(a) A facility shall have personnel qualified to operate emergency equipment and to provide emergency care to patients that is on site and available at all times.     
      (b) A facility shall comply with the following nursing services staffing and training requirements.      
        (1) There shall be an organized nursing service under the direction of a qualified registered nurse (RN). The facility shall be staffed to ensure the nursing needs of all patients are met.       
        (2) There shall be a written plan of administrative authority for all nursing services with responsibilities and duties of each category of nursing personnel delineated and a written job description for each category. The scope of nursing services shall be limited to nursing care rendered to patients as authorized by Texas Occupations Code Chapter 301 (relating to Nurses).                  (A) The responsible individual for nursing services shall be a qualified RN whose responsibility and authority shall be clearly defined and shall include supervision of both personnel performance and patient care.                   (B) There shall be a written delineation of functions, qualifications, and patient care responsibilities for all categories of nursing personnel.                   (C) Nursing services shall be provided in accordance with current recognized standards or recommended practices.         
        (3) There shall be an adequate number of RNs on duty to meet minimum staff requirements, including supervisory and staff RNs, to ensure the immediate availability of an RN for emergency care or for any patient when needed.       
        (4) There shall be other nursing personnel in sufficient numbers to provide nursing care not requiring the service of an RN. An RN shall assign the nursing care of each patient to other nursing personnel in accordance with the patient's needs and the preparation and qualifications of the nursing staff available.       
        (5) An RN qualified, at a minimum, with current certification in advanced cardiac life support and pediatric advanced life support shall be on duty at the facility at all times whenever patients are present in the facility.       
        (6) All direct care staff members shall maintain current certification and competency in basic cardiac life support.       
        (7) The facility shall establish a nursing peer review committee to conduct nursing peer review, to the extent required by Texas Occupations Code Chapter 303 (relating to Nursing Peer Review).       
      (c) In addition to meeting the requirements for nursing staff under subsection (b) of this section, a facility shall comply with the following minimum staffing requirements:      
        (1) A facility that provides only topical anesthesia, local anesthesia, or minimal sedation shall have a second individual, who is trained and currently certified in basic cardiac life support, on duty at the facility until all patients have been discharged from the facility.       
        (2) A facility that provides moderate sedation or analgesia shall have the following additional staff:                  (A) a second individual, who is trained and currently certified in basic cardiac life support, on duty at the facility until all patients have been discharged from the facility; and                   (B) an individual trained and currently certified in advanced cardiac life support and pediatric advanced life support, until all patients have been discharged.         
        (3) A facility that provides deep sedation or analgesia or regional anesthesia shall have the following additional staff:                  (A) a second individual, who is trained and currently certified in basic cardiac life support, on duty at the facility until all patients have been discharged from the facility; and                   (B) an individual who is trained and currently certified in advanced cardiac life support and pediatric advanced life support, on duty and sufficiently free of other duties to enable the individual to respond rapidly to emergency situations, until all patients have been discharged.         
     Source Note:        The provisions of this §509.46 adopted to be effective December 4, 2023, 48 TexReg 7064