Strict adherence to the DMH Licensing minimum required nursing care hours per patient day requirements may be reduced if necessary due to workforce challenges as long as the following are always in place:
- Attempts have been made to cover all staffing shortages with on call, per diem, or agency staff when applicable.
- An RN must be present on all units and all shifts, and if this is the only licensed person, the nurse must be able to reasonably fulfill responsibilities for all medication administration, admission assessments, as well as oversight of the unlicensed staff on the unit, given the current and anticipated census of the unit.
- A staff person must be assigned to conduct patient safety checks at all times on every unit, without the addition of other assigned duties.
- Any ordered constant observations of patients must be fully assigned throughout every shift.
- There must be adequate staff in addition to the above to meet the needs of the patients being served at the current and anticipated census of the unit on that shift, including the provision of meals, outdoor access, and any assigned programming for patients.
- Active clinical programming must continue to be provided that is beyond the nursing staff assigned to the unit.
- The staffing levels throughout a multi-unit hospital must allow for an adequate emergency response, without leaving any staff person alone on an inpatient unit.
- All staff working and providing care on a shift must have a documented assignment in written form which accurately reflects what was completed by each person throughout the shift.