N.M. Code R. § 7.7.2.27 - NURSING SERVICES
A.
Requirement. The hospital shall provide a 24-hour nursing service,
supervised by a professional registered nurse, and have a licensed practical
nurse or professional registered nurse on duty at all times.
B.
Administration.
(1) The nursing services shall be directed by
a professional registered nurse with appropriate education and experience to
direct the service. A professional registered nurse with administrative
authority shall be designated to act in the absence of the director of the
nursing services. Appropriate administrative staffing shall be provided on all
shifts.
(2) There shall be a
written plan showing the flow of authority throughout the nursing service, with
delineation of the responsibilities and duties of each category of nursing
staff.
(3) The delineation of
responsibilities and duties for each category of the nursing staff shall be in
the form of a written job description for each category.
C.
Staffing.
(1) An adequate number of professional
registered nurses shall be on duty at all times to meet the nursing care needs
of the patients. There shall be qualified supervisory personnel for each
service or unit to ensure adequate patient care management.
(2) The number of nursing personnel for all
patient care services of the hospital shall be consistent with the nursing care
needs of the hospital's patients.
(3) The staffing pattern shall ensure the
availability of professional registered nurses to assess, plan, implement and
direct the nursing care for all patients on a 24-hour basis.
D.
Patient Care.
(1) Care planning:
(a) All nursing care shall be planned and
directed by professional registered nurses. A professional registered nurse
shall be on duty and immediately available to give direct patient care when
needed.
(b) A professional
registered nurse shall be available at all times to render direct care in the
facility.
(2) Care
determinants:
(a) A professional registered
nurse shall assign the nursing care of each patient to other nursing personnel
in accordance with the patient's needs and the preparation and competence of
the available nursing staff.
(b)
The ratio of licensed nursing personnel to patients shall be determined by the
acuity of patients, the patient census, and complexity of care that must be
provided.
(c) A professional
registered nurse shall plan, supervise and evaluate the care of all patients,
including the care assigned to licensed practical/vocational nurses and
non-licensed care givers.
(d) There
shall be other nursing personnel in sufficient numbers to provide nursing care
not requiring the services of a professional registered nurse.
(3) Special care units: Areas
providing specialized nursing care shall be well defined by policies and
procedures specific to the nursing services provided. These areas may include,
but shall not be limited to, intensive care, coronary care, obstetrics,
nursery, renal units, burn units, and emergency rooms.
(a) Specific policies and procedures shall
supplement basic hospital nursing policies and procedures. Nursing policies and
procedures of special care units shall keep pace with best practice and new
knowledge and shall include but not be limited to: protocols for resuscitation
and disaster situations, immediate availability of emergency equipment and
drugs, appropriate and safe storage of pharmaceuticals and biologicals,
programs for maintenance and safe operation of all equipment, appropriate
infection-control measures, control of visitors and non-essential personnel,
and documentation of quality improvement.
(b) Special-care unit nursing services shall
be integrated with other hospital departments and services.
(c) Supervision of nursing care in the unit
shall be provided by a professional registered nurse with relevant education,
training, experience, and demonstrated current competence.
(d) All nursing personnel shall be prepared
for their responsibilities in the special-care unit through appropriate
orientation, ongoing in-service training, and continuing education programs.
Each hospital shall have a planned, formal training program for all nurses and
shall be of sufficient duration and substance to cover all patient-care
responsibilities in the special care unit.
E.
Staff Qualifications.
(1) Individuals selected for the nursing
staff shall be qualified by education, experience, and current competence for
the positions to which they are appointed.
(2) The education and experience
qualifications of the director of nursing supervisors, and other medical
professionals shall be commensurate with the scope and complexity of the
services of the hospital.
(3) The
functions and qualifications of nursing personnel shall be clearly defined in
relation to the duties and responsibilities delegated to them.
(4) Personnel records, including application
forms and verifications of current licensure and credentials, shall be on
file.
(5) Nursing management shall
make decisions about the selection and promotion of nursing personnel based on
their qualifications and capabilities and shall recommend the termination of
employment when necessary.
(6)
Approval: There shall be a policy and procedure to ensure that hospital nursing
personnel for whom registration, a license or other approval is required by law
shall have valid and current registration, licensure or other
approval.
(7) There shall be a
policy and procedure governing the qualifications and selection of nursing
personnel during periods of disaster and emergency.
F.
Evaluation and Review of Nursing
Care: There shall be a review and evaluation of the nursing care
provided for patients. There shall be written nursing care procedures and plans
of care.
(1) Responsible staff: A licensed
professional registered nurse shall plan, supervise, and evaluate the nursing
care for each patient.
(2) The
director of nursing is responsible for the effective use of care plans by the
nursing staff.
(3) Nursing care
plan: Nursing care plans shall be kept current. Plans shall indicate nursing
care needed, how it is to be accomplished, and methods, approaches, and
modifications necessary to obtain best results for patients.
(4) Nursing notes: Nursing notes shall be
legible, informative and descriptive of the nursing care given and include
information and observations of significance so that they contribute to the
continuity of patient care.
G.
Orientation and In-Service.
(1) There shall be a comprehensive and
thorough employee orientation program for all nursing services
personnel.
(2) The facility shall
provide orientation to nursing services personnel before they provide care to
patients.
H.
Hospital Relationships.
(1) General:
The nursing service shall have well-established working relationships with the
medical staff and with other hospital staff that provide and contribute to
patient care.
(2) Policies: Written
policies and procedures affecting nursing services shall be developed and
reviewed with the participation of the director of nursing or designee, in
consultation with other appropriate health professionals and administration.
The governing body shall approve the policies. The nursing service shall be
represented on hospital committees that affect patient care policies and
practices.
I.
Documentation, Staff Meetings and Evaluation.
(1) Nursing care policies and procedures that
reflect optimal standards of nursing practice shall be written and approved,
and shall be reviewed and revised as necessary to keep pace with current
knowledge. Written nursing care policies and procedures shall be available on
each nursing unit.
(2) There shall
be a written nursing care plan for each patient, which shall include the
elements of assessment, planning, intervention and evaluation.
(3) Documentation of nursing care shall be
pertinent and concise and shall describe patient status needs, problems,
capabilities and limitations. Nursing intervention and patient response shall
be noted.
(4) Meetings of the
nursing staff shall be held at least once every two months to discuss patient
care, nursing services problems and administrative policies. Minutes of all
meetings shall be kept and shall be available to all staff members.
(5) The nursing services director shall
ensure that there is ongoing review and evaluation of the nursing care provided
for patients and shall assure that nursing care standards and objectives are
established and met. If the nursing department is decentralized into clinical
departmental services or clinical programs are established, there shall be one
administrator to whom the nursing directors shall be accountable and who has
the responsibility to assure one standard of nursing practice within the
organization.
J.
Additional Patient Care Requirements.
(1) In this subsection, "circulating nurse"
means a professional registered nurse who is present during an operation to
provide emotional support to the patient, assist with the anesthesia induction,
and throughout the surgical procedure or delivery, coordinate the activities of
the room, monitor the traffic in the room, maintain an accurate account of
urine and blood loss, and who, before the surgical procedure or delivery is
completed, informs the recovery rooms of specials needs and ensures that the
sponge, needle and instrument counts have been done according to hospital
policy.
(2) Obstetrical: Every
patient admitted in labor shall be assessed initially by a professional
registered nurse or physician.
(3)
Surgical:
(a) A professional registered nurse
shall supervise the operating room(s).
(b) A qualified professional registered nurse
shall function as the circulating nurse in the surgical and obstetrical room
whenever general anesthesia is used and on all local anesthesia cases involving
a high degree of patient risk. Individual surgical technologists and licensed
practical nurses may function as assistants under the direct supervision of a
qualified professional registered nurse.
(4) Temporary nursing personnel:
(a) When contract nursing personnel from
outside registries or agencies are used by the hospital, the nursing services
shall have a means for evaluating the credentials and competence of these
personnel. Contract nursing personnel shall function under the direction and
supervision of a qualified professional registered nurse from the hospital
nursing staff. The temporary nursing personnel shall have an orientation to the
facility.
(b) If private duty
nursing personnel are employed by the patients, the nursing department shall
ensure the private duty nursing agency has a means for evaluating the
credentials and competence of these personnel. The hospital shall have policies
regarding use of these personnel in the facility.
(5) Medications: Only the following shall be
permitted in accordance with the Nurse Practice Act and the requirements of the
board of nursing:
(a) a professional
registered nurse may pass medications;
(b) a licensed practical nurse or a student
nurse in an approved school of nursing under the supervision of a licensed
professional registered nurse may pass medications;
(c) medications may not be prepared by
nursing personnel on one shift for administration during succeeding
shifts;
(d) medication
administration may not be delegated to unlicensed personnel.;
(6) Reporting: The hospital shall
have effective policies and procedures for reporting transfusion reactions,
adverse drug reactions, accidents and medication errors. The medical staff
shall review summary reports of these reactions, accidents and errors at least
quarterly.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.