Registered Nurse Coverage

There shall be a sufficient number of registered nurses on duty at all times to plan, supervise and evaluate nursing care, as well as to give patients the nursing care that requires the judgment and specialized skills of a registered nurse. (A) Supervisory Coverage. Registered nurses shall be assigned to supervise nursing care and nursing personnel according to a written staffing plan that provides for adequate coverage for all nursing units during each shift. (B) Unit Coverage. At least one registered nurse shall be assigned to work in each nursing unit at all times. The only exceptions to 105 CMR 130.311(B) shall be the following: (1) If a registered nurse is on duty in one nursing unit of a skilled nursing unit or of a chronic disease hospital, an adjoining nursing unit (on the same floor or floor above or below, if readily accessible) may be staffed by licensed practical nurses, provided that the registered nurse on duty shall be readily available to go from one nursing unit to another when skilled nursing services are needed. (2) If a registered nurse is available to provide supervision and skilled nursing services when needed, an outpatient ambulatory care unit (not an emergency service unit) in which skilled nursing care is not routinely needed, may be staffed by licensed practical nurses. (C) Intensive Care Units. The ratio of qualified registered nurses to patients in the unit must comply with M.G.L. c. 111, § 231 and 958 CMR 8.00: Patient Assignment Limits for Registered Nurses in Intensive Care Units in Acute Hospitals.