New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter A - Medical Facilities-minimum Standards › Article 2 - Hospitals › Part 405 - Hospitals-Minimum Standards › Section 405.5 - Nursing services

Current through Register Vol. 46, No. 28, July 10, 2024
The governing body shall ensure that the hospital has an
						organized nursing service that provides 24-hour services and that meets the
						care needs of all patients in accordance with established standards of nursing
						practice. The nursing services for all patients shall be provided or supervised
						by a registered professional nurse who is on duty and available at all
						times.
(a)
Organization and
					 staffing.
(1) The hospital shall have
					 a written nursing service plan of administrative authority and delineation of
					 responsibilities. The director of the nursing service shall be a licensed
					 registered professional nurse who is qualified by training and experience for
					 such position. The director of the nursing service shall be responsible for the
					 operation of the service, including developing such nursing service plan to be
					 approved by the hospital for determining the types and numbers of nursing
					 personnel and staff necessary to provide nursing care for all areas of the
					 hospital in accordance with the hospital's clinical staffing plan as provided
					 in paragraph (8) of this subdivision.
(2) The hospital shall employ licensed and
					 currently registered professional nurses, licensed practical nurses, and other
					 personnel to provide nursing care to all patients as needed. The hospital shall
					 provide supervisory and staff personnel for each department or nursing unit to
					 ensure, when needed in accordance with generally accepted standards of nursing
					 practice, the immediate availability of a registered professional nurse for
					 bedside care of any patient.
(3)
					 Job descriptions for each position classification of registered professional
					 nurses and ancillary nursing personnel shall specify standards of performance
					 and delineate the functions, responsibilities, and specific qualifications of
					 each classification.
(4) A written
					 evaluation of the performance, credentials, and competence of registered
					 professional nurses and ancillary nursing personnel shall be conducted on at
					 least a biennial basis.
(5) When
					 nursing services are provided by nursing students, nurses with limited permits,
					 or by personnel from outside sources, the hospital shall retain full
					 responsibility for the quality of nursing care rendered in the hospital.
(i) Nursing students, nurses with limited
					 permits, and registered professional nurses from outside sources who are
					 working in the hospital shall adhere to the policies and procedures of the
					 hospital.
(ii) The director of
					 nursing services shall provide for the supervision and evaluation of the
					 clinical activities of all nursing personnel.
(6) All nursing services personnel, including
					 nursing students and nonemployee licensed nurses who are working in the
					 hospital, shall receive a basic orientation to prepare them for their specific
					 duties and responsibilities prior to performing any nursing functions within a
					 patient care area. For employee nurses and nursing students, the hospital shall
					 provide or arrange for the provision of training programs to augment their
					 knowledge of pertinent new developments in patient care. The hospital shall
					 also require that nonemployee licensed nurses obtain education and training
					 pertinent to the clinical duties to which they are assigned.
(7) Nursing services personnel employed in
					 specialty areas, including, but not limited to, emergency services, must
					 complete training and education specific to the specialty area. Nursing
					 services personnel must be periodically reevaluated for competency and ongoing
					 education and training provided to maintain competency in the specialty
					 area.
(8) Hospitals must establish
					 and maintain a clinical staffing committee as provided in section 2805 t of the
					 Public Health Law. The clinical staffing committee shall develop and oversee
					 the implementation of an annual clinical staffing plan. The clinical staffing
					 plan shall delineate intensive care and critical care units of the hospital.
					 The clinical staffing plan shall include specific staffing for each patient
					 care unit and work shift and shall be based on the needs of patients. Staffing
					 plans shall include specific guidelines or ratios, matrices, or grids
					 indicating how many patients are assigned to each registered nurse and the
					 number of nurses and ancillary nursing personnel to be present on each unit and
					 shift. Ancillary nursing personnel includes, but is not limited to, certified
					 nurse assistants, patient care technicians, and other non-licensed members of
					 the frontline team assisting with nursing tasks. Each hospital shall adopt and
					 submit its first clinical staffing plan under this paragraph no later than July
					 1, 2022, and annually thereafter. Beginning January 1, 2023, and annually
					 thereafter, each hospital shall implement the clinical staffing plan adopted by
					 July 1 of the prior calendar year, and any subsequent amendments, and assign
					 personnel to each patient care unit in accordance with the plan. Factors to be
					 considered and incorporated in the development of the clinical staffing plan
					 shall include, but are not limited to:
(i)
					 census, including total numbers of patients on the unit on each shift and
					 activity such as patient discharges, admissions, and transfers;
(ii) measures of acuity and intensity of all
					 patients and nature of the care to be delivered on each unit and
					 shift;
(iii) skill mix;
(iv) the availability, level of experience,
					 and specialty certification or training of nursing personnel providing patient
					 care, including charge nurses, on each unit and shift;
(v) the need for specialized or intensive
					 equipment;
(vi) the architecture
					 and geography of the patient care unit, including but not limited to placement
					 of patient rooms, treatment areas, nursing stations, medication preparation
					 areas, and equipment;
(vii)
					 mechanisms and procedures to provide for one-to-one patient observation, when
					 needed, for patients on psychiatric or other units as appropriate;
(viii) other special characteristics of the
					 unit or community patient population, including age, cultural and linguistic
					 diversity and needs, functional ability, communication skills, and other
					 relevant social or socio-economic factors;
(ix) measures to increase worker and patient
					 safety, which could include measures to improve patient throughput;
(x) staffing guidelines adopted or published
					 by other states or local jurisdictions, national nursing professional
					 associations, specialty nursing organizations, and other health professional
					 organizations;
(xi) availability of
					 other personnel supporting nursing services on the unit;
(xii) waiver of plan requirements in the case
					 of unforeseeable emergency circumstances as defined in subdivision fourteen of
					 section 2805 t of the Public Health Law;
(xiii) coverage to enable registered nurses,
					 licensed practical nurses, and ancillary staff to take meal and rest breaks,
					 planned time off, and unplanned absences that are reasonably foreseeable as
					 required by law or the terms of an applicable collective bargaining agreement,
					 if any, between the general hospital and a representative of the nursing or
					 ancillary staff;
(xiv) the nursing
					 quality indicators required under section
					 400.25 of this Title;
(xv) general hospital finances and resources;
					 and
(xvi) provisions for limited
					 short-term adjustments made by appropriate general hospital personnel
					 overseeing patient care operations to the staffing levels required by the plan,
					 necessary to account for unexpected changes in circumstances that are to be of
					 limited duration.