headmaster) through the online nurse aide services portal. Endorsement candidates do not repeat the 75-hour program and do not retake the Headmaster competency exam.
[!NOTE] Exam-day distinction to memorize: An endorsement candidate transfers an existing, active out-of-state listing. A Reactivation by Exam candidate is someone whose North Dakota listing expired — they retake both exam components rather than repeating training. A candidate whose ND listing lapsed and who was never trained (a legacy "challenge" candidate) has no reactivation route, because the challenge option ended July 1, 2024.
3. Registry Renewal & Employment Verification Rules
Listing on the North Dakota Nurse Aide Registry is not permanent; it must be renewed periodically to confirm ongoing clinical competency and active engagement in the healthcare workforce.
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| NORTH DAKOTA REGISTRY RENEWAL STANDARDS |
| |
| [RENEWAL TIMEFRAME] ---> Registry status is limited to TWENTY-FOUR |
| MONTHS (N.D. Admin. Code 33-43-01-11(1)(d)) |
| |
| [MANDATORY WORK HOUR] ---> At least EIGHT (8) HOURS of nursing or |
| nursing-related services FOR PAY within a |
| continuous 24-month period |
| (N.D. Admin. Code 33-43-01-11(1)(e)) |
| |
| [VERIFICATION METHOD] ---> Completed CNA renewal application plus |
| verification of employment within the |
| immediate past twenty-four months |
| |
| [RENEWAL FEE] ---> NONE. 33-43-01-11(1)(f) bars ND HHS from |
| charging a fee for initial CNA listing or |
| renewal. (Home health aides DO pay $25.) |
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Breakdown of Renewal Requirements:
- 24-Month Registry Cycle: N.D. Admin. Code 33-43-01-11(1)(d) states plainly that "registry status is limited to twenty-four months." Upon receipt of a completed CNA renewal application and verification of employment within the immediate past twenty-four months, ND HHS updates the listing to current status.
- The 8-Hour Paid Work Rule: Subsection (1)(e) is the operative test — a certified nurse aide who "has not performed at least eight hours of nursing or nursing-related services for pay within a continuous twenty-four-month period" must complete a department-approved training and competency evaluation program or a department-approved competency evaluation in order to renew.
- The statutory trigger is the words "for pay." Volunteer shifts, unpaid family caregiving, and non-nursing duties such as housekeeping, laundry, or clerical work do not satisfy the rule.
- Eight hours is a floor for the entire two-year window, not an annual or monthly quota. A single paid eight-hour shift anywhere in the 24 months preserves eligibility.
- No Renewal Fee: Subsection (1)(f) forbids ND HHS from charging any fee for initial certified nurse aide registry status or renewal. Do not confuse this with the $25 nonrefundable fee that the same chapter imposes on home health aide and medication assistant applications.
Consequences of a Lapsed / Inactive Registration
If a certified nursing assistant fails to perform at least eight hours of nursing or nursing-related services for pay within a continuous 24-month period, the listing can no longer be renewed on an application alone and the registry status becomes Lapsed (Inactive).
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| ACTIVE VS. LAPSED VS. DISQUALIFIED STATUS |
| |
| Status: [ACTIVE] |
| - Meaning: Fully certified, in good standing, eligible for hire. |
| - Requirements: Renewal application filed + employment verified within |
| the immediate past 24 months (>= 8 paid hours). |
| |
| Status: [LAPSED / INACTIVE] |
| - Meaning: No 8 paid hours of nursing/nursing-related work in a |
| continuous 24-month period. |
| - Employment: CANNOT work as a CNA in a certified nursing facility. |
| - Reinstatement (33-43-01-11(1)(e)): complete a department-approved |
| training AND competency evaluation program, -OR- a |
| department-approved COMPETENCY EVALUATION alone. An aide who |
| can document prior ND-approved training and who did not |
| challenge the exam applies for REACTIVATION BY EXAM and |
| simply retakes BOTH the knowledge and skill components. |
| |
| Status: [REVOKED] |
| - Meaning: Substantiated finding of abuse or neglect. |
| - Penalty: PERMANENT revocation (33-43-01-01(28)); no Medicare/Medicaid |
| certified facility may employ the individual. |
| - One narrow exception: a NEGLECT finding (not abuse) may be petitioned |
| for removal after ONE YEAR under 33-43-01-24. |
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[!WARNING] The most-missed lapsed-registry fact: A lapsed North Dakota aide cannot simply pay a late fee, take a refresher class, or work a few catch-up shifts — the listing is not renewable on an application alone. But the rule does not automatically force a repeat of the 75-hour course either. N.D. Admin. Code 33-43-01-11(1)(e) offers two routes: an approved training and competency evaluation program, or an approved competency evaluation by itself. D&SDT-Headmaster implements the second route as Reactivation by Exam (application form at
nd.tmutest.com/apply/6), open to a candidate who (a) was previously listed on the North Dakota registry and (b) did not challenge the exam for that initial placement, and who can show proof of completing an ND HHS-approved training program. That candidate retakes both the knowledge exam and the manual skill test. Choosing "retake only the written test" or "retake nothing" is always wrong.
4. Disciplinary Actions, Abuse Findings & Permanent Disqualification
The North Dakota Department of Health and Human Services is legally charged with investigating all reported allegations of misconduct involving nurse aides in licensed healthcare settings.
The Investigation & Due Process Protocol:
- Allegation & Incident Report: When an incident of alleged abuse, neglect, or misappropriation occurs, the facility must report it immediately to ND HHS and suspend the accused employee pending investigation.
- State Administrative Investigation: ND HHS investigators conduct an independent inquiry, reviewing medical records, interviewing witnesses, and examining physical evidence.
- Notice of Due Process: If the state investigator substantiates the allegation, the CNA receives formal written notice outlining the charges and explaining their constitutional right to a fair administrative hearing before an administrative law judge.
- Hearing or Default: The CNA has a specified window (typically 30 days) to request an administrative hearing to contest the findings. If the CNA does not request a hearing, or if the administrative judge upholds the charges, the finding becomes official and final.
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| CONSEQUENCES OF A SUBSTANTIATED REGISTRY FINDING |
| |
| [1. PERMANENT REGISTRY NOTATION] |
| A permanent, irrevocable notation of the substantiated finding |
| (Abuse, Neglect, or Misappropriation) is entered on the ND Registry. |
| |
| [2. LIFETIME EMPLOYMENT BAN] |
| Federal law (OBRA '87 / 42 CFR § 483.12) prohibits any Medicare- |
| or Medicaid-certified facility from EVER hiring the individual. |
| |
| [3. NATIONAL EXCLUSION LISTINGS] |
| Reported to the HHS Office of Inspector General (OIG) and the |
| National Practitioner Data Bank (NPDB) Exclusion Databases. |
| |
| [4. EXPUNGEMENT IS ESSENTIALLY CLOSED - WITH ONE EXCEPTION] |
| A substantiated ABUSE finding remains on the registry permanently and |
| can never be expunged. A NEGLECT finding is also a permanent |
| revocation, but 33-43-01-24 lets the individual petition ND HHS in |
| writing to remove it after ONE YEAR - granted only if there is no |
| pattern (2+ occurrences), the neglect was a single occurrence, and a |
| criminal-history/background check is clean. |
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Summary Table: North Dakota Registry Rules
| Regulatory Dimension | Requirement / Benchmark | Governing Authority / Rule |
|---|---|---|
| Initial Training | Minimum 75 total hours (≥16 classroom theory, ≥16 lab skills before resident contact) | ND HHS / OBRA 1987 Standards |
| Knowledge Exam | 72 multiple-choice questions, electronic (TMU©), 90 minutes; passing score ≥75% | ND Candidate Handbook v6 (rev. April 2025) |
| Manual Skill Test | 3 or 4 randomly assigned tasks in 30 minutes; all key (bold) steps correct plus 80% of non-key steps on each task | ND Candidate Handbook v6 (rev. April 2025) |
| Exam Attempt Limit | Three attempts to pass both portions, counted from the training completion date; three failures require repeating an approved training program | ND Candidate Handbook v6 |
| Endorsement | Met another state's CNA listing requirements, current registry status, and no validated finding | N.D. Admin. Code 33-43-01-11(1)(c) |
| Renewal Frequency | Registry status limited to 24 months; no fee may be charged for CNA listing or renewal | N.D. Admin. Code 33-43-01-11(1)(d), (1)(f) |
| Renewal Employment | At least 8 hours of nursing or nursing-related services for pay in a continuous 24-month period | N.D. Admin. Code 33-43-01-11(1)(e) |
| Lapsed Consequence | Approved training and competency evaluation program, or an approved competency evaluation alone (Headmaster "Reactivation by Exam" — retake both components) | N.D. Admin. Code 33-43-01-11(1)(e) |
| Abuse / Neglect Finding | Permanent revocation of registration; a neglect finding alone may be petitioned for removal after one year | N.D. Admin. Code 33-43-01-01(28), 33-43-01-24 |
To obtain initial listing on the North Dakota Nurse Aide Registry, what examination benchmark must a candidate achieve through D&SDT-Headmaster?
A Certified Nursing Assistant registered in North Dakota is approaching their two-year registry renewal deadline. What minimum employment requirement must be verified to maintain an active registry status?
An individual's North Dakota CNA registration lapsed three years ago due to absence from the healthcare workforce. What is required for this individual to regain active CNA certification in North Dakota?
Following an administrative investigation and formal hearing with the North Dakota Department of Health and Human Services, a CNA is found guilty of a substantiated allegation of resident abuse. What is the legal consequence of this finding?