SMQT - Surveyor Minimum Qualifications Nursing and Physician Services Questions and Answers — Questions and Answers
Question 1: According to federal regulations for skilled nursing facilities (42 CFR §483.35), which of the following is a mandatory daily staffing requirement for a Registered Nurse (RN), unless a waiver is granted?
- An RN must be on-site 24 hours a day, 7 days a week.
- An RN must hold the position of facility administrator.
- An RN must be on duty for at least 8 consecutive hours, 7 days a week. (Correct answer)
- The facility must employ at least one RN for every 30 residents.
Correct answer: An RN must be on duty for at least 8 consecutive hours, 7 days a week.
Federal regulation 42 CFR §483.35(b)(1) explicitly requires a facility, except when waived, to use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week. While a licensed nurse must be on duty 24/7, the specific requirement for an RN is the 8-hour daily minimum.
Question 2: A surveyor reviews a resident's record and notes the admission date was 40 days ago. The initial physician visit was completed on day 5. There is no documentation of any subsequent physician visits. How should the surveyor interpret this finding in relation to 42 CFR §483.30?
- The facility is compliant, as the next visit is not required until 60 days after admission.
- The facility is non-compliant, as a follow-up physician visit was required within 30 days of the initial visit. (Correct answer)
- The facility is compliant, as long as a nurse practitioner has documented a visit in the record.
- The facility is non-compliant, because weekly physician visits are required for the first 90 days.
Correct answer: The facility is non-compliant, as a follow-up physician visit was required within 30 days of the initial visit.
According to 42 CFR §483.30(c)(1), a resident must be seen by a physician at least once every 30 days for the first 90 days after admission. Since the resident was admitted 40 days ago and the first visit was on day 5, a follow-up visit was due by day 35. The absence of this visit constitutes non-compliance.
Question 3: A surveyor is at a facility with an average daily occupancy of 85 residents. The Director of Nursing (DON), an RN, is assigned as the charge nurse for a specific unit every weekday from 7 a.m. to 3 p.m. This staffing assignment is:
- Permitted, because the DON is a qualified RN.
- Permitted, as long as the DON works full-time.
- Not permitted, because the DON can only be a charge nurse in a facility with a daily occupancy of 120 or fewer residents.
- Not permitted, because the DON may only serve as a charge nurse in facilities with an average daily occupancy of 60 or fewer residents. (Correct answer)
Correct answer: Not permitted, because the DON may only serve as a charge nurse in facilities with an average daily occupancy of 60 or fewer residents.
Federal regulation 42 CFR §483.35(b)(3) specifies that the Director of Nursing may serve as a charge nurse only when the facility has an average daily occupancy of 60 or fewer residents. Since this facility's occupancy is 85, this arrangement is a violation.
Question 4: A resident's attending physician has arranged for a nurse practitioner (NP), who is not an employee of the facility, to provide care. Which of the following describes a compliant schedule of required visits after the physician's initial visit?
- The NP performs the required visits at day 30 and day 60, and the physician performs the visit at day 90, alternating thereafter. (Correct answer)
- The physician must personally perform all required visits for the first 90 days; the NP can only perform visits after that.
- The NP can only perform visits if the physician is physically present in the facility to supervise.
- The physician must personally perform all required visits; NPs cannot fulfill this requirement.
Correct answer: The NP performs the required visits at day 30 and day 60, and the physician performs the visit at day 90, alternating thereafter.
42 CFR §483.30(c)(4) allows a physician, at their option, to alternate required visits with a qualified nurse practitioner, physician assistant, or clinical nurse specialist after the initial physician visit. The NP performing visits that alternate with the physician's personal visits is a compliant practice.
Question 5: During a survey, a nurse is observed struggling to operate a new model of a mechanical lift, placing a resident at risk. The nurse states they have not received formal training on this specific device. This observation most directly points to a potential failure by the facility to meet which requirement under Nursing Services?
- To post daily nurse staffing data in a prominent place.
- To designate a licensed nurse as a charge nurse on each tour of duty.
- To provide regular in-service education based on performance reviews.
- To ensure nursing staff have the specific competencies and skill sets needed to care for residents. (Correct answer)
Correct answer: To ensure nursing staff have the specific competencies and skill sets needed to care for residents.
42 CFR §483.35 requires a facility to have sufficient nursing staff with the appropriate competencies and skill sets to provide nursing services and assure resident safety. The inability to safely operate essential equipment like a mechanical lift is a direct indicator that the staff member may lack the necessary competency for the task, which is the facility's responsibility to ensure.
Question 6: A resident experiences a sudden, acute medical issue at 2:00 a.m. The on-duty nurse is unable to reach the resident's attending physician. The facility has no designated backup physician to call in such situations. This scenario represents a potential violation of the facility's duty to:
- Ensure the resident's medical care is supervised by a single, primary physician.
- Provide or arrange for emergency physician services 24 hours a day. (Correct answer)
- Ensure the physician writes, signs, and dates progress notes at each visit.
- Have a registered nurse on duty for at least 8 consecutive hours.
Correct answer: Provide or arrange for emergency physician services 24 hours a day.
According to 42 CFR §483.30(d), the facility must provide or arrange for the provision of physician services 24 hours a day in case of an emergency. This includes having a plan for when the attending physician is unavailable, such as a designated on-call or backup physician.
SMQT - Surveyor Minimum Qualifications Nursing and Physician Services Questions and Answers
According to federal regulations for skilled nursing facilities (42 CFR §483.35), which of the following is a mandatory daily staffing requirement for a Registered Nurse (RN), unless a waiver is granted?