Director of Nurses Requirements for the State of Maryland
10.07.02.12
.12 Nursing
Services.
B. Director of Nursing. The facility shall
provide for an organized nursing service, under the direction of
a full-time registered nurse except that a licensed practical
nurse serving as director of nursing as of the effective date of
these regulations may continue to serve as director of nursing
in the comprehensive care facility in which employed. Upon
departure of the licensed practical nurse, the successor shall
be a registered nurse. If the director of nursing is a licensed
practical nurse, there shall be sufficient hours of consultation
with the licensed practical nurse from a registered nurse to
assess and plan the patient care, to evaluate the outcomes of
the services provided, and to initiate reassessment and
replanning.
C. Signed Agreement.
(1) A signed
copy of the agreement between the
administrator and the director of
nursing, showing the license number,
shall be filed with the Department
upon:
(a) Application
for an initial license; and
(b) A change of
director of nursing.
(2) The
agreement shall specify the duties
of the director of nursing.
D. Termination
of Services of Director of Nursing.
If the director of nursing
terminates his services, the
administrator immediately shall
notify the Department of the
termination. The name of the
replacement and registration number
shall be supplied to the Department
as soon as the employment is
effected. A copy of the agreement
between the administrator and the
replacement shall be sent to the
Department.
E. Director of Nursing's Vacancy Exceeding
30 Days. If the position of director of nursing remains vacant
for a period of 30 days, the license may be revoked unless the
administrator and the governing body are able to demonstrate
that they have made every effort to obtain a replacement.
F. Relief for Director of Nursing. When the
director of nursing is absent, he shall designate an
experienced, qualified registered nurse to direct the nursing
service. In facilities in which the director of nursing serves
as relief for the administrator, the director of nursing shall
designate a specific registered nurse who shall be in charge of
the nursing service. See Regulation .07C, above.
G. Responsibilities of the Director of
Nursing. The responsibilities of the director of nursing shall
include:
(1) Assisting in the development and
updating of statements of nursing philosophy and objectives,
defining the type of nursing care the facility shall provide;
(2) Preparation of written job descriptions
for nursing personnel;
(3) Planning for the total nursing needs of
patients to be met and recommending the assignment of a
sufficient number of supervisory and supportive personnel for
each tour of duty;
(4) Development and maintenance of nursing
service policies and procedures to implement the program of
care;
(5) Participation in the coordination of
patient services through appropriate staff committee meetings
(pharmacy, infection control, patient care policies, and
utilization review) and departmental meetings;
(6) Cooperation with administration in
planning the orientation program and the staff development
program to upgrade the competency of the personnel;
(7) Ensurance that the philosophy and
objectives are understood and practiced by nursing personnel;
(8) Participation in planning and budgeting
for nursing services;
(9) Establishment of a procedure to ensure
that nursing personnel, including private duty nurses, have
valid and current Maryland licenses;
(10) Execution of patient care policies
(unless delegated to principal physician, medical director);
(11) Participation in the selection of
prospective admissions to ensure that facility's staff is
capable of meeting the needs of all patients admitted;
(12) Coordination of the interdisciplinary
patient care management efforts;
(13) Supervision of medicine aides to
ensure that there is no deviation from the limitations and
restrictions placed upon them.
H. Delegation of Responsibilities. If any
of the above responsibilities are delegated to others, there
shall be a clear delegation of authority.
I. Supervisory Personnel--Comprehensive
Care Facilities.
(1) Comprehensive care facilities shall
provide at least the following supervisory personnel:
|
Patients |
Registered Nurses
|
|
(a) 2—99 |
One—full-time |
|
(b) 100—199 |
Two—full-time |
|
(c) 200—299 |
Three—full-time
|
|
(d) 300—399 |
Four—full-time |
(2) The director of nursing is included in
the above requirements.
J. Hours of Bedside Care--Comprehensive
Care Facility. Comprehensive care facilities shall employ
supervisory personnel and a sufficient number of supportive
personnel, trained and experienced, or both, to provide a
minimum of 2 hours of bedside care per licensed bed per day, 7
days per week. Bedside hours include the care provided by
registered nurses, licensed practical nurses, and supportive
personnel except that ward clerks' time shall be computed at 50
percent of the time provided in the nursing unit. Only those
hours which the director of nursing spends in bedside care may
be counted in the 2-hour minimal requirement. The director of
nursing's time counted in bedside care shall be documented.
M. Staffing in Distinct Part Extended Care
Facility. In multi-level facilities the director of nursing
shall be in charge of the entire facility. A registered nurse at
all times shall be in charge of a distinct part extended care
facility. Additional registered nurses, licensed practical
nurses, and supportive personnel shall be employed to meet the
needs of all the patients admitted. The distinct part shall be
staffed in accordance with guidelines established by the
Department.
P. Daily Rounds--Director of Nursing.
Although daily rounds are primarily the responsibility of the
charge nurse or nurses, the director or assistant director of
nursing should make clinical rounds to nursing units, randomly
reviewing clinical records, medication orders, patient care
plans, staff assignments, and visiting patients. If indicated,
the director or assistant director of nursing should accompany
physicians visiting patients.
Q. Charge Nurse. At least one licensed
nurse shall be on duty at all times and shall be designated by
the director of nursing to be in charge of the nursing
activities during each tour of duty. The charge nurse or nurses
shall have the ability to recognize significant changes in the
condition of patients and to take necessary action.
U. Inservice Educational Program. There
shall be a continuing inservice educational program in effect
for all nursing personnel in addition to a thorough job
orientation for new personnel. There shall be documentation of
content of programs and names and titles of participants. The
program which shall be the responsibility of the director of
nursing shall be approved by the Department.
V. Director of Nursing's Continuing
Education. The director of nursing shall assume responsibility
for maintaining his own professional competence through
participation in programs of continuing education.
W. Responsibility to Report Care Which is
Considered Questionable. If a nurse has any reason to doubt or
question the care provided to any patient or believes that
appropriate consultation is needed and has not been obtained,
the nurse shall call this to the attention of the supervisor
who, in turn, shall, if indicated, refer the matter to the
director of nursing services. If warranted, the director of
nursing shall bring the matter to the attention of the principal
physician or medical director, as applicable. |
