POLICY STATEMENT.

The Division of Veterans Healthcare Services (DVHS) requires that each of the New Jersey Veterans Memorial Homes (VMH) establish a nursing services program that provides nursing services by registered professional nurses, licensed practical nurses and certified nurses aides, in accordance with the New Jersey Department of Health and Senior Services’ Long-Term Care Acuity Regulatory Standard 8:39-25.2(b)(1,2).

PURPOSE.

This policy and procedure shall serve to ensure that the New Jersey Veterans Memorial Homes provide nursing services by registered professional nurses, licensed practical nurses, and certified nurses aides/assistants at all times, in accordance with the New Jersey Department of Health and Senior Services’ Long-Term Care Acuity Regulatory Standard 8:39-25.2(b)(1,2); and to ensure that each resident receives all the care and services needed to attain and maintain the highest practicable level of care services.

DEFINITIONS.

TRACHEOSTOMY CARE - The care of a surgically created opening in the trachea. This care must be given by a licensed nurse (Registered Nurse/Licensed Practical Nurse). This includes care for new tracheostomy sites, established tracheostomy sites, as well as care for complicated cases involving symptomatic infections and unstable respiratory functioning.

USE OF RESPIRATOR - A respirator (also called a ventilator) is an artificial device designed to provide mechanical ventilation and assist/sustain respirations for a person. A respirator must be monitored and adjusted in accordance with the medical protocol by a Registered Nurse.

HEAD TRAUMA STIMULATION - Is stimulation given to affect the resurgence of nerve pathways in the brain.  Specifically trained nursing personnel give this therapy.
 
ADVANCED NEUROMUSCULAR CARE - Must be given by skilled nursing personnel who are educated to meet the specialized needs of residents who suffer from chronic disorders that affect the neurons of the body, such as ALS, Multiple Sclerosis, Parkinson’s Disease, or Huntington’s Chorea. Also to be used with residents who have sustained a Cerebral Vascular Accident (CVA or stroke) that rendered them partially or totally paralyzed, with associated problems. These residents require observation for neurological complications, monitoring, and administration of medications or nursing interventions to stabilize the condition, and prevent unnecessary regression.

ADVANCED ORTHOPEDIC CARE – Is the care of plastered body parts with a pre-existing peripheral vascular or circulatory condition requiring observation for complications, and monitoring and administration of medication to control pain and/or infection. Care must be given by skilled nursing personnel who are educated/trained to meet the specialized needs of residents.

INTRAVENOUS THERAPY - A specialized treatment ordered by the physician, which introduces fluid into a vein through a sterile catheter, for the purpose of providing medication, electrolytes, fluids and nutrition.  This procedure must be performed by an I.V.-Certified Registered Nurse and requires specialized equipment and close monitoring.

WOUND CARE - A wound is a break in the integrity of the skin, which requires dressings be applied using aseptic technique.  A licensed nurse, working under a physician’s order, must perform wound care.

OXYGEN THERAPY - Is the administration of oxygen via mask, nasal cannula, or other appropriate device to increase the oxygen content of the blood.  A licensed nurse administers oxygen.

NASOGASTRIC TUBE FEEDINGS - Is the insertion of a tube through the nose into the stomach that allows the patient to receive nutritional sustenance.  A specially trained registered nurse shall perform the insertion of the nasogastric tube.  Licensed nurses shall administer nasogastric tube feedings.

GASTROSTOMY TUBE FEEDINGS - A gastrostomy tube is a feeding tube surgically inserted through the abdominal wall into the stomach.  Licensed nurses shall administer gastrostomy tube feedings.

PROCEDURE.

1. New Jersey Veterans Memorial Homes

1. The New Jersey Veterans Memorial Homes shall provide staffing for their respective nursing services programs in accordance with New Jersey State Department of Health and Senior Services’ Long-Term Care Mandatory Standard of Acuity Hours 8:39-25.2(b)(1) and 8:39-25.2(b)(2) as follows:

1. Total number of residents multiplied by 2.5 hours of nursing care per 24-hour period; plus

1. Total number of residents receiving each service listed below, multiplied by the corresponding number of hours per 24-hour period:

1. At least 20% of the total acuity hours of care required should be provided by individuals who are either Registered Professional Nurses or Licensed Practical Nurses.

Note:  Supervisors of Nursing Service and Nursing Service Clerks are excluded from these hours.  If a Supervisor of Nursing Services must deliver direct care due to staffing shortages, these hours are to be applied to meet acuity standards.

1. For staffing purposes, only the in-house census is used to determine acuity hours.

1. It is the responsibility of the shift supervisor or designee to compute required staffing patterns by reviewing current daily acuity and matching available personnel to meet this need.

1. Daily census and acuity categories must be maintained for each nursing care unit for a 24-hour period, and a record must be maintained according to requirements.

Revised: June 2007