Nursing Services Requirements for the State of Montana
37.106.134 CERTIFICATE OF NEED APPLICATION:
REQUIRED INFORMATION The following must be included in a
certificate of need application:
(5) A discussion of the program staffing
and operational capabilities of the project, including the
following information:
(a) an itemized list of
full-time-equivalent staff positions (current and after
completion of project), and estimated number of personnel
available, including:
(i) administration;
(ii) physician services;
(iii) nursing services;
(iv) social services;
(v) other professional/technical;
(vi) all other (specify);
37.106.1120 MEDICAL ASSISTANCE FACILITIES:
NURSING SERVICES
(1) A medical assistance facility must have a
nursing service that provides 24-hour nursing services whenever
a patient is in the facility and that meets the following
standards:
(a) The director of nursing services must
be a licensed registered nurse and must:
(i) Determine the types and numbers of
nursing personnel and staff necessary to provide nursing care;
and
(ii) Schedule adequate numbers of licensed
registered nurses, licensed practical nurses, and other
personnel to provide nursing care as needed.
(b) A registered nurse must be on duty at
least eight hours per day, and the director of nursing or
another registered nurse designated as the director's alternate
must be on call and available within 20 minutes at all times.
(c) The nursing service must have a
procedure to ensure that all nursing personnel have valid and
current licenses.
(d) The nursing staff must develop and keep
current a nursing care plan for each patient.
(e) Upon admission of a patient to the
facility, a registered nurse must assign the nursing care of
that patient to other nursing personnel in accordance with the
patient's needs and the specialized qualifications and
competence of the nursing staff available.
(f) All drugs and biologicals must be
administered by, or under the supervision of, nursing or other
personnel in accordance with federal and state law and rules,
including applicable licensing requirements, and in accordance
with medical staff policies and procedures which have been
approved by the facility's governing body.
(g) Each order for drugs and biologicals
must be consistent with federal and state law and be in writing
and signed by the practitioner who is both responsible for the
care of the patient and legally authorized to prescribe.
(h) When an oral or
telephonically-transmitted order must be used, it must be:
(i) Accepted only by personnel that are
authorized to do so by the medical staff policies and
procedures, consistent with federal and state law; and
(ii) Signed or initialled by the
prescribing practitioner as soon as possible and in conformity
with state and federal law.
(i) The facility must adopt a procedure for
reporting to the attending practitioner adverse drug reactions
and errors in administration of drugs. (History: Sec. 50-5-103,
MCA; IMP,
Sec. 50-5-101, 50-5-103 and 50-5-204, MCA;
NEW, 1989 MAR p. 663,
Eff. 4/28/89; TRANS, from DHES, 2002 MAR p.
185.)
37.107.1843 SPECIALTY MENTAL HEALTH
FACILITY: NURSING SERVICES (1) A specialty mental health
facility must provide 24-hour nursing services and meet the
following standards:
(a) The director of nursing services must
be a licensed registered nurse and must:
(i) determine the types and numbers of
nursing personnel and staff necessary to provide nursing care;
and
(ii) schedule adequate numbers of licensed
registered nurses, licensed practical nurses, and other
personnel to provide nursing care as needed.
(b) A registered nurse must be on duty at
least eight hours per day, and the director of nursing or
another registered nurse designated as the director's alternate
must be on call and available within 20 minutes at all times.
(c) The nursing service must have a
procedure to ensure that all nursing personnel have valid and
current Montana nursing licenses.
(d) The nursing staff must develop and keep
current a nursing care plan for each patient when a nursing care
plan is required.
(e) Upon admission of a patient to the
facility, a registered nurse must assign the nursing care of
that patient to other nursing personnel in accordance with the
patient's needs as determined by the admitting psychiatrist and
the specialized qualifications and competence of the nursing
staff.
(f) All drugs and biologicals must be
administered by, or under the supervision of, nursing or other
qualified medical personnel in accordance with federal and state
law and rules, including applicable licensing requirements, and
in accordance with medical staff policies and procedures which
have been approved by the governing body.
(g) Each order for drugs and biologicals
must be consistent with federal and state law and be in writing
and signed by the practitioner who is both responsible for the
care of the patient and legally authorized to prescribe.
(h) When an oral or
telephonically-transmitted order must be used, it must be:
(i) accepted only by personnel that are
authorized to do so by the medical staff policies and
procedures, consistent with federal and state law; and
(ii) signed or initialed by the prescribing
practitioner as soon as possible and in conformity with state
and federal law.
(i) The facility must adopt a procedure for
reporting to the attending practitioner adverse drug reactions
and errors in administration of drugs. (History: Sec. 50-5-103,
MCA; IMP,
Sec. 50-5-103, MCA; NEW, 1991 MAR
Sec. 50-5-103, MCA; IMP,p. 2454, Eff.
12/13/91; TRANS, from DHES, 2002 MAR p. 185.)
37.106.2151 NURSING SERVICES AND STAFF (1)
The facility must provide each client with nursing services in
accordance with their needs, including:
(a) participation as appropriate in the
development, review, and update of an individual treatment plan
as part of the interdisciplinary team process;
(b) the development, with a physician, of a
medical care plan of treatment for a client when the physician
has determined that an individual client requires such a plan;
(c) for each client who is certified as not
needing a medical care plan, a review of their health status
which must:
(i) be by a direct physical examination;
(ii) be by a licensed nurse;
(iii) be on a quarterly or more frequent
basis depending on client need;
(iv) be recorded in the client's record;
and
(v) result in any necessary action
(including referral to a physician to address client health
problems);
(d) other nursing care as prescribed by the
physician or as identified by client needs; and
(e) implementation of appropriate
protective and preventive health measures that include, but are
not limited to:
(i) training any client and staff as needed
in appropriate health and hygiene methods;
(ii) control of communicable diseases and
infections, including the instruction of other personnel in
methods of infection control; and
(iii) training of direct care staff in
detecting signs and symptoms of illness or dysfunction, first
aid for accidents or illness, and basic skills required to meet
the health needs of the client.
(2) The facility must:
(a) employ or arrange for licensed nursing
services sufficient to care for the client's health needs
including any client with a medical care plan;
(b) utilize registered nurses as
appropriate and required by Montana law to perform the health
services specified in this rule;
FACILITY FOR
EACH 24 HOUR PERIOD: STAFFING
(1) The
following table indicates an absolute minimum staffing pattern
below which an acceptable level of care and safety cannot be
maintained. Even with this staffing it would be difficult.
Therefore, it is recommended that the quantity and quality of
staffing should be determined by the administrator in
consultation with his director of nursing. This decision should
be based on the nursing needs of the patients and should reflect
the current concepts of restorative and geriatric care.
(History: Sec.
50-5-103 and 50-5-404, MCA; IMP, Sec. 50-5-103, 50-5-204 and
50-5-
404, MCA; Eff.
12/31/72; TRANS, from DHES, 2002 MAR p. 185.)
Nurse Staffing Ratios: [PDF]
 |
