.18 Nursing Services.

A. Organization, Policies, and Procedures.

(1) Nursing service personnel shall provide care appropriate to the residents’ needs with the organizational plan, authority, functions, and duties clearly defined.

(2) Nurses and support personnel shall be chosen for their training, experience, and ability.

(3) Policies and procedures shall be adopted and made available to all nursing service personnel.

B. Signed Agreement.

(1) A signed copy of the agreement between the nursing home and the director of nursing, showing the license number of the nurse, shall be filed with the Department upon:

(a) Application for an initial nursing home license; and

(b) A change of director of nursing.

(2) The agreement shall specify the duties of the director of nursing.

C. Nursing Care 24 Hours a Day. The administrator shall employ sufficient and satisfactory licensed nursing service personnel and support personnel to:

(1) Be on duty 24 hours a day;

(2) Provide appropriate bedside care; and

(3) Ensure that a resident:

(a) Receives treatments, medications, and diet as prescribed;

(b) Receives rehabilitative nursing care as needed;

(c) Receives proper care to prevent pressure ulcers and deformities;

(d) Is kept comfortable, clean, and well-groomed;

(e) Is protected from accident, injury, and infection;

(f) Is encouraged, assisted, and trained in self-care and group activities; and

(g) Receives prompt and appropriate responses to requests for assistance.

D. Assistance by Nursing Service Personnel. Nursing service personnel shall help the resident perform daily routine dental hygiene.

E. Charge Nurse.

(1) At least one licensed nurse shall be:

(a) On duty at all times; and

(b) Be designated by the director of nursing to be in charge of the nursing activities during each tour of duty.

(2) The charge nurse or nurses shall have the ability to recognize significant changes in the condition of residents and to take necessary action.

F. Charge Nurses’ Daily Rounds. The charge nurse or nurses shall make daily rounds on all nursing units for which they are responsible, performing such functions as:

(1) Visiting each resident;

(2) Reviewing clinical records, medication orders, resident care plans, and staff assignments; and

(3) To the degree possible, accompanying physicians when visiting residents.

G. Program of Restorative Nursing Care. There shall be an active program of restorative nursing care aimed at assisting each resident to achieve and maintain the individual’s highest level of independent function, including activities of daily living. This program shall include:

(1) Ambulation and range of motion;

(2) Maintaining good body alignment and proper positioning of bedfast residents;

(3) Encouraging and assisting residents to change positions at least every 2 hours to stimulate circulation and prevent pressure ulcers and deformities;

(4) Encouraging and assisting residents to keep active and out of bed for reasonable periods of time, within the limitations permitted by physicians’ orders;

(5) Encouraging residents to engage in resident-chosen community and independent activities and achieve independence; and

(6) Assisting residents to adjust to their disabilities and ensuring availability and use of their prosthetic and assistive devices.

H. Coordination of Nursing and Dietetic Services. Nursing and dietetic services shall establish an effective policy to ensure that:

(1) Nursing service personnel are aware of the nutritional needs and food and fluid intake of residents;

(2) Nursing service personnel provide special meals and nourishment when required;

(3) Residents’ food choices and preferences are honored as much as practical;

(4) Nursing service personnel promptly aid residents when necessary in eating;

(5) The dietetic service is informed of physicians’ diet orders and of residents’ nutrition-related issues; and

(6) Food and fluid intake of residents is observed, and deviations from normal are recorded and reported to the:

(a) Charge nurse;

(b) Physician; and

(c) Dietetic service.

I. In-Service Education Program.

(1) The director of nursing shall:

(a) Provide a continuing in-service education program for all nursing service personnel;

(b) Provide a thorough job orientation for new personnel; and

(c) Document the content of the continuing in-service education program and include the names and titles of participants.

(2) The director of nursing shall obtain approval from the Department.

J. Responsibility to Report Care that Is Considered Questionable.

(1) If a nurse questions the care provided to any resident or believes that appropriate consultation is needed and has not been obtained, the nurse shall inform the supervisor.

(2) If indicated, the supervisor shall refer the matter to the director of nursing.

(3) If warranted, the director of nursing shall report the matter to the medical director or principal physician.