SECTION 568.63. Nursing Services

(a) Nursing services in treatment plan. A hospital shall provide nursing services to a patient in accordance with a treatment plan developed in accordance with §568.61 of this subchapter (relating to Inpatient Mental Health Treatment and Treatment Planning).

(b) Organization of nursing staff. The hospital shall have a written description of the organizational hierarchy and responsibilities of the nursing staff.

(c) Director of psychiatric nursing (DPN). A hospital shall have a DPN who:

(1) has administrative authority over the nursing staff;

(2) directs, monitors, and evaluates the nursing services provided;

(3) for a hospital licensed under Texas Health and Safety Code Chapter 577 and Chapter 510 of this title (relating to Private Psychiatric Hospitals and Crisis Stabilization Units), reports directly to the administrator; and

(4) for an identifiable mental health services unit in a hospital licensed under Texas Health and Safety Code Chapter 241, and 25 TAC Chapter 133 (relating to Hospital Licensing), reports directly to the chief nursing officer as described in 25 TAC §133.41 (relating to Hospital Functions and Services) or reports directly to a registered nurse (RN) who reports directly to the chief nursing officer.

(d) Qualifications of DPN. The DPN shall be:

(1) an RN with a master's degree in psychiatric-mental health from a nursing education program accredited by an organization recognized by the U.S. Commission of Education and Council for Higher Education Accreditation as an accreditation agency, such as the National League for Nursing or the Commission on Collegiate Nursing Education;

(2) an RN with a bachelor's degree in nursing and a master's degree in a health-related field from an accredited college or university and have three years of experience as a full-time employee or contractor (or its equivalent as a part-time employee or contractor) as an RN in a hospital; or

(3) an RN with a bachelor's degree in nursing and:

(A) have three years of experience as a full-time employee or contractor (or its equivalent as a part-time employee or contractor) as an RN in a hospital; and

(B) receive four hours per month of clinical consultation from an RN with:

(i) a master's degree in psychiatric-mental health from a nursing education program accredited by an organization recognized by the U.S. Commission of Education and Council for Higher Education Accreditation as an accreditation agency, such as the National League for Nursing or the Commission on Collegiate Nursing Education; or

(ii) a bachelor's degree in nursing and a master's degree in a health-related field from an accredited college or university.

(e) Assessment. An RN shall conduct and complete an initial comprehensive nursing assessment of a patient within eight hours of the patient's admission.

(f) Reassessment. An RN shall reassess a patient, based on the patient's needs, but at least every 12 hours after the initial comprehensive nursing assessment, required by subsection (e) of this section, is conducted.

(g) Staffing plan.

(1) The DPN shall develop and implement a written staffing plan that:

(A) describes the number of RNs, licensed vocational nurses (LVNs), and unlicensed assistive personnel (UAPs) on each unit for each shift;

(B) provides for at least one RN to be physically present and on-duty at all times on each unit when a patient is present on the unit;

(C) if the hospital has only one unit, in addition to the RN required by subparagraph (B) of this paragraph, provides for at least two staff members who provide direct patient care to be physically present and on-duty at all times on the unit when a patient is present on the unit; and

(D) provides for an adequate number of registered nurses on each unit to supervise all UAPs.

(2) The staffing plan described in paragraph (1) of this subsection shall be based on the following factors:

(A) the number of patients;

(B) the characteristics of the patients, including the intensity of the patient's emotional, mental, and medical needs;

(C) the anticipated admissions, discharges and transfers;

(D) the architecture of the unit, including geographic dispersion of patients, arrangement of the unit and surveillance and communication technology;

(E) the expertise of the nursing staff;

(F) the nursing staff's familiarity with the patients;

(G) nursing staff continuity and cohesion;

(H) the amount of time required by the nursing staff to perform administrative activities; and

(I) recommendations of the advisory committee regarding the adequacy of the staffing plan made in accordance with §568.144(b)(3) of this chapter (relating to Advisory Committee for Nurse Staffing).

(3) The DPN shall document the DPN's determinations made about each factor described in paragraph (2) of this subsection, at the time the staffing plan is developed and when the staffing plan is revised based on a change in such factors.

(4) A hospital shall retain the staffing plan and the documentation required by paragraph (3) of this subsection, for two years after such documentation is created.

(5) The DPN shall revise the staffing plan, as necessary.

(6) The DPN shall report to the advisory committee established in accordance with §568.144 of this chapter (relating to Advisory Committee for Nurse Staffing) any variance between the number of staff members specified in the staffing plan and the actual number of staff members on duty.

(h) Process for reporting concerns regarding staffing plan.

(1) A hospital shall develop and implement a process for RNs and LVNs to report concerns regarding the adequacy of the staffing plan to the advisory committee established in accordance with §568.144 of this chapter.

(2) A hospital shall not retaliate against a nurse for reporting a concern to the advisory committee.

(i) Orientation of nursing staff.

(1) A hospital shall provide orientation to a nursing staff member when the staff member is initially assigned to a unit on either a temporary or long-term basis. The orientation shall include a review of:

(A) the location of equipment and supplies on the unit;

(B) the staff member's responsibilities on the unit;

(C) relevant information about patients on the unit;

(D) relevant schedules of staff members and patients; and

(E) procedures for contacting the staff member's supervisor.

(2) A hospital shall document the provision of orientation to nursing staff.

(j) Verification of licensure. A hospital shall verify that a member of the nursing staff for whom a license is required has a valid license at the time the staff member assumes responsibilities at the hospital and maintains the license throughout the staff member's employment or association with the hospital.

(k) Mandatory overtime. A hospital shall develop and implement a policy regarding the use of mandatory overtime by the nursing staff. The policy shall require:

(1) documentation of the justification for the use of mandatory overtime;

(2) monitoring and evaluation of the use of mandatory overtime; and

(3) development of a plan to reduce or eliminate the use of mandatory overtime.

(l) The hospital shall establish a nursing peer review committee to conduct nursing peer review, as required by Texas Occupations Code Chapter 303.

Source Note: The provisions of this §568.63 adopted to be effective May 27, 2021, 46 TexReg 3276