1. (a) The facility shall provide nursing services to prevent or reduce complications, maximize the patient's functional status, and educate the end stage renal disease patient, patient's family, patient's caregiver, or significant other.
2. (b) The facility shall employ a full-time supervising nurse to supervise and manage the provision of safe patient care. A facility shall not use contract staff as a full-time supervising nurse.

3. (c) The facility shall ensure a registered nurse is in the facility when patients are present in the facility.

   1. (1) The facility's governing body shall develop policies and procedures for allowing patients in the building when a registered nurse is not present and inclement weather or safety concerns exist. The policies and procedures shall require a review of any occurrence when patients are allowed in the building when a registered nurse is not present. Facility staff shall present the date of the incident, reasons, patients affected, and staff present to the facility's quality assessment and performance improvement (QAPI) committee and governing body for review and development of an appropriate plan.
   2. (2) In inclement weather or due to safety concerns, when two or more basic cardiopulmonary life support-trained staff members are in the facility, patients may enter the facility lobby in accordance with the facility's policies and procedures.

4. (d) A registered nurse shall conduct:

   1. (1) admission nursing assessments;
   2. (2) assessments of a patient upon a change in the patient's status, extended or frequent hospitalizations, or at the patient's request;
   3. (3) dialysis assessments on all patients within the first hour of treatment each time the patient receives treatment; and
   4. (4) immediate assessments if an abnormal finding or change of condition is identified pre-dialysis, intradialytic, or post-dialysis.
5. (e) A registered nurse shall participate in the interdisciplinary team review of a patient's progress and recommend changes in treatment based on the patient's current needs and facilitate communication between the patient, patient's family, and the patient's significant other, as applicable, and other interdisciplinary members, to ensure the facility delivers the necessary care.
6. (f) A registered nurse shall provide oversight and direction to dialysis technicians and licensed vocational nurses.
7. (g) A registered nurse shall participate in the facility's QAPI activities.
8. (h) A registered nurse functioning in the charge role shall be present during all dialysis treatments.
9. (i) If the facility provides pediatric dialysis, a registered nurse with experience or training in pediatric dialysis shall be available to provide care for pediatric dialysis patients smaller than 35 kilograms in weight.

10. (j) The facility shall ensure sufficient direct care staff, as defined in §507.2(26) of this chapter (relating to Definitions), are on site to meet the needs of the patients, and at least one licensed nurse is available on site for every 12 patients or portion thereof, as demonstrated in §507.60 of this subchapter (relating to Staffing Table). The nurse can be either a registered nurse (RN) or licensed vocational nurse (LVN). A registered nurse functioning in the charge role shall be present during all dialysis treatments. Each direct care staff shall only be assigned a maximum of four patients.

    1. (1) During treatment of seven or fewer patients, direct care staff shall consist of at least one registered nurse and one direct care staff, as demonstrated in §507.60 of this subchapter.
    2. (2) For one to seven patients, the direct care staff may be assigned a maximum of four patients and the charge nurse may be assigned a maximum of three patients.
    3. (3) During treatment of 8-12 patients, the registered nurse functioning as charge nurse shall not be assigned as direct care staff, as demonstrated in §507.60 of this subchapter.
    4. (4) For pediatric dialysis patients, one registered nurse shall be provided on site for each patient weighing less than 10 kilograms and one registered nurse provided on site for every two patients weighing from 10 to 20 kilograms.
11. (k) A facility shall ensure patients are in view of staff during hemodialysis treatments, and staff shall observe the patient, their access site, and their bloodline connections during the dialysis treatment.
12. (l) The facility shall include documentation in the patient's record verifying the patient was educated during treatment, upon admission, and annually on the importance of leaving their access sites uncovered.

13. (m) A licensed nurse or dialysis technician shall collect and document objective and subjective data for each patient before and after treatment, according to facility policy and the staff member's level of training.

    1. (1) The facility shall have written policies and procedures specific to the facility to guide nursing staff actions in the event a patient's condition deteriorates during treatment to identify parameters which would require a patient be referred to a nurse for evaluation.
    2. (2) A registered nurse shall conduct a patient assessment when indicated by a question relating to a change in the patient's status or at the patient's request.
14. (n) A registered nurse shall conduct the initial patient assessment before the patient's first dialysis treatment by the facility.
15. (o) This chapter does not preclude a licensed vocational nurse (LVN) from practicing in accordance with the rules adopted by the Texas Board of Nursing. If the LVN is acting in the capacity of a dialysis technician, the facility shall determine that the LVN has passed a training and competency evaluation curriculum that meets the requirements in §507.72 of this chapter (relating to Training Curricula and Instructors) and §507.73 of this chapter (relating to Competency Evaluation).
16. (p) A dialysis technician providing direct patient care shall demonstrate knowledge and competency for the responsibilities specified in §507.72 and §507.73 of this chapter.

Source Note:The provisions of this §507.48 adopted to be effective December 23, 2025, 50 TexReg 8289.