INSTRUCTIONS FOR LICENSED NURSE STAFFING CALCULATION
IN NURSING HOMES
1. Determine facility census 120
2. Multiply census by 1.0 hours to obtain minimum total hours 120
3. From time sheets, total licensed nurse work-hours: 130
4. Line 3 exceeds Line 2 MINIMUM STAFFING IS SATISFIED
1. Determine facility Census 120
2. Multiple census by 1.0 hours to obtain minimum total hours 120
3. From time sheets, total licensed nurse work-hours: 110
4. Line 2 exceeds Line 3 MINUM STAFFING IS NOT SATISFIED
The above hours do NOT include non-resident care hours, such as lunch and work breaks. These are "patient care" hours, according to Pat Hall, Agency for Health Care Administration.
These above figures are a "minimum". Nursing Home are require to staff over the minimum if necessary to meet the needs of the residents, according to Peggy Rigsby, Florida Health Care Association.
The above hours are for a 24-horus period on a single date. There is no requirement for any particular eight hours shift.
(a) Minimum staffing:
1. Facility Shall maintain the following minimum staff hours per week:
Number of Residents Staff Hours/Week
0 - 5 168
6 - 15 212
16 - 25 253
26 - 35 294
36 - 45 335
46 - 55 375
56 - 65 416
66 - 75 457
76 - 85 498
86 - 95 539
For every 20 residents over 95 add 42 staff hours per week.
2. At least one staff member who has access to facility and resident
records in case of an emergency shall be within the facility at all times when residents are in the facility. Residents serving as paid or volunteer staff may not be let solely in charge of other residents while the facility administrator, manager or other staffs are absent from the facility.
3. In facilities with 17 or more residents, there shall be one staff member
awake at all hours of the day and night.
4. At least one staff member who is trained in Fist Aid and CPR, as
provided under Rule 58A-5.0191, shall be within the facility at all times when residents are in the facility.
5. During periods of temporary absence of the administrator or manager
when residents are on the premises, a staff member who is at least 18 years of age must be designated in writing to be in charge of the facility.
6. Staff whose duties are exclusively building maintenance, clerical, or
food preparation shall not be counted toward meeting the minimum staffing hours requirements.
7. The Administrator or manager's time may be counted for the purpose
of meeting the required staffing hours provided the administrator is actively involved in the day-to-day operation of the facility, including making decisions and providing supervision for all aspects of resident care, and is listed on the facility's staffing schedule.
8. Only on the job-staff may be counted in meeting the minimum staffing
hours. Vacant positions or absent staff may not be counted.
(b) Notwithstanding the minimum staffing requirements specified in paragraph (a), all facilities including those composed of apartments, shall have enough qualified staff to provide resident supervision, and to provide or arrange for resident services in accordance with the residents scheduled and unscheduled service needs, resident contracts and resident care standards as described in Rule 58A-5.0182.
(c) The facility shall maintain a written work schedule which reflects the facility's 24-hour staffing pattern for a given time period.
To make the above calculations:
1. Obtain the Daily Nursing Assignment and Signature Sheet or nurse assignment sheet for the date (s) in question. It may be called something different at each nursing home.
There may be a nursing assignment sheet for each of the day's three shifts. In addition, each wing or floor may have a separate sheet. If there are two floors in the Nursing Home, with a north and south wing on each floor, there may be 12 Daily Nursing Assignment and Signature Sheets for the Day: three sheets for each of the four wings. Each sheet will have the names of staff with the names of hours worked.
The assignment sheets are not valid indications of work hours unless each name is accompanied by a signature.
If you have questions if any of the people actually worked the hours documented on the sheets, you can ask the administrator or assistant if the documentation on the sheets can be supported by time cards.
2. Obtain the facility census sheet for the date (s) in questions.
3. If the Nursing Home also has an ALF on the premises, ask if any of the staffs names found on the Nursing Home assignment sheets can be documented for the same date on the ALF work schedule. If they can be, then ask for proof of the number of hours this staff worked solely in the Nursing Home. If it can't be proven, you can't count these hours.
4. If in interviews with residents, you are told that staff do not assist in eating, turn bed bound residents every two hours at a minimum, reposition people in wheelchairs, etc., or provide showers only twice a week when residents have asked to be showered three times a week, then even if the staffing meets the minimum as calculated above, there is insufficient staff.
The federal law states staffing must be sufficient to meet the needs of residents.
NURSING HOME STAFFING
SB 1202 page 72 (section 30)
Hours of Direct Care per Resident per Day
Certified Nursing Assistants Licensed Nurses
- 1/1/02 - 2.3. Hours - Effective 1/1/02
Never Below 1:20 - 1.0 Hours
- 1/1/03 - 2.6 Hours - Never Below 1:40
- 1/1/04 - 2.9 Hours
Never Below 1:20 CNA and 1:40 Licensed Nurse is an Alternative to Per Shift Ratios.