PURPOSE: This rule describes the course of instruction and training that may be prescribed by the board under the authority as set forth in section 344.030.1., RSMo.

1. (1) Applicants who do not otherwise qualify for examination shall complete one of the following courses of instruction and training. The formal instruction shall be coursework qualifying for academic credit, completed with a grade of not less than “C.” A portion of the formal instruction may be from an intensive and comprehensive seminar of at least forty (40) clock hours specific to nursing home administration which has been approved by the board. An applicant who has completed—

   1. (A) A high school education or the equivalent, must complete three hundred fifteen

2. (315) clock hours of formal instruction and a minimum of two thousand (2,000) clock hours of internship;

   1. (B) A licensed practical nurse program, must complete two hundred twenty-five (225) clock hours of formal instruction and a minimum of eight hundred (800) clock hours of internship;
   2. (C) An associate degree, must complete six hundred forty (640) clock hours of internship;
   3. (D) A three (3) year diploma program or a baccalaureate of science (BS)/baccalaureate of arts (BA), must complete five hundred

3. (500) clock hours of internship; or

   1. (E) A masters or beyond, must complete five hundred (500) clock hours of internship.
4. (2) The course of instruction and training shall follow the core of knowledge areas and other subject matter as deemed necessary by the board to properly prepare an applicant for health care administration. The core of knowledge shall include, but shall not be limited to, the following subject areas:
5. (A) Nursing and Physician Services:
6. 1. Restorative nursing;
7. 2. Rehabilitation;
8. 3. Definition, concept and procedures of nursing;
9. 4. Skin and wound care;
10. 5. Infection control procedures;
11. 6. Drug administration and drug effects;
12. 7. Disease recognition and process;
13. 8. Quality assurance;
14. 9. Physician’s role in the facility; and
15. 10. Physician/resident relationships;
16. (B) Social Services:
17. 1. Resident rights;
18. 2. Living wills and advance directives;
19. 3. Social, emotional, religious, and financial needs of the resident;
20. 4. Family counsel and consultation;
21. 5. Grieving process;
22. 6. Death and dying;
23. 7. Communication with the resident; and
24. 8. Ombudsman program;
25. (C) Food Services:
26. 1. Proper nutrition;
27. 2. Therapeutic diets; and
28. 3. Resident satisfaction;
29. (D) Social and Therapeutic Recreational Activities:
30. 1. Needs of the resident;
31. 2. Community resources;
32. 3. Rehabilitation services;
33. 4. Volunteers and auxiliaries; and
34. 5. Chemical dependency of the resident;
35. (E) Medical Recordkeeping:
36. 1. Medical records systems;
37. 2. Appropriate charting and documentation; and
38. 3. Evaluation and revision of care plans;
39. (F) Pharmaceutical Services:
40. 1. Proper drug handling and control;
41. 2. Proper drug dispensing; and
42. 3. Drug interactions;
43. (G) Personnel Management:
44. 1. Maintaining a positive atmosphere;
45. 2. Grievance procedures;
46. 3. Effective communication;
47. 4. Evaluation procedures;
48. 5. Recruitment of staff;
49. 6. Interviewing candidates;
50. 7. Selecting future employees;
51. 8. Staff development and training;
52. 9. Personnel policies and procedures;
53. 10. Health and safety; 11 Departmental organization and management;
54. 12. Professional ethics and conduct;
55. 13. Total quality management; and
56. 14. Health care reform;
57. (H) Financial Management:
58. 1. Budgeting;

59. 2. Marketing principles;

    1. 3. Asset management; and
    2. 4. Accounting;

    3. (I) Marketing and Public Relations:

       1. 1. Public relation principles;
       2. 2. Marketing principles;
       3. 3. Newsletters;
       4. 4. Community and social organizations;

and

1. 5. Working with the media;

2. (J) Physical Resource Management:

   1. 1. Building and grounds management;
   2. 2. Environmental services;
   3. 3. Safety procedures and programs; and
   4. 4. Fire and disaster plans; and

3. (K) Laws, Regulatory Codes and Governing Boards:

   1. 1. Medicare and Medicaid;
   2. 2. Omnibus Budget Reconciliation Act

(OBRA);

1. 3. Occupational Safety and Health

Administration (OSHA);

1. 4. Americans With Disabilities Act

(ADA);

1. 5. Life safety;
2. 6. Legislative process;
3. 7. Board responsibilities; and
4. 8. By-laws.

1. (3) The course of instruction and training shall include instruction in the services which must be provided in nursing homes, the protection of the rights and interests of the residents and the elements of good nursing home administration as well as other subject matter as deemed necessary by the board to properly prepare that applicant for nursing home administration.
2. (4) Instruction and training prescribed by the board shall be recognized as meeting the requirements of this rule only if it is offered by an accredited educational institution or affiliate which has been duly registered with the Missouri Board of Nursing Home Administrators.

3. (5) Internships as required by section (1) shall be under the direct supervision of a licensed nursing home administrator approved and designated as a preceptor by the Missouri Board of Nursing Home Administrators. An administrator may be approved and designated as a preceptor for a period of two (2) years, if s/he—

   1. (A) Has been licensed and employed as a Missouri nursing home administrator for at least thirty-six (36) months immediately prior to application to become a preceptor;
   2. (B) Is currently serving as the administrator of a duly licensed intermediate care facility (ICF), skilled nursing facility (SNF), or a Residential Care Facility (RCF) II with sixty

4. (60) or more beds;

   1. (C) Is an administrator of an ICF, SNF, or RCF II with sixty (60) or more beds which is in substantial compliance with the rules governing nursing homes; and
   2. (D) Has not been the subject of any action by any board of nursing home administrators or licensing authority which resulted in discipline, including but not limited to, formal reprimand, probation, suspension or revocation of license or privileges as a nursing home administrator; and
   3. (E) Has successfully completed a board approved preceptor training program. Nursing home administrators who are approved and designated as a preceptor prior to the effective date of this amendment, shall not have to complete a board-approved preceptor training program until reapplication is made after the current approval period expires.

5. (6) Designated preceptors shall request in writing board approval to conduct an internship for an applicant who has been found not qualified for licensure by the board, based upon 13 CSR 73-2.041. Approval may be granted by the board if the preceptor—

   1. (A) Is not related to the intern within the fourth degree of consanguinity;
   2. (B) Agrees to give the intern an opportunity to observe and take part in the managerial tasks of the preceptor;
   3. (C) Will acquaint the intern with the organization and operation of all the various departments of the facility by permitting his/her observation and/or participation in department activities;
   4. (D) Will hold an exit interview with the intern upon completion of an internship to point out noted strengths and weaknesses; and
   5. (E) Upon satisfactory completion of the internship will prepare and return to the board office the mandatory form certifying the completion of the required hours of internship.
6. (7) The board, for good cause, may refuse to approve or renew a preceptor designation or may refuse to approve an assignment of an intern to a preceptor.
7. (8) A preceptor may supervise no more than one (1) intern concurrently.
8. (9) Internships shall be completed within nine
9. (9) months of completion of classroom or other formal instruction unless approved by the board.
10. (10) A portion of an internship may be completed in a duly licensed RCF II with sixty

11. (60) or more beds if the intern desires experience in an RCF II. The maximum hours of internship that may be served in such an RCF II are designated as follows. Applicants may complete up to—

    1. (A) 667 clock hours if 2000 clock hours are required by the board;
    2. (B) 267 clock hours if 800 clock hours are required by the board;
    3. (C) 214 clock hours if 640 clock hours are required by the board; or
    4. (D) 167 clock hours if 500 clock hours are required by the board.
12. (11) Each day of an internship experience shall include at least one (1) four (4)-hour block of time within the primary working hours of the administrator.

AUTHORITY: section 344.070, RSMo Supp. 1997.* Original rule filed May 13, 1980, effective Aug. 11, 1980. Amended: Filed April 14, 1983, effective July 11, 1983. Amended: Filed Oct. 16, 1985, effective March 14, 1986. Amended: Filed Oct. 1, 1987, effective Jan. 14, 1988. Amended: Filed Jan. 3, 1992, effective May 14, 1992. Amended: Filed July 14, 1993, effective Jan. 13, 1994. Amended: Filed June 30, 1994, effective Feb. 1, 1995. Amended: Filed May 15, 1995, effective Nov. 30, 1995. Amended: Filed April 30, 1998, effective Oct. 30, 1998. *Original authority: 344.070, RSMo 1969, amended 1979, 1993, 1995.