California
Psychiatric Nursing Service Staff.
22 CCR 71215.1
Source text
43 segments
22 CCR 71215.1
22 CCR 71215.1
§ 71215.1. Psychiatric Nursing Service Staff.
(a)
The psychiatric nursing service shall be under the direction of a registered nurse licensed by the California Board of Registered Nursing pursuant to Business and Professions Code section 2700 who shall meet at least the following qualifications:
(1)
Master's degree in psychiatric nursing or related field with experience in administration; or
(2)
Baccalaureate degree in nursing or related field with experience in psychiatric nursing and two years of experience in nursing administration; or
(3)
Four years of experience in nursing administration or supervision and with experience in psychiatric nursing.
(b)
For the purposes of this section, “licensed nurses” includes psychiatric technicians, licensed vocational nurses, and registered nurses.
(c)
The director of nurses serving pursuant to subdivision (a) shall not be designated to serve as a charge nurse.
(d)
Registered nursing personnel shall be provided to:
(1)
Assist the director of nurses for evening and night services and when necessary for day services.
(2)
Give direct nursing care based on patient need.
(3)
Have a registered nurse on duty and awake at all times.
(4)
Provide ongoing patient assessments as defined in Business and Professions Code, section 2725(b)(4). Such assessments shall be performed, and the findings documented in the patient's medical record, for each shift, and upon receipt of the patient when they are transferred to another patient care area.
(5)
Provide for the planning, supervision, implementation, and evaluation of the nursing care provided to each patient. The implementation of nursing care may be delegated by the registered nurse responsible for the patient to other licensed nursing personnel or may be assigned to unlicensed mental health workers, subject to any limitations of their licensure, certification, level of validated competency, and regulation.
(e)
The director of nurses shall establish a multidisciplinary staffing committee. Membership shall include the director of nurses, at least one member of the hospital's executive team or a governing board member, and at least 50 percent of the membership shall be comprised of registered nurses providing patient care in the hospital.
(f)
The multidisciplinary staffing committee shall develop, implement, and maintain documented policies and procedures that address the following minimum requirements:
(1)
How multidisciplinary staffing levels are determined in each staffing plan to ensure patient needs are met.
(2)
How adjustments in staffing are determined when patient needs change during a shift, including the assignment of responsibility and authority for the maintenance of staffing levels.
(3)
What data the hospital shall collect and the specific measures the hospital shall analyze to validate that the policies and procedures accurately determine staffing levels that meet patient needs.
(g)
The hospital administration shall approve staffing procedures developed pursuant to subdivision (f), and the governing body shall approve policies developed pursuant to subdivision (f).
(h)
The hospital shall maintain, at all times, the following minimum nurse-to-patient ratios:
(1)
At least one licensed nurse for every six adult patients.
(2)
At least one licensed nurse for every five patients below the age of eighteen.
(i)
For the purposes of determining nurse to patient ratios, licensed vocational nurses, psychiatric technicians, or a combination of both, shall not exceed 50 percent of the licensed nurses on the unit.
(j)
Only licensed nurses providing direct patient care shall be included in the nurse-to-patient ratio.
(k)
Licensed nurse-to-patient ratios represent the maximum number of patients that shall be assigned to one licensed nurse at any one time. “Assigned” means the licensed nurse has responsibility for the provision of care to a particular patient within their scope of practice. There shall be no averaging of the number of patients and the total number of licensed nurses on the unit during any one shift nor over any period of time. Nothing in this section shall prohibit a licensed nurse from assisting with specific tasks within their scope of practice for a patient assigned to another nurse. “Assist” means that licensed nurses may provide patient care beyond their patient assignments if the tasks performed are specific and time-limited.
(l)
Nurse administrators, nurse supervisors, nurse managers, charge nurses, and other licensed nurses shall be included in the calculation of the licensed nurse-to-patient ratio only when those licensed nurses are providing direct patient care. Nurse administrators, nurse supervisors, nurse managers, charge nurses, and other licensed nurses must have documented, unit specific competencies prior to providing direct patient care. When a nurse administrator, nurse supervisor, nurse manager, charge nurse, or other licensed nurse is engaged in activities other than direct patient care, that nurse shall not be included in the ratio. Nurse administrators, nurse supervisors, nurse managers, charge nurses, and other licensed nurses who have demonstrated current competence to the hospital in providing care on a particular unit may relieve licensed nurses during breaks, meals, and other routine, expected absences from the unit.
(m)
Staffing shall comply with the policies and procedures developed pursuant to subdivision (f) and the considerations in subdivision (n), which may require the hospital to exceed the minimum ratios in subdivision (h).
(n)
The hospital shall consider the following elements when determining staffing levels above the minimum ratios:
(1)
Patient acuity, including, but not limited to:
(A)
Risk of harm to self or others, including suicide risk and violence risk assessments.
(B)
The ability of each patient to independently perform activities of daily living.
(C)
Degree of illness.
(2)
Skill level and skill mix of personnel required for patient care and risk mitigation, including licensed personnel and unlicensed mental health workers.
(3)
Requirements for special nursing activities.
(4)
Placement of the patient in the nursing unit.
(5)
Time required to conduct assessments, care planning, and discharge planning or preparation needed to safely discharge a patient and reduce the likelihood of hospital readmission.
(o)
The staffing committee shall validate the effectiveness of the process to determine staffing needs at least annually and report to the governing body.
(p)
The hospital shall retain staffing documentation for a period of three years including:
(1)
Staffing plans developed in compliance with the policies and procedures described in subdivision (f) for the time period between licensing surveys.
(2)
Documentation of the actual time worked for licensed nurses and their unit assignments for each shift.
(3)
Documentation of the actual time worked and their unit assignments for each shift for unlicensed personnel used to assist with patient care or mitigate risk.
(q)
If the Department determines that additional personnel are necessary to meet patient needs or ensure the safety of the patients or personnel, the Department may require a hospital to provide additional personnel.
(r)
This section shall apply to hospitals not operated by the California Department of State Hospitals.
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