This letter from the Centers for Medicare and Medicaid Services (CMS) outlines the requirements for nursing services in healthcare facilities in order to ensure the safety of residents and their highest possible physical, mental, and psychosocial wellbeing. Facilities must provide sufficient numbers of licensed nurses and other nursing personnel, such as nurse aides, on a 24-hour basis to meet the needs of all residents as determined by their individual care plans. A licensed nurse must also be designated as a charge nurse on each tour of duty. Facilities must consider the number, acuity, and diagnoses of the resident population when determining the appropriate number of nursing staff. CMS also provides guidance on staffing decisions, such as citing deficiencies related to the sufficiency of nursing staff and referencing other tags if the survey investigation reveals deficiencies in other areas. Facilities must also assess the resident population to determine the appropriate level of staff needed and must provide sufficient qualified nursing staff at all times.

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