| (a) A facility shall have personnel qualified to operate
emergency equipment and to provide emergency care to patients that
is on site and available at all times.
(b) A facility shall comply with the following nursing
services staffing and training requirements.
(1) There shall be an organized nursing service under
the direction of a qualified registered nurse (RN). The facility shall
be staffed to ensure the nursing needs of all patients are met.
(2) There shall be a written plan of administrative
authority for all nursing services with responsibilities and duties
of each category of nursing personnel delineated and a written job
description for each category. The scope of nursing services shall
be limited to nursing care rendered to patients as authorized by Texas
Occupations Code Chapter 301 (relating to Nurses).
(A) The responsible individual for nursing services
shall be a qualified RN whose responsibility and authority shall be
clearly defined and shall include supervision of both personnel performance
and patient care.
(B) There shall be a written delineation of functions,
qualifications, and patient care responsibilities for all categories
of nursing personnel.
(C) Nursing services shall be provided in accordance
with current recognized standards or recommended practices.
(3) There shall be an adequate number of RNs on duty
to meet minimum staff requirements, including supervisory and staff
RNs, to ensure the immediate availability of an RN for emergency care
or for any patient when needed.
(4) There shall be other nursing personnel in sufficient
numbers to provide nursing care not requiring the service of an RN.
An RN shall assign the nursing care of each patient to other nursing
personnel in accordance with the patient's needs and the preparation
and qualifications of the nursing staff available.
(5) An RN qualified, at a minimum, with current certification
in advanced cardiac life support and pediatric advanced life support
shall be on duty at the facility at all times whenever patients are
present in the facility.
(6) All direct care staff members shall maintain current
certification and competency in basic cardiac life support.
(7) The facility shall establish a nursing peer review
committee to conduct nursing peer review, to the extent required by
Texas Occupations Code Chapter 303 (relating to Nursing Peer Review).
(c) In addition to meeting the requirements for nursing
staff under subsection (b) of this section, a facility shall comply
with the following minimum staffing requirements:
(1) A facility that provides only topical anesthesia,
local anesthesia, or minimal sedation shall have a second individual,
who is trained and currently certified in basic cardiac life support,
on duty at the facility until all patients have been discharged from
the facility.
(2) A facility that provides moderate sedation or analgesia
shall have the following additional staff:
(A) a second individual, who is trained and currently
certified in basic cardiac life support, on duty at the facility until
all patients have been discharged from the facility; and
(B) an individual trained and currently certified in
advanced cardiac life support and pediatric advanced life support,
until all patients have been discharged.
(3) A facility that provides deep sedation or analgesia
or regional anesthesia shall have the following additional staff:
(A) a second individual, who is trained and currently
certified in basic cardiac life support, on duty at the facility until
all patients have been discharged from the facility; and
(B) an individual who is trained and currently certified
in advanced cardiac life support and pediatric advanced life support,
on duty and sufficiently free of other duties to enable the individual
to respond rapidly to emergency situations, until all patients have
been discharged.
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