Title: Section 721.7 - Nursing Care

Section 721.7 Nursing Care. In addition to providing nursing care that meets generally accepted professional standards, hospitals shall meet the following additional nursing requirements at each designated level of care.

(a) Level I perinatal care service hospital. Maternal and newborn nursing care shall be provided under the direct supervision of a registered nurse. All obstetric nursing personnel shall be qualified in interpretation of fetal heart rate monitoring and understand the physiology of labor. All newborn nursing personnel shall be qualified in assessment of the newborn and all aspects of routine monitoring and care, including education and support related to breastfeeding.

(b) Level II care hospital. In addition to the qualifications described in subdivision (a) of this section, direct patient care shall be provided by registered nurses who have education and experience in the care of moderately high-risk women and/or newborns. All nurses caring for ill women or newborns shall demonstrate competence in the observation and treatment of such patients, including cardiorespiratory monitoring. Registered nurses in a Level II perinatal care hospital shall be able to: monitor and support the stability of cardiopulmonary, neurologic, metabolic, and thermal functions; assist with special procedures such as lumbar puncture, endotracheal intubation, and umbilical catheterization; and perform emergency resuscitation.

(c) Level III perinatal care hospital. Responsibilities of registered nurses shall include those defined in subdivisions (a) and (b) of this section. In addition, registered nurses in the Level III perinatal care hospital shall have specialty certification or advanced training and experience in the nursing management of high-risk women, neonates and their families. They shall also be experienced in caring for unstable women and neonates with multi-organ system problems and in specialized care technology. An advanced practice nurse shall be available to the staff for consultation and support on nursing care issues. Assessment and monitoring activities shall remain the responsibility of a registered nurse or advanced practice nurse in obstetric-neonatal nursing, even when personnel with a mixture of skills are used.

(d) RPC. Responsibilities of registered nurses shall include those defined in subdivisions (a), (b), and (c) of this section. In addition, nurses with special training shall participate in regional perinatal center responsibilities such as outreach, training, education and support.