{"ref":"MO-HH-CS-02","title":"Skilled Nursing Services and Missouri Nursing Practice","category":"Clinical tasks","summary":"Sets out how the Agency furnishes skilled nursing: only registered nurses and licensed practical nurses licensed where they practice (a Missouri license or a Nurse Licensure Compact multistate license), working within the Missouri Nursing Practice Act and the Agency's policies; the responsibilities 42 CFR §484.75(b) gives skilled professionals; what only a registered nurse may do; how licensed practical nurses are directed and supervised; competency for high-risk procedures; visit standards; and the MO HealthNet skilled nursing rules.","inShort":["Only registered nurses (RNs) and licensed practical nurses (LPNs) with a license valid where the patient lives provide nursing care.","An RN does the first assessment, writes the plan with the patient and doctor, and supervises LPNs and aides.","LPNs work under an RN's direction and tell the RN case manager about changes the same day.","Give only the care that is ordered, and tell the doctor quickly if the patient's condition changes.","Finish your visit note by the end of the next business day."],"primaryCitation":"42 CFR §484.75 (adopted by 19 CSR 30-26.010(1)(A))","citations":["19 CSR 30-26.010(1)(A)","RSMo §335.016","RSMo §335.360","RSMo §197.400(4)","20 CSR 2220-2.010(5)","13 CSR 70-90.010(2)(A), (3)"],"federalCitations":["42 CFR §484.75","42 CFR §484.115(e), (k)","42 CFR §484.55(a), (b)","42 CFR §484.60","42 CFR §484.80(g), (h)","42 CFR §409.44(b)"],"surveyorAsks":["Who supervises your licensed practical nurses, and how is that supervision documented?","Show me how a nurse took part in care coordination and communicated with the physician for this patient."],"forms":[],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §484.75 (adopted by 19 CSR 30-26.010(1)(A)))","5. What Registered Nurses and Licensed Practical Nurses Do","6. Responsibilities of Every Skilled Nurse","7. Nursing Visits","8. Direction and Supervision of Licensed Practical Nurses","9. Competency for Nursing Procedures","10. Teaching, Delegation, and Assignment to Aides","11. Licensure and Practice Location","12. MO HealthNet Skilled Nursing","13. Responsibilities","14. Records and Compliance Monitoring","15. Staff Training","16. References","17. Related Policies and Forms","18. Approval","19. Revision History"],"version":"1.0","sample":false,"pack":"mo-hha","state":"Missouri","service":"Home health","guides":[{"path":"/guides/home-health-agency-policies/","h1":"What policies and procedures are required for home health agencies?"},{"path":"/guides/home-health-conditions-of-participation/","h1":"Home health Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}