(a) Organization.

1. (1) The center shall be organized to ensure twenty-four-hour registered nurse coverage as needed.
2. (2) A physician, certified nurse midwife, and/or registered nurse shall be available and onsite for patient care during the entire time a patient is in the center.
3. (3) Services during labor and delivery shall be provided under protocols developed by the clinical staff and approved by the governing body in accordance with accepted standards of care.
4. (4) Authority and responsibilities of all patient care staff shall be clearly defined in written policies.

5. (5)

   1. (A) Services shall be organized to ensure that management functions are effectively conducted.
   2. (B) These functions shall include but are not limited to:

(i) Development and implementation of policies and procedures related to patient care;

1. (ii)

(b) (b) The first page of each manual shall have the:

1. (1) (1) Review date; and

2. (2) (2) Approval signatures of the person or persons conducting the review;

   1. (iii) Establishment of a mechanism for review and evaluation of care and services provided at the center;

      1. (iv) Orientation and maintenance of qualified staff for provision of care;
      2. (v) Provisions for staff development, including at least twelve (12) in-service education programs for professional staff annually; and
      3. (vi) Provisions for current nursing literature and reference materials.

3. (6) Patients shall have access to twenty-four-hour telephone consultation with either a:

   1. (A) Registered nurse;
   2. (B) Certified nurse midwife; or
   3. (C) Physician.

(b) Qualifications.

1. (1)

   1. (A) The certified nurse midwife shall provide documentation of current licensure as required by the Arkansas State Board of Nursing.
   2. (B) The documentation shall be maintained as part of the credential file for that person.
2. (2) Licensed nursing personnel shall practice in accordance with the Nurse Practice Act, Arkansas Code § 17-87-101 et seq.
3. (3) Documentation of current licensure shall be maintained for all nursing personnel who practice in the center.

4. (4) All clinical staff of the center shall be required to provide documentation of training and continued competence in adult and Neonatal Resuscitation Programs or their equivalents.

   1. (c) Staffing.
5. (1) A physician, certified nurse midwife, or registered nurse with demonstrated competencies in labor and delivery shall be required to deliver one to one (1:1) care during labor, delivery, and postdelivery until both mother and newborn are stable.

6. (2) There shall be adequate numbers of professional and support staff on duty and on call to meet the patient’s needs:

   1. (A) For services routinely provided;
   2. (B) During periods of high demand or emergency;
   3. (C) To ensure patient safety and satisfaction; and
   4. (D) To ensure that no patient in active labor is unattended.

7. (3) During the second stage of labor, two to one (2:1) patient care is required, with:

   1. (A) One (1) of the clinical staff being a physician or certified nurse midwife; and
   2. (B) The other being a registered nurse.
8. (4) Clinical staff who have demonstrated ability to perform neonatal and adult resuscitation procedures shall be present during each birth.