FAQs Regarding the Registered Nurse, Case Manager/Delegating Nurse in Assisted Living

​The following are frequently asked questions regarding activities of the Registered Nurse (RN), case manager/delegating nurses (CM/DN) in assisted living.

1. May the RN, CM/DN delegate the 45 day nursing site visit and client assessment to the LPN?

The 45 day site visit, which includes an assessment of: the client; the task; the caregiver to whom the task has been delegated; and the environment in which the task is to be performed may not be delegated to an LPN.

2. May the RN, CM/DN utilize the sample Office of Health Care Quality (OHCQ) Resident Assessment Form contained in the 16 hour RN, Case Manager/Delegating Nurse Training Program to assess clients in the Assisted Living (A.L) Facility?

The Resident Assessment form in the 16 hour RN, CM/DN Training Program is a Sample form. The RN, CM\DN must obtain the approved final version of the tool from OHCQ. While the content is accurate on the Sample form, the formatting is different and it also lacks the State Control number. Be sure to obtain the Resident Assessment form from OHCQ.

3. If the facility has a LPN administering all medications or if the facility is owned and operated by a LPN who administers all the medications, is the LPN or the facility required to have a RN, CM/DN? 

The RN, CM/DN 45 day nursing assessment is required when a medication technician is performing the delegated nursing function of medication administration. Therefore, if the LPN is administering all the medications, a 45 day RN, CM/DN site visit with assessment is not needed. HOWEVER because Nursing oversight is required under OHCQ regulations a RN, CM/DN is required to be involved in the facility’s care to patients. Nursing oversight is different from Delegation of Nursing functions – see OHCQ’S regulations COMAR 10.07.14(.02) (.04F) and (.21) F.).

4. Is the service plan to be written by or signed by the RN, CM/DN for the facility? 

Neither the Board or the OHCQ’s regulations require the RN, CM/DN to prepare or sign the service plan. However, the patient’s service plan is a collaborative effort between both the A.L. manager and the RN, CM/DN. This collaborative effort assures that that the health needs of the patient are integrated into the service plan. 

5. What about the resident specific Waiver - Is the RN, CM/DN responsible for this?

The resident specific waiver is specific to the health and safety needs of that client, and to the resources of the specific facility- including the level of staff available to care for the resident (CNA, medication technician, unlicensed person, LPN or RN). Therefore, the resident specific Waiver application to OHCQ is a collaborative effort between the A.L. manager and the RN, CM/DN. Contact OHCQ, Valerie Richardson RN at 410-402-8185 for more information on how to obtain a resident specific waiver for your specific client.

6. Is the RN, CM/DN required to sign off the scheduling of staff in the facility (or time cards or time sheets)?

The RN, CM/DN is not responsible for signing time cards/time sheets for any A.L. facility employee unless that is an assigned responsibility as the Director of Nursing etc. In regard to signing off on the scheduling of personnel for the facility, the RN, CM/DN is not required to sign off on the scheduling of staff. HOWEVER, the RN, CM/DN is responsible for determining the skill set and competencies needed of personnel who are assigned to provide assistance in care to residents or to actually provide care to dependent residents. Therefore, when hiring, training or scheduling staff for care of residents, the RN, CM/DN and A.L. manager should collaborate in this scheduling process.

 7. If the RN, CM/DN is on vacation, must the fill in or on call RN be a RN, CM/DN?

Yes, the RN filling in will need to interact with and direct the activities of the medication technician and/or the CNA and/or the unlicensed person. The RN, CM/DN training is designed to provide the RN with information he/she needs to keep the resident safe, the facility safe and the RN safe and in compliance with all State laws and regulations.

8. Must the RN, CM/DN review and sign off on the resident’s MAR?. 

The RN, CM/DN in assessing the resident and the staff providing care to the resident during the 45 day site visit, must review the MAR which includes but is not limited to:

A. The RN/CM/DN signing the MAR.
B.The RN, CM/DN checking to assure that all medication boxes have been appropriately signed. If the medication box is empty, the reason for it is noted on the back of the MAR. This includes when the client is absent from the facility.
C. All drugs must be appropriately discontinued. 
D. All medication orders are to be entered appropriately on the MAR. 
E. The RN, CM/DN is to utilize his or her review of the MAR as a means to teach and remediate the medication technician as necessary.
F. The MAR is a visual picture of that patient's medication use or misuse for the month. Therefore this MAR review is absolutely critical to the assessment, monitoring, and functioning of the medication technician.

9. Is the length of the medication technician class really limited to 6 hours per day? 

Yes, the RN, CM/DN teaching the medication technician training program must limit the medication technician class day to six hours. 

10. May the RN, CM/DN teaching the 20 hour medication technician student fax the reading and math test to the potential student to complete prior to the student taking the course?

No – absolutely not. The RN, CM/DN teaching the medication technician course: must give the exams in the classroom setting - must observe the student take the exams face to face and then must collect the exams from the student. The reason that exams are given is so those applicants who can not do simple math or read English are not admitted or permitted to progress through the medication technician class.

11. How can the new Assisted living manager who needs the medication technician training program to be licensed as a A.L. facility and who does not have patients in his/her facility complete the medication technician training requirements.?

The AL Manager is expected to make arrangements with another AL facility for the AL manager to do his/her clinical medication technician experience at the second AL facility. The RN, CM/DN can assist the AL manager obtain this clinical experience. However it is the AL manager's responsibility to arrange this clinical. Regardless of who arranges this, the AL manager must meet the same requirements as everyone else in the medication technician training program. These requirements include completing all three (3) components of the medication technician training program within 44 days e.g. theory, simulated medication pass, and the clinical experience of administering medication to an A.L. resident in an A.L. facility. 

12. Is it true that the medication technician’s competency is only assessed every two years at the time of the Clinical update?

No, This is not true. The RN, CM/DN at the time of the 45 day site visit is to assess the client; the environment; the nursing task to be delegated; and the clinical competency of the medication technician who is in the facility at the time of the site visit. That means the RN, CM/DN must vary the date and time of the 45 day site visit to assure that all medication technicians who administer meds 24-7 are seen with some regularity. Each medication technician must successfully complete the required Clinical Update every two years to maintain his/her certification.​

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