Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59A - Health Facility and Agency Licensing › Chapter 59A-4 - MINIMUM STANDARDS FOR NURSING HOMES › Section 59A-4.108 - Nursing Services

Current through Reg. 50, No. 138; July 16, 2024
(1) The
				Administrator of each nursing home must designate one registered nurse as a
				Director of Nursing (DON) who shall be responsible and accountable for the
				supervision and administration of the total nursing services program. When a
				Director of Nursing is delegated institutional responsibilities, a full time
				qualified registered nurse (RN), as defined in Chapter 464, F.S., must be
				designated to serve as Assistant Director of Nursing. In a facility with a
				census of 121 or more residents, an RN must be designated as an Assistant
				Director of Nursing.
(2) Persons
				designated as Director of Nursing or Assistant Director of Nursing must serve
				only one nursing home facility in this capacity, and shall not serve as the
				administrator of the nursing home facility.
(3) The Director of Nursing must designate
				one licensed nurse on each shift to be responsible for the delivery of nursing
				services during that shift.
(4) In
				accordance with the requirements outlined in subsection
				400.23(3)(a),
				F.S., the nursing home licensee must have sufficient nursing staff, on a
				24-hour basis to provide nursing and related services to residents in order to
				maintain the highest practicable physical, mental, and psychosocial well-being
				of each resident, as determined by resident assessments and individual plans of
				care.
(5) In multi-story,
				multi-wing, or multi-station nursing home facilities, there must be a minimum
				of one nursing services staff person who is capable of providing direct care on
				duty at all times on each floor, wing, or station.
(6) No nursing services staff person shall be
				scheduled for more than 16 hours within a 24 hour period, for three consecutive
				days, except in an emergency. Emergencies shall be documented and must be for a
				limited, specified period of time.
(7) Upon approval by the Agency, a nursing
				home licensee may allow a licensed nurse that performs both licensed nursing
				and certified nursing assistant duties during the same shift to divide the
				hours of patient care provided between the licensed nurse and certified nursing
				assistant staffing ratio requirements consistent with services provided, as
				referenced in Section 400.23(3)(a)4., F.S. Approval to utilize licensed nurses
				to perform certified nursing assistant duties must be requested in writing.
				This request may be submitted upon license renewal on the Health Care Licensing
				Application, Nursing Homes, AHCA Form 3110-6001, July 2014, incorporated by
				reference in paragraph
				59A-4.103(1)(a),
				F.A.C. or by letter from the facility administrator. The Agency's approval
				depends upon review of the last three years' inspections from the date of the
				request to determine if there were deficiencies cited related to staffing. The
				licensee must document daily the time the licensed nurse performed personal
				care services to comply with minimum staffing requirements. The hours of a
				licensed nurse with dual job responsibilities may not be counted
				twice.
Rulemaking Authority 400.23 FS. Law Implemented 400.141,
					 400.23 FS.
New 4-1-82, Amended 4-1-84, 8-1-85, 7-1-88, 7-10-91,
					 Formerly 10D-29.108, Amended 4-18-94,
					 12-21-15.