Temporary Waivers Applicable to Rural Hospitals

2030 - Temporary Waivers Applicable to Rural Hospitals (Rev. 1, 05-21-04) If a hospital is found to be out of compliance with the 24-hour registered nurse (RN) requirement, a temporary waiver may be granted by the RO. This waiver, however, may be approved only to the extent that it would not jeopardize or adversely affect the health and safety of patients. The waiver may be issued for any one-year period or less under certain circumstances, and may be withdrawn earlier if this action is necessary to protect the health and safety of patients. The hospital must meet all CoPs except for the waived requirement. In determining whether a hospital qualifies for a waiver, the SA verifies that these additional criteria are met: ● The hospital is located in a rural region. The Census Bureau in the most recent census defines Rural as all areas not delineated as an “urbanized” areas. (Use the material in Appendix G, Standard II A, and Tabs A-C of Appendix G, to ascertain whether the area is rural or urbanized); ● The hospital has 50 or fewer beds. Exclude from the bed-count newborn and intensive care beds; ● The character and seriousness of the deficiencies do not adversely affect the health and safety of patients; ● The hospital has made and continues to make a good-faith effort to comply with personnel requirements consistent with the waiver. Record information concerning the hospital’s effort to employ additional RNs. Document the recruitment efforts of the hospital and whether the wage level offered is consistent with other hospitals in the area. Hospitals that pay below the wage level for the area might not be able to attract new personnel; therefore, the RO might determine that they are not making a good-faith effort to attract new nurses; ● The hospital’s failure to comply with the 24-hour nursing requirement is attributable to a temporary shortage of qualified nursing personnel in the area in which the hospital is located. Obtain and include any information substantiating the prediction that the shortage is temporary, e.g., names of personnel scheduled to complete qualifying training or scheduled to be engaged and anticipated dates of arrival on duty; ● An RN is present on the premises to furnish or supervise nursing services during at least the daytime shift 7 days a week; ● On all tours of duty not covered by an RN, a licensed practical (vocational) nurse (LPN) is in charge. The SA includes in the certification package documentation of the above requirements for waiver and the most recent 2-week duty roster for RNs and LPNs.