(a) The dialysis facility's staff (whether employees or contractors) shall meet the personnel qualifications and demonstrated competencies necessary to serve collectively the comprehensive needs of the patients. The dialysis facility's staff shall have the ability to demonstrate and sustain the skills needed to perform the specific duties of their positions.(1) The facility shall have a written orientation program to familiarize all new employees (including office staff) with the facility, its policies, and job responsibilities. The orientation program shall be developed and implemented.(2) The facility shall ensure that each new direct care staff member (whether employee or contractor) is provided sufficient time to become familiar with the facility. The orientation program provided by the facility shall be a minimum time of two weeks for individuals with previous dialysis experience. For new direct care staff members with no previous dialysis experience, the orientation program shall be two weeks plus additional orientation time as determined by the facility.(3) The facility shall ensure that, in facilities with similar policies and equipment, experienced staff oriented to one facility may be shared with another facility after a shorter orientation period. Documentation of current competency of any shared staff and delegation by that facility's medical director to unlicensed technicians shall be on file in each facility where the shared employee works.(4) The facility shall ensure that registered nurses with no previous dialysis experience shall be provided an orientation program of a minimum of six weeks. For these registered nurses, the six-week orientation program shall contain at least the following subject content specific to the management of the end stage renal disease patient and appropriate to the population served by the facility:(A) fluid, electrolyte and acid-base balance;(B) kidney disease and treatment;(C) dietary management of kidney disease;(D) principles of dialysis;(E) dialysis technology;(F) venipuncture technique;(G) care of the dialysis patient;(H) psychological, social, financial, and physical complications of long-term dialysis;(I) prevention of hepatitis and other infectious diseases; and(J) risks and benefits of reuse (if reuse is practiced).(5) The facility shall ensure that each licensed nurse and dialysis technician demonstrate competency through written and skills testing after the completion of the training program and annually thereafter. Evidence of competency shall be documented in writing and maintained in personnel files. Current certification by a nationally recognized board may substitute for the annual written test. All dialysis technicians must be certified under a national commercially available certification program, within 18 months of being hired as a dialysis technician.(6) The facility shall ensure that documentation shall be maintained to demonstrate that each staff member providing patient care completes at least five hours of continuing education related to end stage renal disease annually. Continuing education may be provided by facility staff. Documentation shall include the title, duration, and the author or instructor of the continuing education course.(b) Medical staff.(1) Each physician on the medical staff shall have a current license to practice medicine in the State of Texas.(2) The members of the medical staff may include nephrologists and other physicians with training or demonstrated experience in the care of end stage renal disease patients.(3) If an advanced practice registered nurse is utilized, such individuals shall meet the requirements established by the Texas Board of Nursing in Texas Administrative Code,