Current through Register Vol. 51, No. 19, September 20, 2024
A.
Organization, Policies, and Procedures.
(1)
Nursing service personnel shall provide care appropriate to the residents'
needs with the organizational plan, authority, functions, and duties clearly
defined.
(2) Nurses and support
personnel shall be chosen for their training, experience, and
ability.
(3) Policies and
procedures shall be adopted and made available to all nursing service
personnel.
B. Signed
Agreement.
(1) A signed copy of the agreement
between the nursing home and the director of nursing, showing the license
number of the nurse, shall be filed with the Department upon:
(a) Application for an initial nursing home
license; and
(b) A change of
director of nursing.
(2)
The agreement shall specify the duties of the director of nursing.
C. Nursing Care 24 Hours a Day.
The administrator shall employ sufficient and satisfactory licensed nursing
service personnel and support personnel to:
(1) Be on duty 24 hours a day;
(2) Provide appropriate bedside care;
and
(3) Ensure that a resident:
(a) Receives treatments, medications, and
diet as prescribed;
(b) Receives
rehabilitative nursing care as needed;
(c) Receives proper care to prevent pressure
ulcers and deformities;
(d) Is kept
comfortable, clean, and well-groomed;
(e) Is protected from accident, injury, and
infection;
(f) Is encouraged,
assisted, and trained in self-care and group activities; and
(g) Receives prompt and appropriate responses
to requests for assistance.
D. Assistance by Nursing Service Personnel.
Nursing service personnel shall help the resident perform daily routine dental
hygiene.
E. Charge Nurse.
(1) At least one licensed nurse shall be:
(a) On duty at all times; and
(b) Be designated by the director of nursing
to be in charge of the nursing activities during each tour of duty.
(2) The charge nurse or nurses
shall have the ability to recognize significant changes in the condition of
residents and to take necessary action.
F. Charge Nurses' Daily Rounds. The charge
nurse or nurses shall make daily rounds on all nursing units for which they are
responsible, performing such functions as:
(1)
Visiting each resident;
(2)
Reviewing clinical records, medication orders, resident care plans, and staff
assignments; and
(3) To the degree
possible, accompanying physicians when visiting residents.
G. Program of Restorative Nursing Care. There
shall be an active program of restorative nursing care aimed at assisting each
resident to achieve and maintain the individual's highest level of independent
function, including activities of daily living. This program shall include:
(1) Ambulation and range of motion;
(2) Maintaining good body alignment and
proper positioning of bedfast residents;
(3) Encouraging and assisting residents to
change positions at least every 2 hours to stimulate circulation and prevent
pressure ulcers and deformities;
(4) Encouraging and assisting residents to
keep active and out of bed for reasonable periods of time, within the
limitations permitted by physicians' orders;
(5) Encouraging residents to engage in
resident-chosen community and independent activities and achieve independence;
and
(6) Assisting residents to
adjust to their disabilities and ensuring availability and use of their
prosthetic and assistive devices.
H. Coordination of Nursing and Dietetic
Services. Nursing and dietetic services shall establish an effective policy to
ensure that:
(1) Nursing service personnel are
aware of the nutritional needs and food and fluid intake of
residents;
(2) Nursing service
personnel provide special meals and nourishment when required;
(3) Residents' food choices and preferences
are honored as much as practical;
(4) Nursing service personnel promptly aid
residents when necessary in eating;
(5) The dietetic service is informed of
physicians' diet orders and of residents' nutrition-related issues;
and
(6) Food and fluid intake of
residents is observed, and deviations from normal are recorded and reported to
the:
(a) Charge nurse;
(b) Physician; and
(c) Dietetic service.
I. In-Service Education Program.
(1) The director of nursing shall:
(a) Provide a continuing in-service education
program for all nursing service personnel;
(b) Provide a thorough job orientation for
new personnel; and
(c) Document the
content of the continuing in-service education program and include the names
and titles of participants.
(2) The director of nursing shall obtain
approval from the Department.
J. Responsibility to Report Care that Is
Considered Questionable.
(1) If a nurse
questions the care provided to any resident or believes that appropriate
consultation is needed and has not been obtained, the nurse shall inform the
supervisor.
(2) If indicated, the
supervisor shall refer the matter to the director of nursing.
(3) If warranted, the director of nursing
shall report the matter to the medical director or principal
physician.
