Nursing Services Requirements for the State of Indiana
410 IAC 16.2-3.1-17 Nursing services
Authority: IC 16-28-1-7; IC 16-28-1-12
Affected: IC 16-28-5-1
Sec. 17. (a) 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.
(b) The facility must provide services
by sufficient number of each of the following types of
personnel on a twenty-four (24) hour basis to provide
nursing care to all residents in accordance with resident
care plans:
(1) Except when waived under subsection
(f), the facility shall provide a licensed nurse
hour-to-resident ratio of five-tenths (.5) licensed nurse
hour per resident per day, averaged over a one (1) week
period. The hours worked by the director of nursing shall
not be counted in the staffing hours.
(2) Except when waived under subsection
(f), the facility must designate a licensed nurse to serve
as a charge nurse on each tour of duty.
(3) Except when waived under subsection
(f), the facility must use the services of a registered
nurse for at least eight (8) consecutive hours a day, seven
(7) days a week.
(4) Except as waived in subsection (f),
the facility must designate a registered nurse who has
completed a nursing management course with a clinical
component or who has at least one (1) year of nursing
supervision in the past five (5) years to serve as the
director of nursing on a full-time basis.
(c) The director of nursing will also
function in the following duties:
(1) Communication to the administrator
and, where appropriate, the physician, the status of the
residents, the occurrence of incidents, and accidents and
unresolved administrative problems of the nursing
department.
(2) Plan for and direct nursing care
services in accordance with the physicians' orders and to
meet the needs of the residents.
(3) Provide for the training of nursing
staff.
(4) Supervise nursing personnel to
assure that preventive and restorative nursing procedures
for each resident are initiated and performed so as to
attain and maintain the highest practicable physical,
mental, and psychosocial well-being in accordance with the
comprehensive assessment and care plan.
(5) Assure that the clinical records
are maintained in accordance with the facility policies and
procedures and in compliance with this rule.
(d) The director of nursing shall have,
in writing, and shall exercise administrative authority,
responsibility, and accountability for nursing services
within the facility and shall serve only one (1) facility at
a time in this capacity, and confer with the administrator
on the evaluation of prospective residents to assure that
only those residents whose physical, mental, and
psychosocial needs can be met by the facility or through
community resources are admitted to and retained by the
facility.
(e) The director of nursing may serve
as a charge nurse only when the facility has an average
daily occupancy of sixty (60) or fewer residents. These
hours worked may be counted toward staffing requirements.
(f) A facility may request a waiver
from either the requirement that a nursing facility provide
a registered nurse for at least eight
(8) consecutive hours a day, seven (7)
days a week, or provide a registered nurse as the director
of nursing, as specified in subsection (b), if the following
conditions are met:
(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 registered nursing services are not
available, a registered nurse or physician is obligated to
respond immediately to telephone calls from the facility.
(4) A waiver granted under the
conditions listed in this subsection is subject to annual
state review.
(5) Effective October 1, 1990, 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 and the protection and advocacy system
in the state for the mentally ill and mentally retarded.
(7) The nursing facility that is granted
such a waiver by the state notifies residents of the facility.
(g) For purposes of IC 16-28-5-1, a breach
of:
(1) subsection (a), (c), or (d) is a
deficiency; and
(2) subsection (b), (e), or (f) is a
noncompliance.
(Indiana State Department of Health; 410
IAC 16.2-3.1-17; filed Jan 10, 1997, 4:00 p.m.: 20 IR 1541, eff
Apr 1, 1997; errata filed Apr 10, 1997, 12:15 p.m.: 20 IR 2414;
readopted filed Jul 11, 2001, 2:23 p.m.: 24 IR 4234) |
