1. (a) Organization.

   1. (1) Nursing services shall be directed by a nurse executive who is a registered nurse qualified by advanced education and management experience.

   2. (2)

      1. (A) The nurse executive’s education and experience shall be directly related to the:

2. (i) Facility’s stated mission; and

   1. (ii) Nursing care needs of the patient population.

      1. (B) The nurse executive shall have overall authority for the development of organization-wide nursing standards, policies, and procedures that describe how patient care needs are assessed, evaluated, and met.
      2. (C) Development and implementation of the organization’s plans for providing nursing care to the patient shall be approved by the nurse executive.

      3. (D)

         1. (i) Policies, procedures, and standards shall be defined, documented, and accessible to the nursing staff in a written or electronic format.
         2. (ii) Each element shall be approved by the nurse executive or designee prior to implementation.
      4. (E) The nurse executive and nursing staff shall collaborate with appropriate governing body, medical staff, management, and other clinical leaders in developing, implementing, revising, and monitoring patient care improvement activities.
      5. (F) The nurse executive or designee shall be responsible for orienting and maintaining adequate numbers of qualified staff for patient care.

      6. (G)

         1. (i) Staff meetings shall be conducted at least monthly for the purpose of reviewing the quality of nursing care provided.
         2. (ii) Meeting minutes and attendance shall be maintained.

      7. (H) If the organization provides clinical facilities for nursing students, there shall be a written agreement that defines:

         1. (i) The facility’s responsibilities; and
         2. (ii) Responsibilities of the educational institution, including:
3. (a) (a) Supervision of students; and

4. (b) (b) Responsibilities of the instructor.

   1. (I)

      1. (i) Clinically relevant educational programs shall be conducted at regularly scheduled intervals not less than twelve (12) times per year.

         1. (ii) There shall be evidence of:
5. (a) (a) Program dates;

6. (b) (b) Attendees; and

   1. (c) (c) Subject matter.

      1. (J)

         1. (i) There shall be a continuous QA/PI program that is specific to the patient care administered.
         2. (ii) The program shall reflect nursing staff participation including reports to appropriate hospital committees.

7. (b) Qualifications.

   1. (1)

      1. (A) A current, valid license to practice nursing in Arkansas shall be held by all nurses hired in the facility as well as private duty and contract/pool nurses.
      2. (B) There shall be a procedure to ensure all licenses are current.

   2. (2) Licensed nursing personnel shall practice under:

      1. (A) The Nurse Practice Act, Arkansas Code § 17-87-101 et seq.; and
      2. (B) Current Arkansas State Board of Nursing rules.

   3. (3)

      1. (A) The qualifications required for each category of nursing staff shall be in written policy.
      2. (B) Job descriptions shall be available for review.
   4. (4) There shall be documented evidence of appropriate training for all nonlicensed staff who are assigned patient care duties.
   5. (5) The nurse executive or designee or designees participate with administration in decisions relative to the selection and promotion of nursing personnel based on qualifications and capabilities, and recommend the termination of employment when necessary.

   6. (6) All licensed nursing personnel shall be competent in life support measures.

      1. (c) Staffing.

   7. (1)

      1. (A) There shall be an adequate number of registered nurses on duty at all times and available for bedside care of any patient when needed on a twenty-four-hour basis.
      2. (B) In addition, there shall be sufficient registered nurses to staff all patient care units.

   8. (2) A registered nurse shall assign the nursing care of each patient to other nursing personnel in accordance with the:

      1. (A) Patient’s needs; and
      2. (B) Preparation and competence of the nursing staff.

   9. (3) There shall be written criteria to substantiate the assignments.

      1. (d) Evaluation and review of patient care services.

   10. (1)

       1. (A) There shall be established working relationships with other services of the hospital, both administrative and professional.

       2. (B) The factors explaining the standard are as follows:

          1. (i) Registered nurses confer with the physicians relative to patient care;
          2. (ii) Interdepartmental policies affecting patient care are made jointly with the:
8. (a) (a) Nurse executive; or

9. (b) (b) Designee or designees; and

   1. (iii) Procedures are established for scheduling laboratory and X-ray examinations, for ordering, securing, and maintaining supplies and equipment needed for patient care, and for ordering diets, etc.

   2. (2)

      1. (A) There shall be ongoing review and evaluation of nursing care provided for patients.
      2. (B) A registered nurse plans, supervises, and evaluates the nursing care for each patient in all settings where nursing care is provided.

      3. (C)

         1. (i) Each patient shall have a plan for provision of care.
         2. (ii) Each patient plan of care shall be current.
         3. (iii) Plans indicate:
10. (a) (a) Patient care required;

11. (b) (b) How it is to be accomplished; and

    1. (c) (c) The methods, approaches, goals, and modifications necessary to ensure best results for the patient.

       1. (iv) The patient’s plan of care shall be initiated upon admission.

       2. (D)

          1. (i) There shall be documentation of the nursing care provided.
          2. (ii) The following information shall be documented:
12. (a) (a) The initial patient assessment;

13. (b) (b) Date and time of treatments and/or dressing changes;

    1. (c)

    2. (1) (c)(1) Medication Administration Record (MAR) including the:

       1. (A) (A) Date, time, dosage, and manner of administration; and
       2. (B) (B) Initials of the nurse administering the medication;

    3. (2) (2) When personnel other than nursing administer medication and the MAR is not utilized, a record of that ancillary department shall:

       1. (A) (A) Comply with this requirement; and

       2. (B) (B) Be included in the medical record;

          1. (d) (d) Date, time, dosage, and manner of administration of all PRN medications to include reason for administration and results;
14. (e) (e) Bedtime and between-meal snacks or feedings and the percentage of diets consumed;
15. (f) (f) Change in patient’s appearance and/or condition;
16. (g) (g) Patient complaints; and

17. (h)

    1. (1) (h)(1) Mode of discharge and to whom the patient was discharged.
    2. (2) (2) If a patient expires, the time the physician was called, time arrived, the time the patient was pronounced dead, and the fact that relatives were present shall be recorded.

    3. (3) (3) If relatives were not present, a note shall be made regarding:

       1. (A) (A) Their notification; and
       2. (B) (B) Disposition of the patient’s belongings.

       3. (E)

          1. (i) A registered nurse shall observe each patient at least once per shift and the observations shall be documented in the patient’s medical record.
          2. (ii) Note. Block charting and cosignatures are not acceptable.

18. (e) Patient care facilities and equipment.

    1. (1)

       1. (A) There shall be no more beds maintained in the building than the number of beds for which the hospital is licensed except in the case of a public disaster or national emergency, and then only as a temporary measure.
       2. (B) Licensable hospital bed means every patient care bed with the exception of bassinets and labor beds.
    2. (2) No beds shall be made up in the hallway or on the floor except in case of emergency.
    3. (3) Children under the age of sixteen (16) years shall not be cared for in a room with an unrelated adult patient.
    4. (4) Provisions shall be made for safe storage of patients’ valuables.
    5. (5) All facilities for cleaning and storage of patient care supplies and equipment shall be used only for the purpose for which they are designed.
    6. (6) Thermometers shall not come in contact with more than one (1) patient without disinfection or proper covers.

    7. (7) All single-use equipment used by a patient shall either be:

       1. (A) Sent home with the patient at the time of discharge; or
       2. (B) Destroyed.

    8. (8)

       1. (A) Only currently dated equipment and supplies shall be available for patient care.
       2. (B) All equipment shall be kept clean and in good condition.
    9. (9) Patients that remain in observation status for a period of twenty-four (24) hours or more shall have provided to them accommodations equivalent to the accommodations they would have if they were admitted as an inpatient.

Codification Notes: “PRN” means pro re nata.