The nursing services of the ASC must be directed and staffed to assure that the nursing needs of all patients are met.

Interpretive Guidelines: §416.46

The ASC must ensure that the nursing service is directed under the leadership of an RN. The ASC must have documentation that it has designated an RN to direct nursing services.

There must be sufficient nursing staff with the appropriate qualifications to assure the nursing needs of all ASC patients are met. This implies that there is ongoing assessment of patients' needs for nursing care, and that identified needs are addressed. The number and types of nursing staff needed will depend on the volume and types of surgery the ASC performs.

Survey Procedures: §416.46

Ask the ASC's leadership to identify the person responsible for the direction of nursing services within the ASC. Is that person an RN?
Review the staffing available for patients undergoing surgery during the survey; is there sufficient staff to address each patient's nursing needs?
Do nursing staff have the appropriate qualifications for the tasks they are asked to perform?

Q-0141

Standard: Organization and Staffing

(Rev.56, Issued: 12-30-09, Effective/Implementation: 12-30-09)

Patient care responsibilities must be delineated for all nursing service personnel. Nursing services must be provided in accordance with recognized standards of practice. There must be a registered nurse available for emergency treatment whenever there is a patient in the ASC.

Interpretive Guidelines: §416.46(a)

Every nurse in the ASC must have clearly delineated assigned responsibilities for providing nursing care to patients. These assignments must be in writing; job descriptions would suffice for a general articulation of the responsibilities for each nurse. Individual patient assignments on a given day must be documented clearly in the assignment sheet.

The ASC's nursing services must be consistent with recognized standards of practice. "Recognized standards of practice" means that the services provided are consistent with State laws governing nursing scope of practice, as well as with nationally recognized standards or guidelines for nursing care issued by organizations such as the American Nurses Association, the Association of Operating Room Nurses, etc.

An RN with specialized training or experience in emergency care must be available to provide emergency treatment whenever there is a patient in the ASC. "Available" means on the premises and sufficiently free from other duties that the nurse is able to respond rapidly to emergency situations. In accordance with the requirements at §416.44(d), the ASC must have personnel present who are trained in the use of the required emergency equipment specified at §416.44(c) and in cardiopulmonary resuscitation whenever there is a patient in the ASC. The RN(s) designated to provide emergency treatment must be able to use any of the required equipment, so long as such use falls within an RN's scope of practice. ASC's would be well advised to assure that the RN(s) designated to provide emergency treatment have training in advanced cardiac life support interventions.

Survey Procedures: §416.46(a)

Are the general responsibilities for each ASC nurse for providing patient care clearly documented?
Ask the nursing staff to explain what their duties for the day of the survey are; can they articulate clearly what their patient care responsibilities are?
Ask the ASC to explain how it evaluates the nursing care provided in the ASC for conformance to acceptable standards of practice.
Ask the ASC to identify the RN(s) who are available for emergency treatment. Is there documentation of their qualifications to provide emergency treatment? Do staff in the ASC know which RN(s) (as well as medical staff) to call when a patient develops an emergency?
Ask the ASC for evidence that one or more RN(s) are readily available to provide emergency treatment. How do they assure that an RN can leave their current task to respond to the emergency without putting another patient at risk of harm?