Supervision of Nursing Services

Section 300 Section 300.1220  Supervision of Nursing Services a)         Each facility shall have a director of nursing services (DON) who shall be a registered nurse. 1)         This person shall have knowledge and training in nursing service administration and restorative/rehabilitative nursing.  This person shall also have some knowledge and training in the care of the type of residents the facility cares for (e.g., geriatric or psychiatric residents).  This does not mean that the director of nursing must have completed a specific course or a specific number of hours of training in restorative/rehabilitative nursing unless this person is in charge of the restorative/rehabilitative nursing program. (See Section 300.1210(a).) 2)         This person shall be a full-time employee who is on duty a minimum of 36 hours, four days per week.  At least 50 percent of this person's hours shall be regularly scheduled between 7 A.M. and 7 P.M. A)        A facility may, with written approval from the Department, have two registered nurses share the duties of this position if the facility is unable to obtain a full-time person.  Such an arrangement will be approved only through written documentation that the facility was unable to obtain the full-time services of a qualified individual to fill this position. Such documentation shall include, but not be limited to:  an advertisement that has appeared in a newspaper of general circulation in the area for at least three weeks; the names, addresses and phone numbers of all persons who applied for the position and the reasons why they were not acceptable or would not work full time; and information about the numbers and availability of licensed nurses in the area.  The Department will grant approval only when such documentation indicates that there were no qualified applicants who were willing to accept the job on a full-time basis, and the pool of nurses available in the area cannot be expected to produce, in the near future, a qualified person who is willing to work full time. B)        In facilities with a capacity of fewer than 50 beds, this person may also provide direct patient care, and this person's time may be included in meeting the staff-to-resident ratio requirements. 3)         In skilled nursing facilities of l00 or more occupied beds, there shall be an assistant director of nursing (ADON) who is a registered nurse.  This person shall also meet the qualifications specified in subsection (a)(1) of this Section for the director of nursing service. 4)         In intermediate care facilities of 150 or more occupied beds, a licensed nurse shall be designated as the ADON.   The assistant may provide direct patient care and be included in staff-to-resident ratio calculations. 5)         The assistant shall be a full-time employee who is on duty a minimum of 36 hours, four days per week.  The assistant may be assigned to work hours any time of the day or night. 6)         The assistant shall assist the DON in carrying out his/her responsibilities. 7)         If other duties interfere with the proper performance of the DON's or ADON's duties, another nurse shall be assigned to perform the duties of the DON or assistant for that period of time. b)         The DON shall supervise and oversee the nursing services of the facility, including: 1)         Assigning and directing the activities of nursing service personnel. 2)         Overseeing the comprehensive assessment of the residents' needs, which include medically defined conditions and medical functional status, sensory and physical impairments, nutritional status and requirements, psychosocial status, discharge potential, dental condition, activities potential, rehabilitation potential, cognitive status, and drug therapy. 3)         Developing an up-to-date resident care plan for each resident based on the resident's comprehensive assessment, individual needs and goals to be accomplished, physician's orders, and personal care and nursing needs.  Personnel, representing other services such as nursing, activities, dietary, and such other modalities as are ordered by the physician, shall be involved in the preparation of the resident care plan.  The plan shall be in writing and shall be reviewed and modified in keeping with the care needed as indicated by the resident's condition.  The plan shall be reviewed at least every three months. 4)         Recommending to the administrator the number and levels of nursing personnel to be employed, participating in their recruitment and selection and recommending termination of employment when necessary. 5)         Participating in planning and budgeting for nursing services, including purchasing necessary equipment and supplies. 6)         Developing and maintaining nursing service objectives, standards of nursing practice, written policies and procedures, and written job descriptions for each level of nursing personnel. 7)         Coordinating the care and services provided to residents in the nursing facility. 8)         Supervising and overseeing in-service education, embracing orientation, skill training, and on-going education for all personnel and covering all aspects of resident care and programming. The educational program shall include training and practice in activities and restorative/rehabilitative nursing techniques through out-of-facility or in-facility training programs.  This person may conduct these programs personally or see that they are carried out. 9)         Participating in the development and implementation of resident care policies and bringing resident care problems, requiring changes in policy, to the attention of the facility's policy development group.  (See Section 300.610(a).) 10)         Participating in the screening of prospective residents and their placement in terms of services they need and nursing competencies available.