Or. Admin. R. 851-045-0060

Current through Register Vol. 63, No. 6, June 1, 2024

Section 851-045-0060 - Scope of Practice Standards for Registered Nurses

(1) The Board recognizes that the scope of practice for the RN encompasses a variety of roles, including, but not limited to:

(a) Provision of client care;

(b) Clinical direction and clinical supervision of others in the provision of care;

(c) Development and implementation of health care policy;

(d) Consultation in the practice of nursing;

(e) Nursing administration;

(f) Nursing education;

(g) Case management;

(h) Nursing research;

(i) Teaching health care providers and prospective health care providers;

(j) Nursing Informatics; and

(k) Specialization as an NP, CRNA, or CNS.

(2) Standards related to the RN's responsibility for ethical practice, accountability for services provided, and competency. The RN shall:

(a) Base RN practice on current and evolving nursing science, other sciences, and the humanities;

(b) Be knowledgeable of the professional nursing practice and performance standards and adhere to those standards;

(c) Be knowledgeable of the Oregon statutes and regulations governing RN practice and practice within those legal boundaries;

(d) Demonstrate honesty, integrity and professionalism in the practice of registered nursing;

(e) Be accountable for individual RN actions;

(f) Maintain competency in one's RN practice role;

(g) Maintain documentation of the method that competency was acquired and maintained;

(h) Accept only RN assignments that are within one's individual scope of practice;

(i) Recognize and respect a client's autonomy, dignity and choice;

(j) Accept responsibility for notifying employer of an ethical objection to the provision of a specific nursing intervention;

(k) Ensure unsafe nursing practices are addressed immediately;

(l) Ensure unsafe practice and practice conditions are reported to the appropriate regulatory agency; and

(m) Protect confidential client information and only share information in a manner that is consistent with current law.

(3) Standards related to the RN's responsibility for nursing practice. Through the application of scientific evidence, practice experience, and nursing judgment, the RN shall:

(a) Conduct comprehensive assessments by:

(A) Collecting data from observations, examinations, interviews, and records in an accurate and timely manner as appropriate to the client's needs and context of care;

(B) Validating data by utilizing available resources, including interactions with the client, with health care team members, and by accessing scientific literature;

(C) Distinguishing abnormal from normal data, sorting, selecting, recording, evaluating, synthesizing and communicating the data;

(D) Identifying potentially inaccurate, incomplete or missing data and reporting data discrepancies as appropriate for the context of care;

(E) Identifying signs and symptoms of deviation from current health status;

(F) Anticipating changes in client status; and

(G) Evaluating the data to identify problems or risks presented by the client.

(b) Develop reasoned conclusions that identify client problems or risks;

(c) Develop a client-centered plan of care based on analysis of the client's problems or risks that:

(A) Establishes priorities in the plan of care;

(B) Identifies measurable outcomes; and

(C) Includes nursing interventions to address prioritized diagnostic statements or reasoned conclusions.

(d) Implement the plan of care;

(e) Evaluate client responses to nursing interventions and progress toward identified outcomes; and

(f) Update and modify the plan of care based on ongoing client assessment and evaluation of data.

(4) Standards related to the RN's responsibility to assign and supervise care.

(a) The RN may assign to the RN, nursing interventions that fall within RN scope of practice and that the licensee receiving the assignment possesses the competency to perform safely.

(b) The RN may assign to the LPN nursing interventions that fall within LPN scope of practice and that the licensee receiving the assignment possesses the competency to perform safely.

(c) The RN may assign to the CNA and CMA authorized duties identified within Chapter 851 Division 63 that the certificate holder possesses the competency to perform safely.

(d) The RN may assign to the UAP work the UAP is authorized to perform within the setting and that the UAP possesses the competency to perform safely.

(e) The RN who has agreed to act as a nurse intern's supervisor must:

(A) Only assign to the nurse intern those plan of care interventions that are identified as nurse intern authorized functions within Chapter 851 Division 041; and,

(B) Provide direct supervision of the nurse intern to whom an assignment has been made.

(f) The RN shall ensure the assignment matches the client's service needs with qualified personnel and available resources.

(g) The RN shall provide clinical supervision of the RN, LPN, CNA, CMA, and UAP to whom an assignment has been made:

(A) Provide clinical supervision per the context of care;

(B) Ensure documentation of supervision activities per the context of the assignment; and

(C) Evaluate the effectiveness of the assignment.

(h) The RN shall revise the assignment as indicated by client outcome data, availability of qualified personnel and available resources.

(i) Prior to making an assignment, the RN is responsible to know the duties, functions, activities or procedures the recipient of the assignment is authorized to perform within the setting.

(5) Standards related to the RN's responsibility for client advocacy. The RN shall:

(a) Advocate for the client's right to receive appropriate care, including client-centered care and end-of-life care, that is respectful of the client's needs, choices and dignity;

(b) Intervene on behalf of the client to identify changes in health status, to protect, promote and optimize health, and to alleviate suffering;

(c) Advocate for the client's right to receive appropriate and accurate information;

(d) Communicate client's choices, concerns and special needs to other members of the health care team; and

(e) Protect the client's right to participate or decline to participate in research.

(6) Standards related to the RN's responsibility for collaboration with the health care team. The RN shall:

(a) Function as a member of the health care team;

(b) Collaborate in the development, implementation and evaluation of integrated plans of care as appropriate to the context of care;

(c) Demonstrate a knowledge of health care team members' roles;

(d) Communicate with health care team members regarding the plan of care; and

(e) Make referrals in a timely manner and ensure follow-up on referrals.

(7) Standards related to the RN's responsibility for the environment of care. The RN shall:

(a) Promote and advocate for an environment conducive to safety; and

(b) Identify safety and environmental concerns, take action to address those concerns and report as needed.

(8) Standards related to the RN's responsibility for leadership and quality of care. The RN shall:

(a) Identify factors that affect quality of nursing service, health services delivery, and client care, and develop quality improvement standards and processes;

(b) Interpret and evaluate policies, protocols, and guidelines that are pertinent to nursing practice and to health services delivery;

(c) Develop and implement policies, protocols, and guidelines that are pertinent to the practice of nursing and to health services delivery;

(d) Participate in quality improvement initiatives and activities within the practice setting; and

(e) Participate in the development and mentoring of new licensees, nursing colleagues, students and members of the health care team.

(9) Standards related to the RN's responsibility for health promotion and teaching. The RN shall develop, implement and evaluate evidence-based teaching plans that address the client's learning needs, readiness to learn and ability to learn. This includes:

(a) Client health promotion and health education;

(b) Teaching a UAP how to administer injectable emergency medications as provided in ORS 433.800 to 433.830;

(c) Teaching a UAP how to administer naloxone as authorized by ORS 689.681;

(d) Teaching school personnel how to administer premeasured doses of epinephrine as provided in ORS 339.869; and

(e) Teaching a UAP how to administer noninjectable medications to a client in a community-based setting.

(10) Standards related to the RN's responsibility for cultural responsiveness. The RN shall:

(a) Apply a broad knowledge and awareness of cultural diversity; and

(b) Recognize and respect the cultural values, beliefs, and customs of the client.

(11) Standards related to the RN in the role of registered nurse first assistant (RNFA) in surgery.

(a) The RN who accepts an assignment to practice in the role of RNFA shall have successfully completed an RNFA program that meets the Association of Perioperative Nurses standards for the RN first assistant programs;

(b) Intraoperatively, the RNFA shall practice at the direction of the surgeon and not concurrently function in any non-RNFA practice role; and

(c) The RNFA shall practice under the direct supervision of the surgeon who is on site in the unit of care and not otherwise engaged in any other uninterruptible procedure or activity.

(12) Pursuant to 678.038, an RN who is employed by a public or private school, or by an education service district or a local public health authority as defined in ORS 431.003 to provide nursing services at a public or private school, may accept an order from a physician licensed to practice medicine in another state or territory of the United States if the order is related to the care or treatment of a student who has been enrolled at the school for not more than 90 days.

Or. Admin. R. 851-045-0060

BN 4-2008, f. &cert. ef. 6-24-08; BN 8-2017, f. 7-7-17, cert. ef. 8/1/2017; BN 10-2022, amend filed 07/26/2022, effective 8/1/2022; BN 16-2022, amend filed 12/27/2022, effective 1/1/2023

Statutory/Other Authority: ORS 678.150 & HB 4003 2022

Statutes/Other Implemented: ORS 678.150 & 678.010