Are SNFs required to have RNs at all times?Register Today!
- by nurseinpa Aug 21, '09I was just wondering if SNFs were required to have an RN on site at all times or if they can staff with only LPNs and CNAs?
- Aug 21, '09 by nurseinpaThanks. I know where I worked it was policy. I was just talking to a friend who works in another state and she was saying that she had to go back into work later to hang Vanco becasue there are no RNs tonight. I though it was a Medicare requirement but I guess thats not true.
- Aug 22, '09 by geriNurse1In Missouri the regs say that there has to be a RN in the Building on the day shift, after that the facility can be staffed with LPN's and CNA's with an RN available 24/7 and that's usually the DON or someone she designates.
- Aug 29, '09 by crissrn27RN in the building 8 hours a day, including weekends.
- Aug 29, '09 by ReigenWading through the complete regs as posted was quite a project, so I looked and found in my own notes just those that pertain to the orignal poster's question:
Description of Federal Requirements
Each facility must designate an RN to be on duty providing direct care for 8 consecutive hours seven days a week, as well as an RN to serve as director of nurses (DON).
The DON may not be counted as the RN on duty in nursing homes with more than 60 beds. The rule also details circumstances under which both the requirement for an RNs every day and an RN as DON can be waived in rural areas, and the safeguards that must be provided in that case—essentially the facilities with the waivers must provide on-call access to an RN at all times.
- Aug 30, '09 by caliotter3They told me that the requirement was also tied to the number of beds. As an LVN, I was the only licensed nurse on duty in a 52 bed facility at night. In other facilities where I worked that had 148 to 160 odd beds, there was at least one RN on duty at night.
- Sep 7, '09 by cheryl254Hi
I am the DON for a SNF and the requirements are 1 RN for 8 hours in a 24 hour period.
- Sep 7, '09 by NRSKarenRNslkilled nursing facilities are under both federal and state guidelines for operation.
some state only follow federal guidelines: 1 rn on duty for 8 consecutive hours 7 days/week.
state operations manual appendix p - survey protocol for long term care facilities
state operations manual appendix pp - guidance to surveyors for ltcfs
please note that these are large files and depending upon your computer and bandwidth speed may take a few minutes.
pa has stronger state standards:
chapter 211. program standards for long-term care nursing facilities
211.12. nursing services.
the facility shall designate a registered nurse who is responsible for overseeing total nursing activities within the facility on each tour of duty each day of the week.
in addition to the director of nursing services, the following daily professional staff shall be available.
(1) the following minimum nursing staff ratios are required:
census: day evening night
59 and under: 1 rn 1 rn 1 rn or 1 lpn
60/150: 1 rn 1 rn 1 rn
151/250: 1 rn and 1 lpn 1 rn and 1 lpn 1 rn and 1 lpn
251/500: 2 rns 2 rns 2 rns
501/1,000: 4 rns 3 rns 3 rns
1,001/upward: 8 rns 6 rns 6 rns
(2) when the facility designates an lpn as a nurse who is responsible for overseeing total nursing activities within the facility on the night tour of duty in facilities with a census of 59 or under, a registered nurse shall be on call and located within a 30-minute drive of the facility.
(g) there shall be at least one nursing staff employee on duty per 20 residents.
(h) at least two nursing service personnel shall be on duty.