Minimum Staffing Requirements
Employers are required to meet minimum staffing requirements set out in:
The Facility Designation Regulations state healthcare organizations and facilities are required to follow the Program Guidelines for Special-care Homes when providing care to residents.
Housing and Special-care Homes Regulations set the following requirements for nursing care:
- carried out by or under the direction of a registered nurse or registered psychiatric nurse;
- every home shall employ at least one full-time registered nurse or registered psychiatric nurse;
- nursing care by a registered nurse or a registered psychiatric nurse shall be provided on a 24-hour basis.
Program Guidelines for Special-care Homes have interpreted the requirements further by stating that staffing includes RNs, RPNs, LPNs, CCAs, and other providers for quality care, to meet resident needs, and for quality outcomes.
The guidelines further interpret registered nurse staffing requirements as:
- a minimum of eight (8) hours a day, five (5) days per week on-site with an RN/RPN on call when not in the home.
Minimum requirements for resident care set by regulations and guidelines must be balanced against the acuity, complexity, predictability, risk for negative outcomes, and work environment to identify what the appropriate staffing complement should be.
Employers are required to have a process for safe, effective staffing and a plan to change the staffing mix to meet changing resident care needs.
Staffing Requirements Affect Nursing Care for Registered Nurses
There is no minimum requirement that the registered nurse must be a SUN member or that the registered nurse must always be on-site. Resident care needs will dictate the on-site presence for providing and coordinating care, assignment and supervision needed.
SUN Provincial believes that a registered nurse should be on-site and immediately available to respond and intervene to provide nursing care to all residents. When it is not a SUN Member on-site or on standby, there must be a registered nurse who will fulfill the requirements for registered nursing practice and accept professional responsibility for resident care.
If your facility Manager is not an RN/RPN, then an out-of-scope registered nurse should be identifiable and available to fulfill registered nurse requirements for care.
Decisions About the Most Appropriate Nursing Provider
The resident, the provider, and the environment are critical factors and will determine who is the most appropriate to provide care supported by evidence, nursing research, and best practice (SALPN, SRNA & RPNAS, 2017).
The Collaborative Decision-making Framework: Quality Nursing Practice, 2017 is a tool for collaborative practice, decision-making among RNs/RPNs/LPNs, and professional obligations based on the nursing process and the continuum of care for safe, competent, appropriate, and high-quality nursing care to residents.
Having the right staffing complement is based on your critical thinking, clinical assessment, identified resident care needs (i.e.: acuity, complexity, predictability, risks), the qualifications of the available staff, resident/staff safety, your ability to meet your regulatory and employer expectations, and the work environment.
If you don’t have the right number or type of staff to provide the required care for your residents, you need to discuss your concerns with your Manager/designate in real time.
If low-level resolution does not result in solutions, notify them that a Work Situation Report (WSR) will be completed.
Registered nurses have the primary responsibility for the coordination of care, assignment, and supervision of resident care using the nursing process.
Call-in Process or Criteria
The Employer can outline a call-in process or criteria to be used when additional staff is required, and the steps are outlined in your collective agreement.
As the registered nurse, you balance this call-in process with your assessment, clinical judgment, and critical thinking for the residents in your care, staff, and work environment.
Consider
Who is the most appropriate provider to meet the resident nursing care needs?
If a registered nurse is needed based on your assessment, acuity, and complexity, then discuss this with your Manager to either obtain the appropriate staffing or identify the most appropriate location for the resident to receive the required continuing care.