Current through Register Vol. 43, No. 12, March 20,
2024
Each nursing facility shall have sufficient nursing staff to
provide nursing and related services to attain or maintain the highest
practicable physical, mental, and psychosocial well-being of each resident as
determined by resident assessments and individual plans of care.
(a) Sufficient staff. The facility shall
employ sufficient numbers of each of the following types of personnel to
provide nursing care to all residents in accordance with each resident's
comprehensive assessment and care plan.
(1)
The nursing facility shall employ full-time a director of nursing who is a
registered nurse. The director of nursing shall have administrative authority
over and responsibility for the functions and activities of the nursing staff.
(2) A registered nurse shall be on
duty at least eight consecutive hours per day, seven days per week. The
facility may include the director of nursing to meet this requirement.
(3) A licensed nurse shall be on
duty 24 hours per day, seven days per week.
(A) On the day shift there shall be the same
number of licensed nurses on duty as there are nursing units.
(B) If a licensed practical nurse is the only
licensed nurse on duty, a registered nurse shall be immediately available by
telephone.
(4) At least
two nursing personnel shall be on duty at all times in the facility. Personnel
shall be immediately accessible to each resident to assure prompt response to
the resident call system and necessary action in the event of injury, illness,
fire, or other emergency.
(5) The
nursing facility shall not assign nursing personnel routine housekeeping,
laundry, or dietary duties.
(6)
Direct care staff shall wear identification badges to identify name and
position.
(7) The nursing facility
shall ensure that direct care staff are available to provide resident care in
accordance with the following minimum requirements.
(A) Per facility, there shall be a weekly
average of 2.0 hours of direct care staff time per resident and a daily average
of not fewer than 1.85 hours during any 24 hour period. The director of nursing
shall not be included in this computation in facilities with more than 60 beds.
(B) The ratio of nursing personnel
to residents per nursing unit shall not be fewer than one nursing staff member
for each 30 residents or for each fraction of that number of residents.
(C) The licensing agency may
require an increase in the number of nursing personnel above minimum levels
under certain circumstances. The circumstances may include the following:
(i) location of resident rooms;
(ii) locations of nurses' stations;
(iii) the acuity level of
residents; or
(iv) that the health
and safety needs of residents are not being met.
(b) The nursing
facility shall maintain staffing schedules on file in the facility for 12
months and shall include hours actually worked and the classification of
nursing personnel who worked in each nursing unit on each shift.