Current through Register Vol. 56, No. 6, March 18, 2024
(a) The hospital shall have in place a staffing plan that addresses nurse staffing requirements and identifies patient needs, including, at a minimum:
1. A daily staffing schedule that ensures at least one registered professional nurse in charge and assigned exclusively to each patient care unit on each shift;
2. A provision that at least 65 percent of direct patient care hours in inpatient units on a hospital wide average be provided by licensed nursing personnel;
3. A method for assessing each unit's additional nursing needs for each shift, including, at a minimum, objective criteria such as:
i. Documented skills, training and competency of staff to plan and provide nursing services in the nursing areas where they function;
ii. Patient data base incorporating objective factors such as case mix index, specific or aggregate patient diagnostic classifications or acuity levels, patient profiles, critical pathways or care progression plans, length of stay, and discharge plans;
iii. Operational factors such as unit size, design, and capacity, admission/discharge/transfer index, and support service availability;
iv. Contingency plans to address critical departures from staffing plan, including policies and procedures to regulate closure of available beds if staffing levels fall below specified levels;
v. Policies and procedures for the reassignment of staff including float and agency staff; and
4. On-going internal institutional evaluation of outcome-based quality indicators related to nursing care to assess and provide a safe and adequate level of patient care including at least:
i. Patient injury rate;
ii. Medication process errors;
iii. Maintenance of skin integrity;
iv. Nosocomial infection rates;
v. Hospital-wide patient satisfaction with overall care, including nursing care;
vi. Nursing turnover rate;
vii. Patient satisfaction with pain management; and
viii. Mix of RNs, LPNs and unlicensed staff caring for patients.
(b) There shall be a registered nurse manager for each patient care unit or units and for surgery, emergency department, and other units, as specified in the hospital organizational plan or policies and procedures.
(c) There shall be at least one registered professional nurse in charge and assigned exclusively to each patient care unit on each shift. Additional staff shall be assigned by the hospital as required by the acuity levels.
(d) Patient care assignments shall be made on an individual basis by a registered professional nurse and reflect staff competence, skill, and aptitude and patient needs.
(e) The hospital shall have in effect a contingency plan for assuring adequate nurse staffing at all times. The plan shall detail policies and procedures to regulate closure of available beds, if actual staffing levels fall below specified levels.
(f) Nurse staffing for all patient care units within the hospital shall also be in accordance with:
1.
8:43G-7.5(a), (b) and (c) in accordance with 8:43G-9.20(a)6 and (i);
2.
8:43G-7.15(d);
3.
8:43G-7.16(a)2 and 3i;
4.
8:43G-7.24(a)2 and 3i;
5.
8:43G-7.27(a)2 and 3i;
6.
8:43G-9.4(a)11;
7.
8:43G-9.5(c), (d) and (e);
8.
8:43G-9.5(c), (d) and (e);
9.
8:43G-9.7(a) and (b);
10.
8:43G-9.7(a) and (b);
11.
8:43G-9.7(a);
12.
8:43G-9.14;
13.
8:43G-9.20(a)6 and (c);
14.
8:43G-9.23;
15.
8:43G-11.4(a) and (b);
16.
8:43G-12.3(e), and (g)1 through 4;
17.
8:43G-12.5(e);
18.
8:43G-12.7(a);
19.
8:43G-12.16(c) and (d);
20.
8:43G-14.1(a);
21.
8:43G-16.6(a), (b) and (f);
22.
8:43G-19.1(b) and (f);
23.
8:43G-19.3(b)1 through 3 and (c);
24.
8:43G-19.3(d);
25.
8:43G-19.11(a);
26.
8:43G-19.13(a) and (c);
27.
8:43G-19.15(b);
28.
8:43G-19.16(c), (f) and (g);
29.
8:43G-19.17(c) and (f);
30.
8:43G-19.18(d) and (h);
31.
8:43G-19.24;
32.
8:43G-19.25;
33.
8:43G-20.1(a)1;
34.
8:43G-20.2(a);
35.
8:43G-21.5(a) and (b);
36.
8:43G-22.10(b);
37.
8:43G-22.15(f);
38.
8:43G-22.16(b);
39.
8:43G-26.3(c);
40.
8:43G-26.5(b); and
41.N.J.A.C. 8:43G-27(d)4.
