| (a) Nursing services in treatment plan. A hospital
shall provide nursing services to a patient in accordance with a treatment
plan developed in accordance with §568.61 of this subchapter
(relating to Inpatient Mental Health Treatment and Treatment Planning).
(b) Organization of nursing staff. The hospital shall
have a written description of the organizational hierarchy and responsibilities
of the nursing staff.
(c) Director of psychiatric nursing (DPN). A hospital
shall have a DPN who:
(1) has administrative authority over the nursing staff;
(2) directs, monitors, and evaluates the nursing services
provided;
(3) for a hospital licensed under Texas Health and
Safety Code Chapter 577 and Chapter 510 of this title (relating to
Private Psychiatric Hospitals and Crisis Stabilization Units), reports
directly to the administrator; and
(4) for an identifiable mental health services unit
in a hospital licensed under Texas Health and Safety Code Chapter
241, and 25 TAC Chapter 133 (relating to Hospital Licensing), reports
directly to the chief nursing officer as described in 25 TAC §133.41
(relating to Hospital Functions and Services) or reports directly
to a registered nurse (RN) who reports directly to the chief nursing
officer.
(d) Qualifications of DPN. The DPN shall be:
(1) an RN with a master's degree in psychiatric-mental
health from a nursing education program accredited by an organization
recognized by the U.S. Commission of Education and Council for Higher
Education Accreditation as an accreditation agency, such as the National
League for Nursing or the Commission on Collegiate Nursing Education;
(2) an RN with a bachelor's degree in nursing and a
master's degree in a health-related field from an accredited college
or university and have three years of experience as a full-time employee
or contractor (or its equivalent as a part-time employee or contractor)
as an RN in a hospital; or
(3) an RN with a bachelor's degree in nursing and:
(A) have three years of experience as a full-time employee
or contractor (or its equivalent as a part-time employee or contractor)
as an RN in a hospital; and
(B) receive four hours per month of clinical consultation
from an RN with:
(i) a master's degree in psychiatric-mental health
from a nursing education program accredited by an organization recognized
by the U.S. Commission of Education and Council for Higher Education
Accreditation as an accreditation agency, such as the National League
for Nursing or the Commission on Collegiate Nursing Education; or
(ii) a bachelor's degree in nursing and a master's
degree in a health-related field from an accredited college or university.
(e) Assessment. An RN shall conduct and complete an
initial comprehensive nursing assessment of a patient within eight
hours of the patient's admission.
(f) Reassessment. An RN shall reassess a patient, based
on the patient's needs, but at least every 12 hours after the initial
comprehensive nursing assessment, required by subsection (e) of this
section, is conducted.
(g) Staffing plan.
(1) The DPN shall develop and implement a written staffing
plan that:
(A) describes the number of RNs, licensed vocational
nurses (LVNs), and unlicensed assistive personnel (UAPs) on each unit
for each shift;
(B) provides for at least one RN to be physically present
and on-duty at all times on each unit when a patient is present on
the unit;
(C) if the hospital has only one unit, in addition
to the RN required by subparagraph (B) of this paragraph, provides
for at least two staff members who provide direct patient care to
be physically present and on-duty at all times on the unit when a
patient is present on the unit; and
(D) provides for an adequate number of registered nurses
on each unit to supervise all UAPs.
(2) The staffing plan described in paragraph (1) of
this subsection shall be based on the following factors:
(A) the number of patients;
(B) the characteristics of the patients, including
the intensity of the patient's emotional, mental, and medical needs;
(C) the anticipated admissions, discharges and transfers;
(D) the architecture of the unit, including geographic
dispersion of patients, arrangement of the unit and surveillance and
communication technology;
(E) the expertise of the nursing staff;
(F) the nursing staff's familiarity with the patients;
(G) nursing staff continuity and cohesion;
(H) the amount of time required by the nursing staff
to perform administrative activities; and
(I) recommendations of the advisory committee regarding
the adequacy of the staffing plan made in accordance with §568.144(b)(3)
of this chapter (relating to Advisory Committee for Nurse Staffing).
(3) The DPN shall document the DPN's determinations
made about each factor described in paragraph (2) of this subsection,
at the time the staffing plan is developed and when the staffing plan
is revised based on a change in such factors.
(4) A hospital shall retain the staffing plan and the
documentation required by paragraph (3) of this subsection, for two
years after such documentation is created.
(5) The DPN shall revise the staffing plan, as necessary.
(6) The DPN shall report to the advisory committee
established in accordance with §568.144 of this chapter (relating
to Advisory Committee for Nurse Staffing) any variance between the
number of staff members specified in the staffing plan and the actual
number of staff members on duty.
(h) Process for reporting concerns regarding staffing
plan.
(1) A hospital shall develop and implement a process
for RNs and LVNs to report concerns regarding the adequacy of the
staffing plan to the advisory committee established in accordance
with §568.144 of this chapter.
(2) A hospital shall not retaliate against a nurse
for reporting a concern to the advisory committee.
(i) Orientation of nursing staff.
(1) A hospital shall provide orientation to a nursing
staff member when the staff member is initially assigned to a unit
on either a temporary or long-term basis. The orientation shall include
a review of:
(A) the location of equipment and supplies on the unit;
(B) the staff member's responsibilities on the unit;
(C) relevant information about patients on the unit;
(D) relevant schedules of staff members and patients;
and
(E) procedures for contacting the staff member's supervisor.
(2) A hospital shall document the provision of orientation
to nursing staff.
(j) Verification of licensure. A hospital shall verify
that a member of the nursing staff for whom a license is required
has a valid license at the time the staff member assumes responsibilities
at the hospital and maintains the license throughout the staff member's
employment or association with the hospital.
(k) Mandatory overtime. A hospital shall develop and
implement a policy regarding the use of mandatory overtime by the
nursing staff. The policy shall require:
(1) documentation of the justification for the use
of mandatory overtime;
(2) monitoring and evaluation of the use of mandatory
overtime; and
(3) development of a plan to reduce or eliminate the
use of mandatory overtime.
(l) The hospital shall establish a nursing peer review
committee to conduct nursing peer review, as required by Texas Occupations
Code Chapter 303.
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