Currently the regulation says that there only needs to be RN coverage in a skilled nursing facility 8 hours per day. Well, that may be changing sometime in the near future. According to an article in McKnights today, Representative Jan Schakowsky (D-IL and co-chair of the Democratic Seniors Task Force) introduced a bill that would require long term care facilities to have an RN on duty 24/7 to assess, monitor, and provide direct care to the residents. The bill defines monitoring or surveillance as the "ongoing acquisition, interpretation, and synthesis of residents' data for clinical decision making.
With the increase in acuity of residents being admitted to facilities, there has been no increase in RN coverage requirements. In most, maybe all states, an LPN or LVN cannot assess, but collect data that either the RN or the physician can interpret.
Here is her statement regarding this bill: