Nursing Services

Question 1

There must be at least ONE RN employed by the facility for?

Answer 1

-Both-(483.30/19.1001-1)

8 consecutive hours a day 7 days a week

Question 2

How many LN’s must a facility have?

Answer 2

-Both-(483.30/19.1001-1)
One nurse for each shift 7 days a week
-State-
Ratio is 1:20

Question 3

Who is required to serve as a charge nurse?

Answer 3

-Both-(483.30/19.1001-1)

LN’s or higher for each shift (3) 7 days a week.

Question 4

when can the DON serve as a charge nurse?

Answer 4

-Both-(483.30/19.1001-1)

When the facility has an average daily occupancy of 60 or fewer residents.

Question 5

How many hours is the DON expected to work?

Answer 5

-Both-(483.30/19.1001-2)

40 hours a week

Question 6

Who can serve as the DON?

Answer 6

-Both-(483.30/19.1001-2)

a RN

Question 7

How often is the wavier to 24 hour nursing care subject to review?

Answer 7

-Both-(483.30/19.1001-1)

Once a year

Question 8

What is the WAVIER requirement to NOT have a LN coverage on shift for 24 hours?

Answer 8

-Both-(483.30/19.1001-3)
1- Unable to Hire, at appropriate rates
2-DADS determines , based on population, that health and safety will not endanger
3-Must have a RN or LN on the day shift 7 days a week (6-9) day shift

Question 9

When WAVIER for 24 hour nurse coverage is given who must cover the facility in case of emergency (phone call)

Answer 9

-Both-(483.30/19.1001-3-a-3)

a registered nurse or a physician is obligated to respond immediately to telephone calls from the facility

Question 10

Can the requirement to have a 8 hours a day 7 days a week RN coverage week be waived in a Medicare? (Including DON)

Answer 10

-Both-(483.30/19.1001-4)
Yes,
1- provided that the SNF is in a RUAL AREA
2-Facility has residents that no not need RN or Doctor assistance for 48 hours
3-When regular full time nurse is off, that arrangements have been made to have a doctor or nurse to be at facility.

Question 11

If there is a possibility of Nurse staffing issues (staffing will fall for 30 of 45 days) what must the Administrator do?

Answer 11

-State Only-19.1001-5
1-Notify DADS regulatory Services Division 
2-Notice must be in writing
3-Notify Residents
4-Notify Family

Question 12

What are the two type of waivers that have to do with NURSE STAFFING?

Answer 12

-Both-
1- 24 Hour coverage of Licensed Nurse
2-8 hours a day 7 Day a Week RN

Question 13

How long must a facility keep record of all Nurse Staff posting requirements?

Answer 13

19.1001-b-4
1-Facility Policy OR;
2- AT least Two years 
** what ever is longer
***Fed Requirement is 18 months (483.30-e-2-4)

Question 14

What is the minimum ratio for Licensed Nurse Staff?

Answer 14

-State Only-19.1002
1:20 – 1 Nurse for every 20 residents (per shift)
Ex: 3 Shifts for 1 Nurse = 3*20 = 60 Residents OR

Minimum of .4 Hours per Resident Day.

Ex: 3 Nurses working 8 hour shifts = 24 Hours
Divide that by 60 Residents = .4
** Note LN can be counted in ratio, but only if that work is nurse related, and not admin duties. (ANN at modern in charge of medical supplies)

Question 15

What nursing staff information must be posted on the beginning of each shift?

Answer 15

-Both-(483.30/19.1001-b)
1-Total number of hours to be worked,
2-What shift (time of day)

Question 16

Can the DON be the DON in two different facilities?

Answer 16

-State-19.1004
No,
The director of nursing services must serve only one facility in this capacity.

Question 17

If a phone verbal ORDER (phone) is give to a LN who must sign the ORDER?

Answer 17

-State-19.1010-d-
1-The nurse who took the order &
2-The Doctor (ect..) who gave the order in a TIMELY manner

Question 18

How often must a NURSE (Enter/Approve/Sign) Nurses NOTES?

Answer 18

-State-19.1010-e-
Once a Month OR
When physical complaints, accidents, incidents, and change in condition or diagnosis happen. - These must happen promptly-

Question 19

When are deaths reported to DHS? (Texas Department of Human Services)

Answer 19

-State-19.1010-f-
Monthly [as part of a routine process.]
(10 days after the first of the month.) 19.606

Question 20

When must death be reported immediately?

Answer 20

-State-19.1010-f-

When the death involves TRAMA, or something unusual.

Question 21

Can nurse students be counted in the NURSE to Resident Ratio?

Answer 21

-State-19.1011

No

Question 22

Who is responsible for PAYMENT of a Nurse sitter in a Medicaid facility?

Answer 22

-State-19.1012

The Family, or Resident - NOT the FACILITY

Question 23

What is the OLDER AMERICANS ACT of 1965 best known for?

Answer 23

-Both- (483.30/19.1001)

Providing a Long Term Care OMBUDSMAN

Question 24

When can a graduate LN work in a facility, when they only have a temp work permit?

Answer 24

-State-19.1002-b-
Under the direction of:
LN / RN / or Doctor as long as they are:
Physically present in the building/

Question 25

If facility has WAVIER for DON to be a LN, how many hours of RN consultation must be provided to the LN who is serving as the DON?

Answer 25

-State-19.1004-

4 Hours a week

Question 26

Regarding advanced Directives, Facility must?

Answer 26

Maintain Written policies and Procedures

Question 27

Who must be contacted when FACILITY dose not meet 24 hours LN coverage OR 40 hours 7 days a week RN Coverage requirement at the facility?

Answer 27

Both
1-State
2-Residents
3-Family

The agency (DADS) will Notify:
1-State Ombudsman
2-And the State agency for protection and advocacy system in the state for the mentally ill and mentally retarded.

Question 28

What is the Recommended “General Rule of Thumb” for CNA’s and LVN’s to be working?

Answer 28

30% LVN
70% CNA

FED
Minimum 1 LVN PER shift for 24 hour period

Texas
.4 hours OR 1:20 Rate of LVN

There are no MINIMUM RATES of CNA’s but if the minimum is 3 CNA (FED) that would be 7 CNA

Question 29

What is the grace period for nurse aids to complete there training, before the facility either has to hire them or let them go?

Answer 29

-Both-483.75/19.1903– admin–
4 months:
. A facility must not use any individual working in the facility as a nurse aide for more than four months, on a full-time basis, unless has completed training.

Question 30

When must nursing staff information be posted?
What information is required?
How long must this be keep on file?

Answer 30

-Both–Both-(483.30/19.1001-b-)
1-Must be posted daily, at the beginning of each shift. +
(i) the facility name;
(ii) the current date;
(iii) the resident census; and
(iv) the specific shifts for the day;
2-Total number of hours and actual hours worked. by all direct care staff (RN, LVN, CNA ..ect)
3-Kept on file for 2 years or facility policy -Texas-
Kept on file for 18 months -Fed-