Ordinarily, the planning and management of a treatment plan which does not involve
the furnishing of skilled services requires the skills of a nurse only where the facts
of the case establish that the aggregate of such unskilled services, when considered
in light of the patient's condition, necessitates the regular daily involvement of
a licensed nurse to ensure the patient's recovery and/or medical safety.
For example, an aged patient with a history of diabetes mellitus and angina pectoris
is recovering from an open reduction of a fracture of the neck of the femur. He requires,
among other services, careful skin care, appropriate oral medication, a diabetic diet,
a therapeutic exercise program to preserve muscle tone and body condition, and observation
to notice signs of deterioration in his condition or complications resulting from
his restricted mobility. Although any one of the required services could be performed
by a properly instructed unskilled person, such a person would not have the capability
of understanding the relationship among the services and their effect on each other.
Since the nature of the patient's condition, his age, and his immobility create a
high potential for serious complications, such an understanding is essential to assure
the patient's recovery and safety.
Under these circumstances, the management of such a plan requires the skills of a
nurse, even though each individual service it involves is normally unskilled.