Are SNFs required to have RNs at all times?

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I 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?

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Specializes in Rehab, Sub Acute.
I 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?

Depends on its policy, most require an RN on unit or at least in building.

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Thanks. 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.

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Specializes in Med-Surg, ICU, ER, Geriatrics.

In 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.

Good luck,:wink2:

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Specializes in ER CCU MICU SICU LTC/SNF.

The regs apply to all states - 483.30(b) Registered Nurse pp 448-455

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Specializes in nursery, L and D.

RN in the building 8 hours a day, including weekends.

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Specializes in Med-Surg, Peds, Ortho, LTC and MORE.

Wading 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.

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They 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.

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Hi

I am the DON for a SNF and the requirements are 1 RN for 8 hours in a 24 hour period.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

slkilled 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

http://www.pacode.com/secure/data/028/chapter211/chap211toc.html

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.

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Specializes in LTC.

I work in assisted living and there is a LPN in the building for 16 hours mon-fri ( 7-3, 3-11), on the weekend the LPN is there from 7a-7p. The RN comes in once a week. And over night there is no nurse in the building just med techs and cnas.

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wow here they have nurse 24/7

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