New York Codes, Rules and Regulations
Title 10 - DEPARTMENT OF HEALTH
Chapter V - Medical Facilities
Subchapter A - Medical Facilities-minimum Standards
Article 2 - Hospitals
Part 405 - Hospitals-Minimum Standards
Section 405.5 - Nursing services
Universal Citation: 10 NY Comp Codes Rules and Regs ยง 405.5
Current through Register Vol. 46, No. 39, September 25, 2024
The governing body shall ensure that the hospital has an organized nursing service that provides 24-hour services and that meets the care needs of all patients in accordance with established standards of nursing practice. The nursing services for all patients shall be provided or supervised by a registered professional nurse who is on duty and available at all times.
(a) Organization and staffing.
(1) The hospital shall have
a written nursing service plan of administrative authority and delineation of
responsibilities. The director of the nursing service shall be a licensed
registered professional nurse who is qualified by training and experience for
such position. The director of the nursing service shall be responsible for the
operation of the service, including developing such nursing service plan to be
approved by the hospital for determining the types and numbers of nursing
personnel and staff necessary to provide nursing care for all areas of the
hospital in accordance with the hospital's clinical staffing plan as provided
in paragraph (8) of this subdivision.
(2) The hospital shall employ licensed and
currently registered professional nurses, licensed practical nurses, and other
personnel to provide nursing care to all patients as needed. The hospital shall
provide supervisory and staff personnel for each department or nursing unit to
ensure, when needed in accordance with generally accepted standards of nursing
practice, the immediate availability of a registered professional nurse for
bedside care of any patient.
(3)
Job descriptions for each position classification of registered professional
nurses and ancillary nursing personnel shall specify standards of performance
and delineate the functions, responsibilities, and specific qualifications of
each classification.
(4) A written
evaluation of the performance, credentials, and competence of registered
professional nurses and ancillary nursing personnel shall be conducted on at
least a biennial basis.
(5) When
nursing services are provided by nursing students, nurses with limited permits,
or by personnel from outside sources, the hospital shall retain full
responsibility for the quality of nursing care rendered in the hospital.
(i) Nursing students, nurses with limited
permits, and registered professional nurses from outside sources who are
working in the hospital shall adhere to the policies and procedures of the
hospital.
(ii) The director of
nursing services shall provide for the supervision and evaluation of the
clinical activities of all nursing personnel.
(6) All nursing services personnel, including
nursing students and nonemployee licensed nurses who are working in the
hospital, shall receive a basic orientation to prepare them for their specific
duties and responsibilities prior to performing any nursing functions within a
patient care area. For employee nurses and nursing students, the hospital shall
provide or arrange for the provision of training programs to augment their
knowledge of pertinent new developments in patient care. The hospital shall
also require that nonemployee licensed nurses obtain education and training
pertinent to the clinical duties to which they are assigned.
(7) Nursing services personnel employed in
specialty areas, including, but not limited to, emergency services, must
complete training and education specific to the specialty area. Nursing
services personnel must be periodically reevaluated for competency and ongoing
education and training provided to maintain competency in the specialty
area.
(8) Hospitals must establish
and maintain a clinical staffing committee as provided in section 2805 t of the
Public Health Law. The clinical staffing committee shall develop and oversee
the implementation of an annual clinical staffing plan. The clinical staffing
plan shall delineate intensive care and critical care units of the hospital.
The clinical staffing plan shall include specific staffing for each patient
care unit and work shift and shall be based on the needs of patients. Staffing
plans shall include specific guidelines or ratios, matrices, or grids
indicating how many patients are assigned to each registered nurse and the
number of nurses and ancillary nursing personnel to be present on each unit and
shift. Ancillary nursing personnel includes, but is not limited to, certified
nurse assistants, patient care technicians, and other non-licensed members of
the frontline team assisting with nursing tasks. Each hospital shall adopt and
submit its first clinical staffing plan under this paragraph no later than July
1, 2022, and annually thereafter. Beginning January 1, 2023, and annually
thereafter, each hospital shall implement the clinical staffing plan adopted by
July 1 of the prior calendar year, and any subsequent amendments, and assign
personnel to each patient care unit in accordance with the plan. Factors to be
considered and incorporated in the development of the clinical staffing plan
shall include, but are not limited to:
(i)
census, including total numbers of patients on the unit on each shift and
activity such as patient discharges, admissions, and transfers;
(ii) measures of acuity and intensity of all
patients and nature of the care to be delivered on each unit and
shift;
(iii) skill mix;
(iv) the availability, level of experience,
and specialty certification or training of nursing personnel providing patient
care, including charge nurses, on each unit and shift;
(v) the need for specialized or intensive
equipment;
(vi) the architecture
and geography of the patient care unit, including but not limited to placement
of patient rooms, treatment areas, nursing stations, medication preparation
areas, and equipment;
(vii)
mechanisms and procedures to provide for one-to-one patient observation, when
needed, for patients on psychiatric or other units as appropriate;
(viii) other special characteristics of the
unit or community patient population, including age, cultural and linguistic
diversity and needs, functional ability, communication skills, and other
relevant social or socio-economic factors;
(ix) measures to increase worker and patient
safety, which could include measures to improve patient throughput;
(x) staffing guidelines adopted or published
by other states or local jurisdictions, national nursing professional
associations, specialty nursing organizations, and other health professional
organizations;
(xi) availability of
other personnel supporting nursing services on the unit;
(xii) waiver of plan requirements in the case
of unforeseeable emergency circumstances as defined in subdivision fourteen of
section 2805 t of the Public Health Law;
(xiii) coverage to enable registered nurses,
licensed practical nurses, and ancillary staff to take meal and rest breaks,
planned time off, and unplanned absences that are reasonably foreseeable as
required by law or the terms of an applicable collective bargaining agreement,
if any, between the general hospital and a representative of the nursing or
ancillary staff;
(xiv) the nursing
quality indicators required under section
400.25 of this Title;
(xv) general hospital finances and resources;
and
(xvi) provisions for limited
short-term adjustments made by appropriate general hospital personnel
overseeing patient care operations to the staffing levels required by the plan,
necessary to account for unexpected changes in circumstances that are to be of
limited duration.
(b) Delivery of services.
(1) There shall be working relationships
among medical staff, nursing staff and staff of other departments or services
to assure that all patient care needs are met.
(i) Nursing services personnel shall execute
the orders of physicians and other practitioners, authorized by the governing
body to order such services.
(ii)
Registered professional nurses shall confer with the responsible practitioner
relative to patient care on an ongoing basis and relative to significant
changes in the patient's condition as necessary.
(iii) The hospital shall develop and
implement policies and procedures for prompt review and correction, as
necessary, of health care practitioner orders which have, or have the likely
potential for having, negative impact on patient care and safety and which
should not be carried out.
(2) There shall be continuous review and
evaluation of the adequacy and appropriateness of nursing care provided for
patients.
(i) Nursing care policies and
procedures shall be written and consistent with generally accepted standards of
nursing practice.
(ii) A registered
professional nurse shall plan, supervise, and evaluate the nursing care for
each patient. A registered professional nurse shall assign the nursing care of
each patient to other nursing personnel in accordance with the patient's needs
and the preparation and competence of such other nursing
personnel.
(3) Written
nursing care plans shall be kept current. Such plans shall indicate what
nursing care is needed, how it is to be provided, and the methods, approaches
and mechanisms for ongoing modifications necessary to ensure the most effective
and beneficial results for the patient. Patient education and patient/family
knowledge of care requirements shall be included in the nursing plan. The
nursing care plan may be integrated into the overall interdisciplinary plan of
care.
(4) Nursing documentation
shall describe the nursing care given and include information and observations
of significance so that they contribute to the continuity of patient care.
Nursing interventions and patient responses shall be
documented.
(c) Administration of drugs.
All drugs and biologicals shall be administered in accordance with the orders of the practitioner or practitioners responsible for the patient's care as specified under section 405.2 of this Part, and generally accepted standards of practice. They shall be administered by a licensed physician or a registered professional nurse, or other personnel in accordance with applicable licensing requirements of title 8 of the New York State Education Law, except for the self-administration of medications as set forth in paragraphs (4) and (5) of this subdivision, and in accordance with hospital policies and procedures. For purposes of this subdivision, self-administration means administration by the patient or the patient's caregiver, including but not limited to a caregiver pursuant to section 2994-ii (3) of the Public Health Law, or a designated caregiver pursuant to section 3360 (5) of the Public Health Law.
(1) All orders for drugs and biologicals
shall be authenticated by the practitioner or practitioners responsible for the
care of the patient as specified under section
405.2 of this Part.
(2) Blood transfusions and intravenous
medications shall be administered in accordance with approved medical staff and
nursing service policies and procedures. If blood transfusions and intravenous
medications are administered by personnel other than physicians, such personnel
shall have completed specific training to prepare them for this duty.
(3) There shall be a hospital procedure and
nursing policies and procedures for the reporting and review of transfusion
reactions, adverse drug reactions, and errors in administration of
drugs.
(4) Hospitals, in accordance
with hospital policies and procedures, may authorize hospital-issued
prescription and non-prescription medications to be self-administered, provided
that:
(i) a practitioner responsible for the
care of the patient in the hospital has issued an order permitting
self-administration;
(ii) the
capacity of the patient or the patient's caregiver to administer the medication
has been assessed;
(iii) the
patient or the patient's caregiver has been given instructions for the safe and
accurate administration of the medication;
(iv) the security of the medication is
addressed; and
(v) documentation is
made of the administration of each medication in the patient's record, as
reported by the patient or the patient's caregiver.
(5) Hospitals, in accordance with hospital
policies and procedures, may authorize a patient to bring in his or her own
medications, including prescription medications, non-prescription medications
and medical marihuana as defined in section
3360
(8) of the Public Health Law, and
self-administer such medications, provided that:
(i) a practitioner responsible for the care
of the patient in the hospital has issued an order permitting
self-administration of the medication the patient brought into the hospital,
and in the case of medical marihuana, upon presentation of the patient or
designated caregiver's registry identification card issued pursuant to section
3363 of the
Public Health Law;
(ii) the
capacity of the patient or the patient's caregiver to administer the medication
has been assessed;
(iii) a
determination is made concerning whether the patient or the patient's caregiver
needs instruction on the safe and accurate administration of the
medication;
(iv) the medication is
identified and visually evaluated for integrity;
(v) the security of the medication is
addressed;
(vi) documentation is
made of the administration of each medication in the patient's record, as
reported by the patient or the patient's caregiver; and
(vii) if a patient dies in the hospital, any
unused prescription medication shall be destroyed or disposed of in accordance
with all applicable State and Federal laws and regulations. Such prescription
medications may not be turned over to the patient's caregiver. In the case of
medical marihuana, it may be turned over to the deceased patient's designated
caregiver or to appropriate law enforcement for destruction or
disposal.
(d) Nasogastric tube feedings.
Following consideration of possible alternatives for short-term nutritional therapy, nasogastric tubes and feeding formulations may be used for feeding purposes when determined clinically appropriate by the attending practitioner. Nasogastric tube feedings shall be used to promote a therapeutic program to maintain adequate nutrition and hydration and include a plan to help the patient develop or regain eating skills.
(1) Nasogastric tube feeding formulations
shall be given in accordance with the manufacturer's instructions or at a rate
appropriate to the physical size of the resident and the amount of fluid and
nutrients necessary to meet the assessed caloric and fluid needs of the
patient.
(2) To minimize patient
discomfort, nasogastric tubes used for patient feeding purposes shall:
(i) be the smallest gauge appropriate for the
patient and shall not exceed 3.96 millimeters (#12 French) in outside diameter
unless medically indicated;
(ii) be
made of a soft, flexible material such as medical grade polyurethane or
silicone; and
(iii) be specifically
manufactured for nasogastric feeding purposes.
(3) Patients receiving nasogastric tube
feedings shall be periodically evaluated for the ability to return to normal
feeding function. If nasogastric feedings are to be continued longer than three
months, permanent enteral feeding procedures such as surgical gastrostomy or
jejunostomy shall be considered. If the nasogastric feeding is continued, the
reasons for continuation shall be documented in the patient's medical
record.
(4) The facility shall
develop and implement policies and procedures for inpatient nasogastric tube
feedings which are written in accordance with prevailing standards of
professional practice and in consultation with the medical, nursing, dietary
and pharmacy services of the facility. Medical practitioners shall be informed
of such policies and procedures governing the use of nasogastric tubes for
patient feeding. The policies and procedures shall address as a minimum:
(i) types and sizes of nasogastric tubes and
the various types of feeding formulations available at the facility;
(ii) the need to assess each patient's
clinical and nutritional status to determine the size of the nasogastric tube
and type of feeding appropriate for that individual;
(iii) standard techniques for inserting a
nasogastric tube and confirming the correct placement of the tube;
(iv) procedures for administering nasogastric
feedings including positioning the patient and the need for patient observation
and monitoring before, during and following the feeding; and
(v) infection control practices related to
tube feedings.
(e) Quality assurance.
The nursing service shall monitor and evaluate the quality and appropriateness of patient care and the resolution of identified problems. This process shall be integrated with the quality assurance committee in accordance with hospital policies and procedures.
(1) Nursing service personnel shall meet as
often as necessary to identify and resolve problems and potential problems in
the provision of nursing care, taking into consideration the findings from
relevant nursing care monitoring and evaluation activities.
(2) Documentation of such reviews shall
include findings, conclusions, recommendations and actions taken in conjunction
with the hospital-wide quality assurance program and shall be maintained for
review and analysis.
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