|(a) The ratio of licensed nurses to residents must
be sufficient to meet the needs of the residents.
(1) At a minimum, the facility must maintain a ratio
(for every 24-hour period) of one licensed nursing staff person for
each 20 residents or a minimum of .4 licensed-care hours per resident
day. To determine licensed-care hours per resident day, multiply the
number of licensed nurses by the number of hours they work in a single
day and divide the product by the number of residents in the facility.
Three nurses working eight-hour shifts is 24 hours, divided by 60
residents, equals .4 licensed-care hours per resident day.
(2) Licensed nurses who may be counted in the ratio
include, but are not limited to, director of nursing, assistant directors
of nursing, staff development coordinators, charge nurses, and medication/treatment
nurses. These licensed nurses may be counted subject to the limitations
of paragraphs (3) and (4) of this subsection.
(3) Staff, who also have administrative duties not
related to nursing, may be counted in the ratio only to the degree
of hours spent in nursing-related duties.
(4) If a multi-level facility (nursing facility or
Medicare SNF) has one director of nursing over the entire facility,
he may not be counted in the nursing ratio. A director of nursing
for a single distinct part may be counted in the ratio for the distinct
(b) A graduate vocational nurse who has a temporary
work permit must work under the direction of a licensed vocational
nurse, registered nurse, or licensed physician who is physically present
in the facility. The graduate nurse who has a temporary work permit
must work under the direction of a registered nurse until registration
has been achieved.
(c) If the facility uses licensed temporary nursing
personnel, the temporary personnel must have the same qualifications
that permanent facility employees do. If temporary personnel are used
for afternoon or night shifts, a full-time, licensed nurse must be
on call and immediately available by telephone. The on-call nurse
must be a registered nurse unless the facility has a current waiver
from DHS and is not required to provide daily RN coverage.
(d) Consultative pediatric nursing services must be
available to facility staff if the facility has a pediatric resident.
|Source Note: The provisions of this §554.1002 adopted to be effective May 1, 1995, 20 TexReg 2393; amended to be effective October 30, 2011, 36 TexReg 7174; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871