Section 59A-4.108 - Nursing Services(1) The Administrator of each nursing home must designate one registered nurse as a Director of Nursing (DON) who shall be responsible and accountable for the supervision and administration of the total nursing services program. When a Director of Nursing is delegated institutional responsibilities, a full time qualified registered nurse (RN), as defined in Chapter 464, F.S., must be designated to serve as Assistant Director of Nursing. In a facility with a census of 121 or more residents, an RN must be designated as an Assistant Director of Nursing.(2) Persons designated as Director of Nursing or Assistant Director of Nursing must serve only one nursing home facility in this capacity, and shall not serve as the administrator of the nursing home facility.(3) The Director of Nursing must designate one licensed nurse on each shift to be responsible for the delivery of nursing services during that shift.(4) In accordance with the requirements outlined in subsection 400.23(3)(a), F.S., the nursing home licensee must have sufficient nursing staff, on a 24-hour basis to provide nursing and related services to residents in order to maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care.(5) In multi-story, multi-wing, or multi-station nursing home facilities, there must be a minimum of one nursing services staff person who is capable of providing direct care on duty at all times on each floor, wing, or station.(6) No nursing services staff person shall be scheduled for more than 16 hours within a 24 hour period, for three consecutive days, except in an emergency. Emergencies shall be documented and must be for a limited, specified period of time.(7) Upon approval by the Agency, a nursing home licensee may allow a licensed nurse that performs both licensed nursing and certified nursing assistant duties during the same shift to divide the hours of patient care provided between the licensed nurse and certified nursing assistant staffing ratio requirements consistent with services provided, as referenced in Section 400.23(3)(a)4., F.S. Approval to utilize licensed nurses to perform certified nursing assistant duties must be requested in writing. This request may be submitted upon license renewal on the Health Care Licensing Application, Nursing Homes, AHCA Form 3110-6001, July 2014, incorporated by reference in paragraph 59A-4.103(1)(a), F.A.C. or by letter from the facility administrator. The Agency's approval depends upon review of the last three years' inspections from the date of the request to determine if there were deficiencies cited related to staffing. The licensee must document daily the time the licensed nurse performed personal care services to comply with minimum staffing requirements. The hours of a licensed nurse with dual job responsibilities may not be counted twice.Fla. Admin. Code Ann. R. 59A-4.108
Rulemaking Authority 400.23 FS. Law Implemented 400.141, 400.23 FS.
New 4-1-82, Amended 4-1-84, 8-1-85, 7-1-88, 7-10-91, Formerly 10D-29.108, Amended 4-18-94, Amended by Florida Register Volume 41, Number 236, December 8, 2015 effective 12/21/2015.New 4-1-82, Amended 4-1-84, 8-1-85, 7-1-88, 7-10-91, Formerly 10D-29.108, Amended 4-18-94, 12-21-15.