<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".21" citation="COMAR 10.07.14.21" title_num="10" subtitle_num="07" chapter_num="14" heading="Delegating Nurse.">
  <paragraph num="A.">
    <text>The assisted living program shall have a current and signed agreement with a registered nurse for services of a delegating nurse and delegation of nursing tasks. If the delegating nurse is an employee of the assisted living program, the employee’s job description may satisfy this requirement.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The program shall maintain documentation that the delegating nurse has completed the mandatory training course developed by the Board of Nursing.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Duties. The delegating nurse shall:</text>
    <paragraph num="(1)">
      <text>Be on-site to observe each resident at least every 45 calendar days;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Be available on call at all times as required under this chapter or have a qualified alternate delegating nurse available on call; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Have the overall responsibility for:</text>
      <paragraph num="(a)">
        <text>Managing the clinical oversight of resident care in the assisted living program;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Issuing nursing or clinical orders, based upon the needs of residents;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Reviewing the assisted living manager’s assessment of residents;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Appropriate delegation of nursing tasks; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Notifying the Department:</text>
        <paragraph num="(i)">
          <text>If the delegating nurse’s contract or employment with the assisted living program is terminated; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Of the reason why the contract or employment was terminated.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>If the delegating nurse is not available to perform any duties, there shall be a qualified alternate delegating nurse available to perform those duties.</text>
  </paragraph>
  <paragraph num="E.">
    <text>When an assisted living manager fails to implement nursing or clinical orders without identifying alternatives to the care or service order, the delegating nurse shall notify the resident’s health care practitioner, the Department, and the resident, or, if applicable, the resident representative.</text>
  </paragraph>
</regulation>