CMS SOM App. A, Tag A-1704

practical nurses, and mental health workers to provide the nursing care necessary

under each patient’s active treatment program.

Interpretive Guidelines §482.62(d)(2)

In addition to meeting the requirements of this standard, the requirements at

§482.23(b)(1) must also be met. The interpretive guidelines for that regulation at Tag A-

0393 state, “The hospital must provide nursing services 24 hours a day, 7 days a week.

An LPN can provide nursing services if an RN, who is immediately available for the

bedside care of those patients, supervises that care.”

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

patients’ needs and must provide 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 an 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 availability of

an RN for the bedside care of any patient. An RN would not be considered immediately

available if the RN was working on more than one unit, building, or floor in another

building 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.

The evaluation of sufficient numbers and levels of RNs, LPNs, NAs, and mental health

aides is based on the patient characteristics as seen in structured observations of patients

in the sample and other patients in the hospital, patient interviews, and as evidenced in

medical records and other data related to patients (e.g. incident reports,

seclusion/restraint reports). Patient care assignments should be appropriate to the skills

and qualifications of the nursing personnel providing patient care.

Survey Procedure §482.62(d)(2)

• 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:

• Physical layout and size of the hospital;

• Number of patients;

• Acuity of illness and nursing needs;

• Availability of NAs and mental health workers and other resources for

nurses;

• Training and experience of personnel.

• Observe the staffing available, interview patients/patients’ representatives, and

review medical records to determine if each patient’s nursing needs were

addressed. 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.

• Does the nursing staff have the appropriate qualifications for the tasks

they are required to perform?

• Review medical records to determine if nursing care under the patient’s

individualized comprehensive treatment plan is being provided.