Nursing Services Requirements for the State of Idaho
200. NURSING SERVICES.
01. Director of Nursing Services. A
registered nurse currently licensed by the state of Idaho
and qualified by training and experience shall be designated
Director of Nursing Services in each SNF and ICF and shall
be responsible and accountable for: (1-1-88)
a. Participating with the administrator
in planning and budgeting for nursing care; (1-1-88)
b. Participating in the development and
implementation of patient/resident care policies; (1-1-88)
c. Developing and/or maintaining goals
and objectives of nursing service, standards of nursing
practice, and nursing policy and procedures manuals;
(1-1-88)
d. Assisting in the screening and
selection of prospective patients/residents in terms of
their needs, and the services available in the facility;
(1-1-88)
e. Observing and evaluating the
condition of each patient/resident and developing a written,
individualized patient care plan which shall be based upon
an assessment of the needs of each patient/resident, and
which shall be kept current through review and revision;
(1-1-88)
f. Recommending to the administrator
the numbers and categories of nursing and auxiliary
personnel to be employed and participating in their
recruitment, selection, training, supervision, evaluation,
counseling, discipline, and termination when necessary.
Developing written job descriptions for all nursing and
auxiliary personnel; (1-1-88)
g. Planning and coordinating
orientation programs for new nursing and auxiliary
personnel, as well as a formal, coordinated in-service
education program for all nursing personnel; (1-1-88)
h. Making daily rounds of nursing
units, assessing each patient/resident, reviewing clinical
records, patient/resident care plans, medications, staff
assignments and, whenever possible, accompanying physicians
when they visit the facility; (1-1-88)
i. Preparing daily work schedule for
nursing and auxiliary personnel which includes names of
employees, professional designation, hours worked, and daily
patient census; (1-1-88)
j. Coordinating the nursing service
with related patient/resident care services; (1-1-88)
k. Establishing procedures for general
nursing care for the cleanliness, comfort, and welfare of
the patients/residents; (1-1-88)
l. Instructing all personnel in the
proper isolation techniques to prevent infection to
themselves and the patients/residents; (1-1-88)
m. Delegation of any or all of the
Director of Nursing Services duties as appropriate.
(1-1-88)
02. Minimum Staffing Requirements.
(7-1-93)
a. A Director of Nursing Services (D.N.S.)
shall work full time on the day shift but the shift may be
varied for management purposes. If the Director of Nursing
Services is temporarily responsible for administration of
the facility, there shall be a registered nurse (RN)
assistant to direct patient care. The Director of Nursing
Services is required for all facilities five (5) days per
week. (1-1-88)
i. The D.N.S. in facilities with an
average occupancy rate of sixty (60) patients/residents or
more shall have strictly nursing administrative duties.
(1-1-88)
ii. The D.N.S. in facilities with an
average occupancy rate of fifty-nine (59) patients/residents
or less may, in addition to administrative responsibilities,
serve as the supervising nurse. (1-1-88)
b. A supervising nurse, or registered
professional nurse currently licensed by the state of Idaho,
or a licensed practical nurse currently licensed by the
state of Idaho, and who meets the requirements designated by
the Idaho Board of Nursing to assume responsibilities as a
charge nurse and meets the definition in Subsection 002.35.
(12-31-91)
c. A charge nurse, a registered
professional nurse currently licensed by the state of Idaho
or a licensed practical nurse currently licensed by the
state of Idaho and who meets the requirements designated by
the Idaho Board of Nursing to assume responsibilities as a
charge nurse in accordance with the definition in Subsection
002.07. A charge nurse shall be on duty as follows:
(12-31-91)
i. In SNFs with an average occupancy
rate of fifty-nine (59) patients/residents or less a
registered professional nurse shall be on duty eight (8)
hours of each day and no less than a licensed practical
nurse shall be on duty for each of the other two (2) shifts.
(1-1-88)
ii. In SNFs with an average occupancy
rate of sixty (60) to eighty-nine (89) patients/residents a
registered professional nurse shall be on duty for each a.m.
shift (approximately 7:00 a.m. - 3:00 p.m.) and p.m. shift
(approximately 3:00 p.m. to 11:00 p.m.) and no less than a
licensed practical nurse on the night shift. (1-1-88)
iii. In SNFs with an average occupancy
rate of ninety (90) or more patients/residents a registered
professional nurse shall be on duty at all times. (1-1-88)
iv. In facilities licensed exclusively
as an ICF and accepting only intermediate care
patients/residents a registered professional nurse or a
licensed practical nurse shall be on duty at all times as
charge nurse. (1-1-88)
v. In those facilities authorized to
utilize a licensed practical nurse as charge nurse, the
facility must make documented arrangements for a registered
professional nurse to be on call for these shifts to provide
professional nursing support. (1-1-88)
vi. Facilities licensed for both
skilled and intermediate care shall meet the charge nurse
requirements for a SNF. (1-1-88)
d. Nursing hours per patient/resident
per day shall be provided to meet the total needs of the
patients/ residents. The minimum staffing shall be as
follows: (1-1-88)
i. Skilled Nursing Facilities with a
census of fifty-nine (59) or less patients/residents shall
provide two and four-tenths (2.4) hours per patient/resident
per day. Hours shall not include the Director of Nursing
Services but the supervising nurse on each shift may be
counted in the calculations of the two and four-tenths (2.4)
hours per patient/resident per day. (11-20-89)
ii. Skilled Nursing Facilities with a
census of sixty (60) or more patients/residents shall provide
two and four-tenths (2.4) hours per patient/resident per day.
Hours shall not include the Director of Nursing Services or
supervising nurse. (11-20-89)
iii. ICFs that admit only intermediate care
patients/residents shall provide one and eight-tenths (1.8)
hours per patient/resident per day. Hours may include the
Director of Nursing Services, supervising nurse and charge
nurses. (11-20-89)
iv. Nursing hours per patient/resident per
day are required seven (7) days a week with provision for relief
personnel. (11-20-89)
v. Skilled and Intermediate Nursing
Facilities shall be considered in compliance with the minimum
staffing ratios if, on Monday of each week, the total hours
worked by nursing personnel for the previous seven (7) days
equal or exceed the minimum, staffing ratio for the same period
when averaged on a daily basis and the facility has received
prior approval from the Licensing Agency to calculate nursing
hours in this manner.
(11-20-89)
e. Combined Hospital and Skilled Nursing
Facility. In a combined facility the DNS may serve both the
hospital and long term care unit with supervising and charge
nurses as required under Subsection 200.02.b. and 200.02.c. In a
combined facility of less than forty-one (41) beds, the
supervising or charge nurse may be an LPN. Combined beds
(forty-one (41) or less) shall represent the total number of
acute care (hospital) and long term care (nursing home) beds.
(12-31-91)
f. Waiver of Registered Nurse as
Supervising or Charge Nurse. In the event that a facility is
unable to hire registered nursing personnel to meet these
regulation requirements, a licensed practical nurse will satisfy
the requirements so long as: (1-1-88)
i. The facility continues to seek a
registered nurse at a compensation level at least equal to that
prevailing in the community; (1-1-88)
ii. A documented record of efforts to
secure employment of registered nursing personnel is maintained
in the facility; (1-1-88)
iii. The facility shall maintain at least
forty (40) hours a week R.N. coverage. (1-1-88)
g. There shall be at least two (2) nursing
personnel on duty on each shift to ensure patient safety in the
event of accidents, fires, or other disasters. (1-1-88)
h. Nursing care shall be given only by
licensed staff, nursing personnel and auxiliary nursing
personnel. (1-1-88) |
