Director of Nurses Requirements for all the states
§ 483.30 Nursing Services.
The facility
must 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.
(1) The
facility must provide services by
sufficient numbers of each of the
following types of personnel on a 24
hour basis to provide nursing care
to all residents in accordance with
resident care plans:
(i) Except when
waived under paragraph (c) of this
section, licensed nurses; and
(ii) Other
nursing personnel.
(2) Except when
waived under paragraph (c) of this
section, the facility must designate
a licensed nurse to serve as a
charge nurse on each tour of duty.
(b) Registered
nurses.
(1) Except when
waived under paragraph (c) or (d) of
this section, the facility must use
the services of a registered nurse
for at least 8 consecutive hours a
day, 7 days a week.
(2) Except when
waived under paragraph (c) or (d) of
this section, the facility must
designate a registered nurse to
serve as the director of nursing on
a full-time basis.
(3) The
director of nursing may serve as a
charge nurse only when the facility
has an average daily occupancy of 60
or fewer residents.
(c) Nursing
Facilities Waiver of requirement to
provide licensed nurses on a 24-hour
basis.
To the extent
that a facility is unable to meet
the requirements of paragraphs
(a)(2) and (b)(1) of this section.
A State may waive such requirements
with respect to the facility if—
(1) The facility demonstrates to the
satisfaction of the State that the facility has been unable,
despite diligent efforts (including offering wages at the
community prevailing rate for nursing facilities), to recruit
appropriate personnel;
(2) The State determines that a waiver of
the requirement will not endanger the health or safety of
individuals staying in the facility;
(3) The State finds that, for any periods
in which licensed nursing services are not available, a
registered nurse or a physician is obligated to respond
immediately to telephone calls from the facility;
(4) A waiver granted under the conditions
listed in paragraph (c) of this section is subject to annual
State review;
(5) In granting or renewing a waiver, a
facility may be required by the State to use other qualified,
licensed personnel;
(6) The State agency granting a waiver of
such requirements provides notice of the waiver to the State
long term care ombudsman (established under section 307(a)(12)
of the Older American s Act of 1965) and the protection and
advocacy system in the State for the mentally ill and mentally
retarded; and
(7) The nursing facility that is granted
such a waiver by a State notifies residents of the facility (if,
where appropriate, the guardians or legal representatives of
such residents) and members of their immediate families of the
waiver.
(b) SNFs Waiver of the requirement to
provide services of a registered nurse for more that 40 hours a
week.
(1) The Secretary may waive the
requirements that a SNF provide the services of a registered
nurse for more than 40 hours a week, including a director of
nursing specified in paragraph (b) of this section, if the
Secretary finds that—
(i) The facility is located in a rural area
and the supply of skilled nursing facility services in the area
is not sufficient to meet the needs of individuals residing in
the area.
(ii) The facility has one full-time
registered nurse who is regularly on duty at the facility 40
hours a week; and
(iii) The facility either
(A) Has only patients whose physicians have
indicated (through physicians’ orders or admission notes) that
they do not require the services of a registered nurse or a
physician for a 48 hours period, or
(B) Has made arrangements for a registered
nurse or physician to spend time at the facility, as determined
necessary by the physician, to provide necessary skilled nursing
services on days when the regular full-time registered nurse is
not on duty;
(iv) The Secretary provides notice of the
waiver the State long term care ombudsman (established under
section 307(a)(12) of the Older American s Act of 1965) and the
protection and advocacy system in the State for the mentally ill
and mentally retarded; and
(v) The nursing facility that is granted
such a waiver by a State notifies residents of the facility (if,
where appropriate, the guardians or legal representatives of
such residents) and members of their immediate families of the
waiver.
(2) A waiver of the registered nurse
requirement under paragraph (d)(1) of this section is subject to
annual renewal by the Secretary.
[56 FR
48873, Sept. 26, 1991, as amended at 57 FR 43925, Sept. 23,
1992] |
