1. Assessment of the total needs of the patient and planning and management of a patient care plan

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. They require, 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 their condition or complications resulting from their 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, their age, and their 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.