65E-12.105. Minimum Staffing Standards

(1) Each facility shall designate an individual who is responsible for the overall management and operation of a CSU or SRT and whose qualifications and duties are defined in the individual’s job description. The job description shall ensure that other job responsibilities will not impede the operation and administration of the CSU or SRT. The occupant of this position shall possess experience in acute mental health and hold at least a bachelor’s degree in the human services field or be a registered nurse.

(2)(a) Every CSU and SRT shall have at least one psychiatrist as primary medical coverage as defined in Section 394.455(24), F.S. Back-up coverage may be a physician who will consult with the psychiatrist. The psychiatrist or physician shall be on call 24-hours-a-day and will make daily rounds. Counties of less than 50,000 population may utilize a licensed physician for on-call activities and daily rounds as long as the physician has postgraduate training and experience in diagnosis and treatment of mental and nervous disorders.

(b) The psychiatrist shall be responsible for the development of general medical policies, prescription of medications, and medical treatment of persons receiving services. Each person shall be provided medical or psychiatric services as considered appropriate and such services shall be recorded by the physician or psychiatrist in the clinical record.

(3) Sufficient numbers and types of qualified staff shall be on duty and available at all times to provide necessary and adequate safety and care. The program policies and procedures shall define the types and numbers of clinical and managerial staff needed to provide persons with treatment services in a safe and therapeutic environment.

(4) At least one registered nurse shall be on duty 24-hours-a-day, 7-days-a-week.

(5) At no time shall the minimum on-site available nursing coverage and mental health treatment staff be less than the following for shifts from 7:00 a.m. until 11:00 p.m. to assure the appropriate handling and administration of medication and the completion of nursing assessments:

 

Number	Registered Nurses					Mental Health Treatment Staff
of Beds
	CSU	SRT	CSU	SRT
__________________________________________
1-10	1	1	1	1
11-20	1	1	2	2
21-30	2*	1	3	2

 

 

*Licensed Practical Nurse may substitute for one registered nurse.

(6) At no time shall on-site available nursing coverage and mental health treatment staff be less than the following for both CSUs and SRTs for shifts from 11:00 p.m. until 7:00 a.m. to assure the appropriate handling and administration of medication and the completion of nursing assessments:

 

Number	Registered	Mental Health
of Beds	Nurses	Treatment Staff
________________________________________
1-10	1	1
11-20	1	1
21-30	1	2

 

 

(7) A person with a minimum of a master’s degree in psychology, social work, psychiatric nursing, counseling education, or mental health counseling, and has received clinical training, shall regularly provide staff consultation and treatment services to the CSU and SRT as described in the facility’s policies and procedures.

(8) Rehabilitative services shall be made available to the SRT.

(9) Emergency Screening Staff.

(a) The following requirement shall apply to all persons who assume emergency screening responsibilities after the effective date of this rule. Staff who have the responsibility of conducting emergency screening for possible admission to the CSU shall have a master’s degree in psychology, social work, counseling education, mental health counseling, psychiatric nursing; or be a registered nurse; or be a person with a bachelor’s degree, in a human services field, with a minimum of 1 year of work experience in a mental health related field.

(b) All emergency screeners assuming emergency screening responsibilities after the effective date of this rule shall complete a course in emergency screening prior to or within 3 months of assuming emergency screening responsibilities. This course shall include 12 contact hours of training in emergency screening, including clinical assessment, mental status examination, crisis intervention, Baker Act admission criteria, and the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised, Washington, DC, American Psychiatric Association, 1994, which is incorporated by reference and may be obtained from the American Psychiatric Association, 1400 K Street, N.W., Washington, DC 20005. Completion of the training course shall be documented. Persons who deliver training curriculum for emergency screening shall be mental health professionals, physicians, or mental health counselors licensed under Chapter 491, F.S., or under the supervision of a mental health professional, physician, or mental health counselor.

(c) Face-to-face consultation shall be available from a mental health professional or a mental health counselor licensed under Chapter 491, F.S., at all times for newly employed emergency screeners who have not completed the required training. They shall also receive intensive supervision and on the job training until successful completion of the training course.

(d) Emergency screeners shall, at all times, be under the supervision of a mental health professional or a mental health counselor licensed under Chapter 491, F.S. The extent and type of supervision provided to emergency screeners shall be specified in the CSU’s policy and procedures manual.

(e) All emergency screening staff shall have 10 documented contact hours of relevant staff development and training each calendar year.

(f) The CSU will include a training plan in their policy and procedures manual that will reinforce the initial training curriculum and be responsive to their quality assurance findings.

(g) Personnel comprising the minimum CSU staff, as specified in Rule 65E-12.105, F.A.C., shall not function as emergency screeners at the same time as working on the CSU.

(10) Each CSU and SRT shall develop policies and procedures to ensure adequate minimum staffing. These policies shall address double shifting, use of temporary registered nurses, use of regular part-time registered nurses and licensed practical nurses. Policies shall ensure that nursing staff are not used in dual capacity or in ancillary areas which compromise minimum unit staffing requirements, except as expressly provided for by this rule.

Specific Authority 394.879(1), (2) FS. Law Implemented 394.455, 394.879 FS. History–New 2-27-86, Amended 7-14-92, Formerly 10E-12.105, Amended 9-1-98.