STANDARD 9: Nursing Services

9.1 General

1. The nursing service shall be appropriately organized and integrated into the healthcare management system with a plan of administrative authority and delineation of responsibilities for patient care.

2. The nursing service shall provide constant and continual care within the healthcare organization areas of responsibility. At least 1 registered nurse shall be present in each service at all times in order to furnish the supervision required.

NOTE 1 A registered nurse (RN) shall be defined as a LIP with credentials as defined by the healthcare organization and standard of care.

9.2 Personnel

1. The Director of the nursing service shall be a licensed registered nurse. He or she is responsible for the operation of the service, including determining the types and numbers of nursing personnel and staff necessary to provide nursing care for all areas of the healthcare organization.

2. The healthcare organization shall have a single nursing service within the healthcare organization. This service shall be under the direction of one RN.

9.3 Staffing and Delivery of Care

1. The nursing service shall have adequate numbers of licensed registered nurses, and other personnel to provide nursing care to all patients as needed. There shall be supervisory and staff personnel for each department or nursing unit to ensure, when needed, the immediate availability of a registered nurse for bedside care of any patient.

2. The nursing service shall ensure that patient needs are met by ongoing assessments of patients’ needs and provision of nursing staff to meet those needs. There shall be sufficient numbers, types and qualifications of supervisory and staff nursing personnel to respond to the appropriate nursing needs and care of the patient population of each department or nursing unit.

3. The nursing service shall determine the qualifications necessary for personnel assigned to advance care units. Additionally, specific related training required for service in these areas shall be accomplished accordingly. Records of this training shall be retained in the appropriate personnel files as documented information.

4. There shall be a RN physically present and immediately available on the premises of each service and on duty at all times for every inpatient unit and location within the healthcare organization.

NOTE 1 A RN would not be considered immediately available if the RN were working on more than one unit, building, floor in a building, providing dedicated patient care, or performing another duty.

5. Staffing schedules shall be reviewed and revised by the appropriate nursing authority of the healthcare organization as necessary in order to meet the patient care needs and to make adjustments for nursing staff absenteeism.

9.4 Licensure

1. The Director of the nursing service and the healthcare organization shall ensure that nursing personnel with the appropriate education, experience, licensure, competence, and specialized qualifications are assigned to provide nursing care for each patient in accordance with the individual needs of that patient.

9.5 Planning

1. The healthcare organization shall ensure that the nursing staff develops and maintains a current nursing care plan for each patient. This plan of care shall be developed within 24 hours of patient admission and reflect the findings of an appropriate nursing assessment. Input from other disciplines shall be included as appropriate in an interdisciplinary plan of care. This plan of care shall be updated as diagnostic information relative to the patient admission is available.

2. The nursing assessment shall include but not be limited to the following categories:

a) allergies;

b) admitting diagnosis;

c) history and current level of pain;

d) pre-existing and other comorbidities or relevant conditions (i.e. pregnancy, COPD, diabetes);

e) current medications including dose and frequency including any use of illicit drugs;

f) ADL needs;

g) dietary requirements;

h) other requirements as per organization nursing policies.

3. Patient centered care education shall be included in the nursing plan. The following topics shall

include but are not limited to:

a) tobacco abuse;

b) alcohol abuse;

c) opioid and other recreational drug abuse;

d) dietary control relative to obesity/diabetes/hyperlipidemia, etc.;

e) stress management and exercise;

f) hypertension.

4. When needed patient centered care is identified, the healthcare organization shall offer and/or provide patient education to promote health and wellbeing.

5. Nursing staff shall complete a plan of care assessment according to the healthcare organization nursing policies, and standard of care. The patient’s plan of care shall include goals of the treatment or care and shall be reviewed and revised accordingly.

6. Nursing staff shall reassess the patient at regular intervals as the patient’s condition requires. This requirement specifically addresses nursing "hand-off" procedures and documentation. (See the requirements for check point control in 4.1.3–4.1.5).

7. The healthcare organization shall ensure that each patient shall have a designated primary nurse who shall be responsible for overseeing the assessment and care of each individual patient.

8. A registered nurse shall assign the nursing care of each patient to other nursing personnel in accordance with the patient’s needs and the specialized qualifications and competence of the nursing staff available.

9. The healthcare organization shall ensure that there are adequate numbers of clinical nursing personnel to meet its patient nursing care needs. In order to meet their patient needs the healthcare organization may supplement their healthcare organization employed licensed nurses with volunteer and or contract non-employee licensed nurses.

NOTE 1 Nursing care planning starts upon admission. It includes planning the patient’s care while in the healthcare organization as well as planning for discharge to meet post-healthcare organization needs. A nursing care plan is based on assessing the patient’s nursing care needs (not solely those needs related to the admitting diagnosis) and developing appropriate nursing interventions in response to those needs. The nursing care plan is kept current by ongoing assessments of the patient’s needs and the patient’s response to interventions and updating or revising the patient’s nursing care plan in response to assessments. The nursing care plan is part of the patient’s medical record and shall comply with the requirements for patient records and other patient information.