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Round-the-Clock RN Coverage: A Step towards Better Nursing Home Care


Background on 24-Hour RN Bills Introduced in Congress

On July 31, 2014, U.S. Representative Jan Schakowsky introduced the "Put a Registered Nursing in the Nursing Home Act." The bill would require all nursing homes receiving Medicare and/or Medicaid reimbursement to have a registered nurse (RN) on duty twenty-four hours per day, seven days a week. Although most people believe RNs are already required round-the-clock, this is not the case. Under current federal law, nursing homes are only required to have a RN eight hours each day regardless of facility size – no matter how many residents they have or how sick they are. To read Consumer Voice's full press release on this legislation, click here.

The 24 Hour RN Bill is an excellent opportunity for all long-term care advocates because after years of playing “defense,” it gives us an opportunity to go on the offense and expand recognition of what it takes to achieve quality care.

Here is a link to Rep. Schakowsky’s press release announcing the bill.

And here is a message from our Founder, Elma Holder, who worked to make the world understand that the nursing home resident should be the centerpiece of the nursing home experience and whose wishes as well as their human, civil, legal, and medical rights should be honored every minute of the day – and not just when a RN is on duty!

On February 12, 2015, Congresswoman Jan Schakowsky (D-IL) reintroduced legislation in the U.S. House of Representatives to require round-the-clock registered nurse (RN) coverage in nursing homes. H.R. 952, the Put a Registered Nurse in the Nursing Home Act, and would require all nursing homes receiving Medicare and/or Medicaid reimbursement to have a RN on duty twenty-four hours a day, seven days a week. Under current federal law, nursing homes are only required to have a RN eight hours a day regardless of facility size or the complexity of residents’ care needs. This is not sufficient to ensure that quality care is being provided within these settings. It is critical for a RN to be on duty 24 hours a day because she or he is the sole nursing professional in a nursing home who can conduct nursing assessment when residents’ medical conditions suddenly change or deteriorate.

What would H.R. 952, the Put a Registered Nurse in the Nursing Home Act, do?

This bill would require nursing facilities and skilled nursing facilities (“nursing homes”) that receive Medicare and/or Medicaid reimbursement to have a direct-care registered nurse (RN) on duty 24 hours per day, 7 days per week. Current law only requires facilities use an RN for 8 continuous hours each day regardless of facility size.  An RN must be on duty 24 hours a day because she or he is the sole nursing professional in a nursing home who can conduct nursing assessment. Per current federal regulation, nursing facilities are required to have an RN on-site in the building for only 8 consecutive hours each day.  Under current rules, that RN does not have to be a direct care nurse; that RN could work in an administrative capacity.

Why is this Legislation (OR why is 24 Hour RN Coverage) Important? 

Over the past two decades, the medical intensity and complexity of care for nursing home residents has increased dramatically. A resident who is elderly, frail, and has multiple complex conditions may be discharged from the hospital to the nursing home one to two days after surgery for a fractured hip. This requires expert nursing skills to anticipate, identify and respond to changes in condition, ensuring appropriate rehabilitation and maximizing the chances for a safe and timely discharge home. This high level of skill and knowledge for oversight and care is needed 24 hours a day, 7 days a week. RN coverage for only 8 hours a day leaves the residents vulnerable, undermining effective prevention of complications and possibly delaying important interventions. In addition, the absence of RN staffing for up to 16 hours each day means that there is no one present capable of assessing and responding when residents’ medical conditions suddenly change or deteriorate.

How do Registered Nurses (RNs) Help to Improve Nursing Home Care? 

Registered nurses are the only nursing personnel with the education and licensure to conduct head-to-toe physical assessments, interviews and record reviews in order to draw conclusions about nursing diagnoses, appropriate nursing interventions and care planning; to continuously monitor and evaluate interventions; and, finally, to lead the health care team in providing care for each resident. RNs are also the nursing home staff members who work directly with residents’ and other medical professionals to develop plans of care that promote the residents’ highest level of health and well-being. Higher RN levels result in lower antipsychotic use, fewer pressure ulcers, less restraint use and cognitive decline, fewer urinary tract infections and catheterizations, less weight loss and less decrease in function. Of particular relevance to today’s health care improvement initiatives is the decrease in unnecessary hospitalizations of nursing home residents—and research has shown that savings in hospitalizations pay for the increased RN time.


Resources for H.R. 952, the Put a Registered Nurse in the Nursing Home Act

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