TX HHS Form 5497-NATCEP. Texas Nurse Aide Performance Record

The Texas Nurse Aide Performance Record (Form 5497-NATCEP) is a key document used within the Nurse Aide Training and Competency Evaluation Program (NATCEP). This form records the performance of nurse aide trainees across a range of essential skills, ensuring compliance with state standards for healthcare personnel.

Purpose and Overview

Form 5497-NATCEP tracks the competency of nurse aides in Texas. It serves both as a training record and as a verification tool for clinical instructors, helping maintain quality care and patient safety. The form is mandatory for all individuals completing a state-approved NATCEP program.

Section-by-Section Explanation

Section I: Safety and Emergency Program

This section evaluates trainee skills in responding to emergencies such as fainting, seizures, and airway obstruction. Proper use of personal protective equipment (PPE) and safe body mechanics are also assessed.

• Common mistakes: forgetting to check airway obstruction procedure, improper use of PPE.
• Documents typically attached: instructor evaluation sheets or clinical notes.

Section II: Infection Control

Focuses on hand hygiene, isolation precautions, and correct use of PPE. Successful completion is essential to prevent healthcare-associated infections.

Section III: Communication

Assesses trainee's interpersonal and communication skills, crucial for patient interactions and teamwork within clinical settings.

Section IV: Nutrition and Hydration

Tests skills in assisting with meals and feeding dependent residents. Proper techniques reduce choking risks and ensure nutritional needs are met.

Section V: Resident's Environment

Covers making beds (occupied and unoccupied), maintaining a safe and comfortable environment for residents.

Section VI: Basic Nursing Skills

Includes vital sign measurement, intake and output recording, and monitoring weight and height.

Section VII: Personal Care

Evaluates personal hygiene skills such as bathing, oral care, hair care, grooming, dressing, and application of compression stockings.

Section VIII: Elimination Care

Covers procedures related to bedpans, urinals, catheter care, and specimen collection.

Section IX: Care for Resident Death

Assesses trainee's ability to perform postmortem care with dignity and respect.

Section X: Basic Restoration Services

Includes assisting residents with transfers, ambulation, and passive range of motion exercises.

Section XI: Prevention of Pressure Ulcers

Focuses on repositioning and turning residents to prevent bedsores.

Practical Recommendations

• Ensure each skill is marked with the appropriate S (Satisfactory) or U (Unsatisfactory) performance indicator.
• Attach completed CBT certificates for classroom items done online.
• Verify initials and signatures of instructors are complete for each skill section.
• Regularly review and correct mistakes before final submission.

Example Situations Where Form 5497-NATCEP is Required

• A trainee completes a Texas NATCEP program and needs documentation to apply for a nurse aide certification.
• An instructor tracks a resident care session to ensure a trainee meets clinical skill standards.
• A healthcare facility verifies a newly hired aide’s competencies for compliance with state regulations.

Required Documents

• Instructor evaluation sheets
• Clinical Skills Test Checklist
• CBT certificates (if online classroom items completed)
• Any supporting documentation for remedial actions taken

Frequently Asked Questions

Who must complete this form?

All nurse aide trainees enrolled in a Texas NATCEP program must have this form completed.

When is this form submitted?

Upon completion of the training and competency evaluation program, before certification.

What happens if a skill is marked Unsatisfactory?

The trainee must repeat the skill and have it reassessed to meet competency standards.

Who is authorized to sign this form?

Certified NATCEP instructors or clinical supervisors.

Are online skills lab completions accepted?

Yes, provided CBT certificates are attached.

Micro-FAQ (Quick Reference)

• Purpose: Document trainee competency in NATCEP skills.
• Who files: Clinical instructors or NATCEP coordinators.
• Deadline: Before nurse aide certification application.
• Attachments: CBT certificates, evaluation sheets.
• Submitted to: NATCEP program office or certifying body.

Related Forms

• Form 2381 – Nurse Aide Certification Application
• Form 3450 – Clinical Skills Test Checklist
• Form 1123 – Nurse Aide Training Attendance Record

Form Details

Name: Texas Nurse Aide Performance Record

Form Number: 5497-NATCEP

Region: Texas

Revision Date: April 2024