Nursing Services Requirements for the District of Columbia

3209 NURSING SERVICES SUPERVISION

3209.1 A Nursing Services Supervisor shall be on duty at all times.

3209.2 Each Nursing Services Supervisor shall:

(a) Be qualified by education or experience in geriatric, rehabilitation or psychiatric nursing or other appropriate nursing discipline, with appropriate documentation; and
(b) Be currently licensed as a registered nurse in the District of Columbia.

3209.3 The Director of Nursing may serve as the Nursing Services Supervisor while on his or her regular tour of duty, if the facility has a licensed bed capacity of thirty (30) or less.

3209.4 A charge nurse may serve as the Nursing Services Supervisor when he or she is a registered nurse.

3210 LICENSED NURSING COVERAGE

3210.1 Each facility shall employ a charge nurse on each unit twenty-four (24) hours a day.

3210.2 Each charge nurse shall be a licensed registered nurse or licensed practical nurse
in the District with experience in geriatric, rehabilitation, psychiatric, or other appropriate nursing discipline.

3210.3 When a licensed practical nurse serves as a charge nurse, he or she shall have ready access to consultation with a registered nurse.

3210.4 A charge nurse shall be responsible for the following:
(a) Making daily resident visits to assess physical and emotional status and implementing any required nursing intervention;
(b) Reviewing medication records for completeness, accuracy in the transcription of physician orders, and adherence to stop-order policies;
(c) Reviewing residents’ plans of care for appropriate goals and approaches, and revising them as needed;
(d) Delegating responsibility to the nursing staff for direct resident nursing
care of specific residents;
(e) Supervising and evaluating each nursing employee on the unit; and
(f) Keeping the Director of Nursing Services or his or her designee informed about the status of residents.

3211 NURSING PERSONNEL

3211.1 Sufficient nursing time shall be given to each resident to ensure that the resident receives the following:

(a) Treatments, medications, diet and nutritional supplements and fluids as prescribed, and rehabilitative nursing care as needed;
(b) Proper care to minimize pressure ulcers and contractures and to promote the healing of ulcers:
(c) Assistance in daily personal grooming so that the resident is comfortable, clean, and neat as evidenced by freedom from body odor, cleaned and trimmed nails, and clean, neat and well-groomed hair;
(d) Protection from accident, injury, and infection;
(e) Encouragement, assistance, and training in self-care and group activities;
(f) Encouragement and assistance to:
(1) Get out of bed and dress or be dressed in his or her own clothing, and shoes or slippers, which shall be clean and in good repair;
(2) Use the dining room if he or she is able; and
(3) Participate in meaningful social and recreational activities;
(g) Prompt, unhurried assistance if he or she requires or requests help with eating;
(h) Prescribed adaptive self-help devices to assist him or her in eating independently;
(i) Assistance, if needed, with daily hygiene, including oral care; and
(j) Prompt response to an activated call bell or call for help.

3211.2 Each facility shall have at least the following employees:
(a) At least one (1) registered nurse on a twenty-four (24) hour basis, seven (7) days a week;
(b) Twenty-four (24) hour licensed nursing staff sufficient to meet nursing needs of all residents;
(c) At least one practical or registered nurse, serving as charge nurse, on each unit at all times; and
(d) A minimum of two (2) nursing employees per nursing unit, per shift.

3211.3 To meet the requirements of subsection 3211.2, facilities of thirty (30) licensed occupied beds or more shall not include the Director of Nursing Services or any other nursing supervisory employee who is not providing direct resident care.

3211.4 Weekly time schedules shall be maintained and indicate the number and classifications of nursing personnel, including relief personnel who work on each unit for each tour of duty.

3211.5 Nursing personnel, licensed practical nurses, nurse aides, orderlies, and ward clerks shall be assigned duties consistent with their education and experience and based on the characteristics of the patient load.

3211.6 A facility shall not employ an individual as a nurse aide who has been employed as a nurse aide for six (6) of the immediately preceding twelve (12) months and who has not completed a training and competency evaluation program approved by the District.

3211.7 The facility shall provide regular performance review and regular in-service education to ensure that individuals employed as nurse aides are competent to perform services as nurse aides.

3211.8 The facility shall ensure that nurse aides are competent in those skills necessary to care for residents’ needs, as identified in residents’ individualized assessments and in the plans of care.

3212 TEMPORARY NURSING PERSONNEL

3212.1 Each facility may hire temporary nurses, including contract nurses, who shall be licensed in the District of Columbia.

3212.2 The facility shall have policies and procedures for orienting qualified temporary nursing personnel to the facility and to residents.

3212.3 Each temporary employee who serves as a charge nurse on a nursing unit shall be supervised by a licensed registered nurse who is a permanent employee.

3212.4 A written agreement shall be executed between the facility and any contract
agency employed to provide nursing personnel to the facility in compliance with the requirements of this chapter.

3213 RESTORATIVE NURSING CARE PROGRAM

3213.1 The facility shall have a restorative nursing care program to assist in maintaining the highest practicable level of physical, mental and psychosocial well-being of each resident.

3213.2 Each nursing employee shall provide restorative nursing in his or her daily care of residents, which shall include the following: