Federal
Nursing Services Requirements for all 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] |
