R432-151-20. Nursing Services

(1) Nursing services shall be available to residents who require such services.

(2) There shall be nursing staff available according to Table 1 to meet medical needs.

(a) There shall be 24-hour licensed nurse coverage.

(b) In a skilled nursing facility, a registered nurse shall be on duty at least sixteen hours per 24-hour period seven days a week to plan, assign, supervise or provide, and evaluate nursing care needs of the residents.

(3) All prescribed medications shall be administered by licensed personnel.

(4) In an intermediate care facility, if the health services supervisor is a licensed practical nurse, the registered nurse consultant shall be contacted within three days of a new admission to review the resident care plan.

(5) Schedules shall be maintained to indicate hours worked in the treatment program by regularly assigned and relief registered nurses, licensed practical nurses, and aides. The facility shall retain staff schedules and payroll records for at least a 12-month period.

(6) Aides performing housekeeping, dietary, or other functions shall maintain time records reflecting actual time spent in nursing care and time spent in other tasks. Time spent in other tasks will not be included in nursing care staffing ratios.

(7) Table 1 represents the minimum acceptable standards for hours of nursing care; additional staffing time may be necessary to accommodate variables such as staff illness or vacation, resident census, or status and behavior of residents.

TABLE 1

HOURS OF NURSING CARE PER SKILLED AND INTERMEDIATE LEVEL RESIDENT

    Type of Total Nursing Licensed Nursing

    Resident Hours per Resident Hours per resident

                       per 24 hrs. per 24 hrs.

                      (RN + LPN + Aide) (RN + LPN only)

    SKILLED 2.5 (150 minutes) 30% (45 minutes)(a)

   INTERMEDIATE 2.0 (120 minutes) 30% (36 minutes)(a)

     (a) Shall not include director of nursing or health services supervisor in a facility with a resident census over 60.