CMS SOM App. A, Tag A-0392

The nursing service must have adequate numbers of licensed registered nurses, licensed

practical (vocational) nurses, and other personnel to provide nursing care to all patients as

needed. There must be supervisory and staff personnel for each department or nursing

unit to ensure, when needed, the immediate availability of a registered nurse for care of

any patient.

Interpretive Guidelines §482.23(b)

The nursing service must ensure that patient needs are met by ongoing assessments of patients’

needs and provides nursing staff to meet those needs. There must be sufficient numbers, types

and qualifications of supervisory and staff nursing personnel to respond to the appropriate

nursing needs and care of the patient population of each department or nursing unit.

There must be a RN physically present on the premises and on duty at all times. Every inpatient

unit/department/location within the hospital-wide nursing service must have adequate numbers

of RNs physically present at each location to ensure the immediate availability of a RN for the

care of any patient.

A RN would not be considered immediately available if the RN were working on more than one

unit, building, floor in a building, or provider (distinct part SNF, RHC, excluded unit, etc.) at the

same time.

Staffing schedules must be reviewed and revised as necessary to meet the patient care needs and

to make adjustments for nursing staff absenteeism.

Survey Procedures §482.23(b)

• Determine that there are written staffing schedules which correlate to the number and

acuity of patients. Verify that there is supervision of personnel performance and nursing

care for each department or nursing unit. To determine if there are adequate numbers of

nurses to provide nursing care to all patients as needed, take into consideration:

o Physical layout and size of the hospital;

o Number of patients;

o Intensity of illness and nursing needs;

o Availability of nurses’ aides and orderlies and other resources for nurses, e.g.,

housekeeping services, ward clerks etc.;

o Training and experience of personnel;

• Review medical records to determine if patient care that is to be provided by nurses is

being provided as ordered.