Director of Nurses Requirements for the State of Rhode Island

PART III RESIDENT CARE SERVICES Section 19.0 Resident Care Policies

19.1 Each facility shall have written resident care policies to govern the continuing nursing care and related medical or other services provided.

19.2  Resident care policies and procedures shall be developed and reviewed annually, and revised as necessary, in all facilities by a group of professional personnel including one or more physicians, a registered nurse, and other professional personnel as deemed necessary (e.g., social workers, physical therapists,
etc.). Documentation of this annual review shall be made available to the licensing agency upon request.

19.3  Resident care policies shall be available for review by all residents, physicians, community agencies, relatives and personnel and shall include provisions for at least the following:

a) meeting the total medical and psychosocial needs of residents;

b) the establishment of written plans of care for each resident for medical, nursing and other related services provided;

c) the range of services available and provided to residents and constraints imposed by limitations of services, physicians, facilities, staff coverage, payment mechanism or other;

d) the frequency of physician visits shall be at a minimum of 90 days;

e) the protection of residents' personal and property rights;

f) types of clinical conditions acceptable for admission to specific levels of care and appropriate services;

g) emergency admissions or discharges and emergency care of residents;

h) requirements for informed consent by resident, parent, guardian or legal representative for treatment;

i) notification of next of kin, attending physician or responsible agency of any transfer or discharge;

j) notification of next of kin, attending physician or responsible agency of any change of condition;

k) transfer of medical information in accordance with reference 17;

l) discharge and termination of services; and

m) provision for continuity of resident care as related to discharge planning, which shall include a mechanism for recording, transmitting and receiving information essential to the continuity of resident care.

Such information shall contain no less than the following:

i. resident identification data; such as name, address, age, gender, name of next of kin, health insurance coverage, etc.;

ii.  diagnosis and prognosis, medical status of resident, brief description of current illness, medical and nursing plans of care including such information as medications, treatments, dietary needs, baseline laboratory data;

iii. functional status;

iv. special services such as physical therapy, occupational therapy, speech therapy and such other;

v. psychosocial needs;

vi. bed-hold policy and readmission in accordance with section 18.18.1 c) herein; and

vii. such other information pertinent to ensure continuity of resident care.

19.4 There shall be documented evidence of the designation of responsibility to a physician, or to a nurse or to the medical staff for the execution and implementation of resident care policies.

a) When a nurse is designated as the responsible agent for a day-to-day execution of resident care policies, a physician shall be available to provide necessary medical guidance.

Section 22.0 Nursing Service

22.1 Each facility shall have a formally organized nursing service with an organization chart reflecting the lines of communication.  The authority, responsibilities and duties for each nursing service position and/or category shall be clearly delineated in writing through job descriptions.

22.2 The nursing service shall be under the direction of a Director of Nurses who shall be a registered nurse employed full-time.  A relief registered nurse shall be employed to insure full-time coverage in the absence (including vacation, sick time, days off, or other) of the designated registered nurse.

a) The Director of Nurses employed full-time in accordance with section 22.2 above shall not be the administrator nor the assistant administrator and shall:

(1) have at least two years experience in nursing supervision or, by training and experience, shall have demonstrated competency in nursing service management;

(2) be employed by only one facility in said capacity; and

(3) be responsible for the total nursing service which shall include no less than:

i. development, maintenance and evaluation of standards of nursing practice; 

ii. development and periodic revision of nursing policies and procedure manuals;

iii. recommendation to the facility's administration of the number and categories of nursing personnel required to provide resident care;

iv. training, assignment, supervision and evaluation of personnel;  

v. coordination of nursing care services with other services, e.g., medical,
nutrition, etc.; and

vi. all other functions and activities related to nursing service management.

22.4     The Director of Nurses may act as a charge nurse only  when the facility is licensed for 30 beds or less.