US · guidance
CMS SOM App. A, Tag A-0385
§482.23 Condition of Participation: Nursing Services
The hospital must have an organized nursing service that provides 24-hour nursing
services. The nursing services must be furnished or supervised by a registered nurse.
Interpretive Guidelines §482.23
The hospital must have an organized nursing service and must provide on premise nursing
services 24 hours a day, 7 days a week with at least 1 registered nurse (RN) furnishing or
supervising the service 24 hours a day, 7 days a week (Exception: small rural hospitals operating
under a waiver as discussed in §482.23(b)(1)).
The Social Security Act (SSA) at §1861(b) states that nursing services must be furnished to
inpatients and furnished by the hospital. The SSA at §1861(e) further requires that the hospital
have a RN on duty at all times (except small rural hospitals operating under a nursing waiver).
The nursing service must be a well-organized service of the hospital and under the direction of a
registered nurse.
The nursing service must be integrated into the hospital-wide QAPI program.
Survey Procedures §482.23
• Determine if the nursing service is integrated into the hospital-wide QAPI program.
• Interview the director of the service. Request the following items:
○ Organizational chart(s) for nursing services for all locations where the hospital
provides nursing services;
○ Job or position descriptions for all nursing personnel including the director’s position
description.
• Select at least one patient from every inpatient care unit. Observe the nursing care in
progress to determine the adequacy of staffing and to assess the delivery of care. Other
sources of information to use in the evaluation of the nursing services are: nursing care
plans, medical records, patients, family members, accident and investigative reports,
staffing schedules, nursing policies and procedures, and QAPI activities and reports.
Interview patients for information relative to the delivery of nursing services.
History
Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08
Provenance
- Source
- cms.gov
- Retrieved
- 2026-07-22
- Edition
- som-2026-07-22
- Content hash
7cec000e60f74d57fdea3e4fab999c7f0d532d5a2fdcb03fbfd804c03c972287
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