Or. Admin. Code § 411-086-0100 - Nursing Services: Staffing
(1)
STAFFING PLAN.
(a) The facility must have and
implement a written plan that:
(A) Ensures
staffing sufficient to meet the minimum staffing requirements described in
sections (3), (4), and (5) of this rule;
(B) Ensures staffing sufficient to meet the
needs of each resident; and
(C)
Identifies procedures to obtain required staff when absences
occur.
(b) The facility
must maintain a written, weekly staffing schedule showing the number and
category of staff assigned to each shift and the person to be called in the
event of any absence.
(2) DAILY STAFF PUBLIC POSTING.
(a) The facility must have the number of
on-duty nursing staff publicly posted 24 hours each day using form SDS 0717 and
the Nursing Assistant (NA) Staff Ratio Chart form SDS 0717A.
(A) The posted forms must be prominently
displayed in a public area and readily accessible to residents and visitors as
described in OAR 411-085-0030(1)(b).
(B) The posted forms must be at least 8.5 x
14 inches and printed in a minimum font size of 16.
(C) The staffing information must be an
accurate reflection of the actual staff working each shift.
(b) The posted staffing forms must
include:
(A) Facility name;
(B) Current date;
(C) Current resident census per
shift;
(D) The total number and
actual hours worked by registered nurses (RNs), licensed practical nurses
(LPNs), and nursing assistants (CNAs and NAs) directly responsible for resident
services per shift; and
(E) The
minimum staffing standard, nursing assistant to resident ratio, referenced in
section (5)(c) of this rule.
(c) Upon oral or written request, the
facility must make direct care staffing data available to the public for review
at a cost not to exceed the community standard.
(d) The facility must maintain the posted
nurse staffing data for a minimum of 18 months.
(3) MINIMUM STAFFING, GENERALLY. Resident
service needs must be the primary consideration in determining the number and
categories of nursing personnel needed. Nursing staff must be sufficient in
quantity and quality to provide nursing services for each resident as needed,
including restorative services that enable each resident to achieve and
maintain the highest practicable degree of function, self-care, and
independence, as determined by the resident's care plan. Such staffing must be
provided even though it exceeds other requirements specified by this rule or
specified in any waiver.
(4)
MINIMUM LICENSED NURSE STAFFING.
(a) Licensed
nurse hours must include no less than one RN hour per resident per
week.
(b) When an RN serves as the
administrator in the temporary absence of the administrator, the RN's hours
must not be used to meet minimum nursing hours.
(c) In facilities with 41 or more beds, the
hours of a licensed nurse who serves as facility administrator must not be
included in any licensed nurse coverage required by this rule.
(d) The licensed nurse serving as a charge
nurse must not be counted toward the minimum staffing requirement under section
(5)(c) of this rule.
(e) The
facility must have a licensed charge nurse on each shift 24 hours per day.
(A) An RN must serve as the licensed charge
nurse for no less than eight consecutive hours between the start of day shift
and the end of evening shift, seven days a week.
(B) The Director of Nursing Services may
serve as the charge nurse only when the facility has 60 or fewer
residents.
(C) Section (4)(e) of
this rule may be waived by the Department of Human Services (Department). The
request for waiver must comply with OAR
411-085-0040 and must be
reviewed annually. The waiver shall be considered by the Department if the
facility certifies that:
(i) The facility has
been unable to recruit appropriate personnel despite diligent efforts,
including offering wages at the community prevailing rate for nursing
facilities;
(ii) The waiver does
not endanger the health or safety of residents; and
(iii) An RN or physician is available and
obligated to immediately respond to telephone calls from the
facility.
(5) MINIMUM CERTIFIED NURSING ASSISTANT
STAFFING.
(a) The facility must determine the
specific time frame for beginning and ending each consecutive eight-hour shift
using one of the following options:
(A) Option
1.
(i) Day shift from 5:30 a.m. to 1:30
p.m.
(ii) Evening shift from 1:30
p.m. to 9:30 p.m.
(iii) Night shift
from 9:30 p.m. to 5:30 a.m.
(B) Option 2.
(i) Day shift from 6 a.m. to 2 p.m.
(ii) Evening shift from 2 p.m. to 10
p.m.
(iii) Night shift from 10 p.m.
to 6 a.m.
(C) Option 3.
(i) Day shift from 6:30 a.m. to 2:30
p.m.
(ii) Evening shift from 2:30
p.m. to 10:30 p.m.
(iii) Night
shift from 10:30 p.m. to 6:30 a.m.
(D) Option 4.
(i) Day shift from 7 a.m. to 3 p.m.
(ii) Evening shift from 3 p.m. to 11
p.m.
(iii) Night shift from 11 p.m.
to 7 a.m.
(b)
Each resident must have assigned and be informed of the nursing assistant
responsible for his or her care and services on each shift. The numbers listed
in this rule represent the minimum staffing requirement. The numbers do not
represent sufficient nursing staff. The number of staff necessary to meet the
needs of each resident determines sufficient nursing staff.
(c) The number of residents per nursing
assistant must not exceed the following ratios:
(A) Prior to October 1, 2013:
(i) DAY SHIFT: 1 nursing assistant per 7
residents.
(ii) EVENING SHIFT: 1
nursing assistant per 11 residents.
(iii) NIGHT SHIFT: 1 nursing assistant per 18
residents.
(B) Effective
October 1, 2013 to March 30, 2014, each facility must, in addition to the
nursing assistant staff to resident ratios listed in subsection (A) of this
section, increase nursing assistant staffing to the minimum standard of 2.46
hours per resident day in a 24-hour period of time from the start of day shift
until the end of night shift seven days a week.
(C) Effective March 31, 2014:
(i) DAY SHIFT: 1 nursing assistant per 7
residents.
(ii) EVENING SHIFT: 1
nursing assistant per 9.5 residents.
(iii) NIGHT SHIFT: 1 nursing assistant per 17
residents.
(d)
Each facility must submit a quarterly staffing report to the Department using
the Department's approved method and format. The report must provide an
accurate daily account of resident census and nursing assistant staffing levels
for each shift.
(A) The facility must submit
the report to the Department no later than the end of the month immediately
following the end of each calendar quarter. (Example: For the calendar quarter
ending March 31, the report must be received no later than April 30.)
(B) The report must specify the shifts in
which the minimum staffing standards as set forth in section (5)(c) of this
rule were not met.
(C) Upon the
Department's request, the facility must provide documents to support the
quarterly staffing report, including payroll records.
(e) This rule does not prohibit nursing
assistants from providing services to a resident to whom they are not
assigned.
(f) The facility must
ensure that nursing assistants only perform those tasks for which they are
competent and qualified to perform and that are permitted by ORS chapter 678
and OAR 851-063-0030.
(g) Nursing assistants with a restricted duty
status may be counted toward meeting the minimum staffing ratio as set forth in
section (5)(c) of this rule if the nursing assistant is able to perform 90
percent of the authorized duties and responsibilities, with or without
accommodation, required by a certified nursing assistant as determined by the
Oregon State Board of Nursing (OAR
851-063-0030).
(h) The facility must ensure that a nursing
assistant is not assigned more residents than the number for which the nursing
assistant is able to meet the individual service needs.
(i) The facility must have a minimum of two
nursing staff on duty within the facility at all times.
(j) Nursing staff must be present at all
times in each detached building, distinct and segregated area including those
separated by closed doors, and on each level or floor where residents are
housed.
(k) Nursing assistants do
not include dining assistants.
(l)
Nursing assistants serving as restorative aides must not be counted toward the
minimum staffing requirement under section (5)(c) of this rule.
(m) A facility must not employ any person as
a nursing assistant for longer than four months from the date of hire without
an Oregon State Board of Nursing issued CNA 1 certification.
(n) The facility must ensure no more than 25
percent of the nursing assistants assigned to residents per shift pursuant to
section (5)(c) of this rule are uncertified nursing assistants.
(o) If an individual meets the criteria
documented in 411-070-0087, and the Department
has authorized the bariatric rate, the facility must provide one (1) additional
Certified Nursing Assistant (CNA), for each shift, above the licensing staffing
standard in OAR 411-086-0100(5),
for the third through fifth approved individuals for the bariatric rate.
Another CNA is then required, for each shift, for every additional five (5)
individuals receiving the bariatric rate. For example:
(A) For the first two (2) approved
individuals, the facility must meet the requirements in OAR
411-086-0100(3).
(B) For three (3) to five (5) approved
individuals, one (1) CNA would be required above staffing standard, for each
shift.
(C) For six (6) to ten (10)
approved individuals, two (2) CNAs would be required above staffing standard,
for each shift.
(6) CERTIFIED MEDICATION AIDES.
(a) The facility must ensure that all nursing
assistants administering non-injectable medications are certified as nursing
assistants and as medication aides. Documentation of these two certifications
must be maintained in the facility.
(b) The certified medication aide assigned to
administer medications must not be counted toward meeting the minimum staffing
requirements for direct service of residents referenced at section (5)(c) of
this rule.
Notes
Statutory/Other Authority: ORS 410.070, 410.090, 441.055, 441.073 & 441.615
Statutes/Other Implemented: ORS 410.070, 410.090, 441.055, 441.073 & 441.615
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