SECTION 310:675-13-5. Nursing service

(a)   General. The nursing facility shall be organized, staffed, and equipped to provide nursing and health related services to all residents on a continuous basis.

(b)   Licenses. All licensed nurses shall hold a current license issued by the Oklahoma Board of Nursing.

(c)   Director of nursing

(1)   A registered nurse or licensed practical nurse shall be designated as the director of nursing.

(2)   The director of nursing shall be on duty on the day shift and be responsible for all resident care including, but not limited to, the physical, mental, and psycho-social needs. The director of nursing or designee shall be available by telephone when needed by facility staff.

(3)   When necessary, the director of nursing may work other than the day shift but for no more than three shifts a week. This exception shall not exceed three consecutive weeks in a three month period.

(d)   Licensed nurses

(1)   The facility shall employ licensed nurses for a sufficient number of hours to meet the residents' needs.

(2)   A licensed nurse shall supervise direct care staff and shall direct nursing care for the residents.

(3)   The facility shall use licensed practical nurses only for the medical procedures for which they are trained.

(e)   Consultant registered nurse

(1)   If the director of nurses is a licensed practical nurse, a registered nurse shall be employed for at least eight hours per week as a consultant.

(2)   A consultant registered nurse shall evaluate and consult with the director of nursing concerning residents' needs and shall coordinate the assessment and care plan of each resident.

(3)   A consultant registered nurse's visit shall document the date and the hours spent in consultation. The documentation shall be signed and reviewed by the director of nursing.

(f)   Certified medication aide

(1)   Each medication aide shall be a certified nurse aide who has passed a Department approved medication administration program.

(2)   A graduate nurse or a graduate practical nurse, who has not yet been licensed, may administer medications if the nurse has passed an approved competency test for medication administration.

(3)   A certified medication aide may administer physician ordered medications and treatments under the direction of a licensed nurse.

(4)   The facility shall have a licensed nurse or physician on-call to handle medical emergencies. The charge person shall notify the designated person when a medical emergency arises.

(5)   A certified medication aide shall complete eight hours of continuing education a year that is approved by the Department.

(g)   Nurse aide

(1)   No facility shall use, on a full-time basis, any person as a nurse aide for more than 120 days unless that person is enrolled in a training program.

(2)   No facility shall use, on a temporary, per diem, or other basis, any person as a nurse aide unless the individual is listed on the Department's nurse aide registry.

(3)   The facility shall contact the Department's nurse aide registry prior to employing a nurse aide to determine if the person is listed on the registry, and if there is any record of abuse, neglect, or misappropriation of resident property.

(h)   Nursing students. Facilities participating in a state approved nursing education program may allow nursing students to administer medications to residents. The facility shall have a written agreement with the nursing education program. The agreement shall specify the scope of activities, education level, and required supervision. The facility shall maintain a current roster of nursing students in the program. Details about the program and its operation within the facility shall be included in the facility's policy and procedure manual.

(i)   Inservice. The facility shall provide all direct care staff with two hours of inservice training specific to their job assignment per month. This training shall include, at least, the following:

(1)   Fire safety and first aid classes semi-annually.

(2)   Resident rights and resident adjustment to institutional life annually.

(3)   Cardiopulmonary resuscitation and Heimlich maneuver procedures annually.

(4)   All supervisory staff shall receive training in regards to applicable local, state, and federal regulations governing the facility.

(5)   Each staff person shall be provided training in pain recognition at the time of orientation and at least once a year thereafter.

(6)   Each certified nurse aide shall be provided training in pain screening at the time of orientation and at least once every year thereafter.

(7)   Each licensed practical nurse shall be provided training in pain screening and pain management at the time of orientation and at least once every year thereafter.

(8)   Each registered nurse shall be provided training in pain assessment and pain management at the time of orientation and at least once every year thereafter.

[Source: Added at 9 Ok Reg 3163, eff 7-1-92 (emergency); Added at 10 Ok Reg 1639, eff 6-1-93; Amended at 23 Ok Reg 156, eff 10-6-05 (emergency); Amended at 23 Ok Reg 2415, eff 6-25-06; Amended at 27 Ok Reg 2545, eff 7-25-10]