Current through Reg. 49, No. 38; September 20, 2024
(a) Nursing
services in treatment plan. A hospital shall provide nursing services to a
patient in accordance with a treatment plan developed in accordance with §
568.61 of this subchapter (relating to Inpatient Mental Health Treatment and
Treatment Planning).
(b)
Organization of nursing staff. The hospital shall have a written description of
the organizational hierarchy and responsibilities of the nursing staff.
(c) Director of psychiatric
nursing (DPN). A hospital shall have a DPN who:
(1) has administrative authority over the
nursing staff;
(2) directs,
monitors, and evaluates the nursing services provided;
(3) for a hospital licensed under Texas
Health and Safety Code Chapter 577 and Chapter 510 of this title (relating to
Private Psychiatric Hospitals and Crisis Stabilization Units), reports directly
to the administrator; and
(4) for
an identifiable mental health services unit in a hospital licensed under Texas
Health and Safety Code Chapter 241, and 25 TAC Chapter 133 (relating to
Hospital Licensing), reports directly to the chief nursing officer as described
in 25 TAC §
133.41(relating
to Hospital Functions and Services) or reports directly to a registered nurse
(RN) who reports directly to the chief nursing officer.
(d) Qualifications of DPN. The DPN shall be:
(1) an RN with a master's degree in
psychiatric-mental health from a nursing education program accredited by an
organization recognized by the U.S. Commission of Education and Council for
Higher Education Accreditation as an accreditation agency, such as the National
League for Nursing or the Commission on Collegiate Nursing Education;
(2) an RN with a bachelor's degree
in nursing and a master's degree in a health-related field from an accredited
college or university and have three years of experience as a full-time
employee or contractor (or its equivalent as a part-time employee or
contractor) as an RN in a hospital; or
(3) an RN with a bachelor's degree in nursing
and:
(A) have three years of experience as a
full-time employee or contractor (or its equivalent as a part-time employee or
contractor) as an RN in a hospital; and
(B) receive four hours per month of clinical
consultation from an RN with:
(i) a master's
degree in psychiatric-mental health from a nursing education program accredited
by an organization recognized by the U.S. Commission of Education and Council
for Higher Education Accreditation as an accreditation agency, such as the
National League for Nursing or the Commission on Collegiate Nursing Education;
or
(ii) a bachelor's degree in
nursing and a master's degree in a health-related field from an accredited
college or university.
(e) Assessment. An RN shall conduct and
complete an initial comprehensive nursing assessment of a patient within eight
hours of the patient's admission.
(f) Reassessment. An RN shall reassess a
patient, based on the patient's needs, but at least every 12 hours after the
initial comprehensive nursing assessment, required by subsection (e) of this
section, is conducted.
(g)
Staffing plan.
(1) The DPN shall develop and
implement a written staffing plan that:
(A)
describes the number of RNs, licensed vocational nurses (LVNs), and unlicensed
assistive personnel (UAPs) on each unit for each shift;
(B) provides for at least one RN to be
physically present and on-duty at all times on each unit when a patient is
present on the unit;
(C) if the
hospital has only one unit, in addition to the RN required by subparagraph (B)
of this paragraph, provides for at least two staff members who provide direct
patient care to be physically present and on-duty at all times on the unit when
a patient is present on the unit; and
(D) provides for an adequate number of
registered nurses on each unit to supervise all UAPs.
(2) The staffing plan described in paragraph
(1) of this subsection shall be based on the following factors:
(A) the number of patients;
(B) the characteristics of the patients,
including the intensity of the patient's emotional, mental, and medical needs;
(C) the anticipated admissions,
discharges and transfers;
(D) the
architecture of the unit, including geographic dispersion of patients,
arrangement of the unit and surveillance and communication technology;
(E) the expertise of the nursing
staff;
(F) the nursing staff's
familiarity with the patients;
(G)
nursing staff continuity and cohesion;
(H) the amount of time required by the
nursing staff to perform administrative activities; and
(I) recommendations of the advisory committee
regarding the adequacy of the staffing plan made in accordance with §
568.144(b)(3) of this chapter (relating to Advisory Committee for Nurse
Staffing).
(3) The DPN
shall document the DPN's determinations made about each factor described in
paragraph (2) of this subsection, at the time the staffing plan is developed
and when the staffing plan is revised based on a change in such factors.
(4) A hospital shall retain the
staffing plan and the documentation required by paragraph (3) of this
subsection, for two years after such documentation is created.
(5) The DPN shall revise the staffing plan,
as necessary.
(6) The DPN shall
report to the advisory committee established in accordance with § 568.144
of this chapter (relating to Advisory Committee for Nurse Staffing) any
variance between the number of staff members specified in the staffing plan and
the actual number of staff members on duty.
(h) Process for reporting concerns regarding
staffing plan.
(1) A hospital shall develop
and implement a process for RNs and LVNs to report concerns regarding the
adequacy of the staffing plan to the advisory committee established in
accordance with § 568.144 of this chapter.
(2) A hospital shall not retaliate against a
nurse for reporting a concern to the advisory committee.
(i) Orientation of nursing staff.
(1) A hospital shall provide orientation to a
nursing staff member when the staff member is initially assigned to a unit on
either a temporary or long-term basis. The orientation shall include a review
of:
(A) the location of equipment and
supplies on the unit;
(B) the
staff member's responsibilities on the unit;
(C) relevant information about patients on
the unit;
(D) relevant schedules
of staff members and patients; and
(E) procedures for contacting the staff
member's supervisor.
(2) A hospital shall document the provision
of orientation to nursing staff.
(j) Verification of licensure. A hospital
shall verify that a member of the nursing staff for whom a license is required
has a valid license at the time the staff member assumes responsibilities at
the hospital and maintains the license throughout the staff member's employment
or association with the hospital.
(k) Mandatory overtime. A hospital shall
develop and implement a policy regarding the use of mandatory overtime by the
nursing staff. The policy shall require:
(1)
documentation of the justification for the use of mandatory overtime;
(2) monitoring and evaluation of
the use of mandatory overtime; and
(3) development of a plan to reduce or
eliminate the use of mandatory overtime.
(l) The hospital shall establish a nursing
peer review committee to conduct nursing peer review, as required by Texas
Occupations Code Chapter 303.
