Or. Admin. Code § 851-045-0060

Current through Register Vol. 63, No. 9, September 1, 2024

Section 851-045-0060 - Standards Related to RN Scope in the Practice of Nursing

(1) The RN's practice of registered nursing is independent and can occur in a variety of roles. Such roles commonly include but are not limited to:

(a) Nursing administration;

(b) Nursing education;

(c) Health care policy development, implementation and evaluation;

(d) Consultation in the practice of nursing;

(e) Provision of direct care;

(f) Clinical direction and clinical supervision of others;

(g) Health promotion and wellness;

(h) Case management;

(i) Nursing research;

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

(k) Nursing Informatics; and

(l) With additional education, professional certification, and licensure, engagement in an advanced practice registered nurse practice role.

(2) The RN's engagement in the practice of registered nursing occurs through the following actions:

(a) Assessment of client to identify their overall response to their current state of health that brought them into contact with the RN;

(b) Identification of reasoned conclusions based on validation, analysis and synthesis of assessment data.

(c) Identification of expected outcomes for reasoned conclusions.

(d) Development of a plan of care to:

(A) Prioritize reasoned conclusions;

(B) Identify interventions to attain expected outcomes;

(C) Identify implementation responsibilities, timelines and documentation requirements; and

(D) Utilization of language appropriate to the context of care.

(e) Implementation of plan of care. RN may include utilization of practice team members to carry out planned interventions per the context of care.

(f) Evaluation of client progress toward expected outcomes through:

(A) Ongoing collection and analysis of assessment data; and

(B) Revision of reasoned conclusions, expected outcomes, planned interventions, implementation responsibilities and timelines as indicated by clinical judgment.

(3) The RN may assign to a practice team member work the team member is authorized by license or certification and organizational position description to perform in the practice setting.

(a) This includes assigning to:

(A) Another RN;

(B) LPN;

(C) CNA or CMA; and

(D) UAP.

(b) Prior to assigning work, the RN must know the duties, functions, activities or interventions the recipient is authorized to perform.

(c) The RN who assigns work must:

(A) Assign according to the health, safety and welfare of their client;

(B) Provide supervision and evaluation of assigned work consistent with:

(i) The context of care; and

(ii) The RN's nursing practice relationship with the team member who accepts the assignment.

(C) Revise how work is distributed as indicated by client outcome data, availability of qualified practice team members and other appropriate resources.

(d) The RN who agrees to act as a nurse intern (NI) supervisor must:

(A) Assign to the nurse intern only those functions authorized for performance by a NI per OAR Chapter 851, Division 41;

(B) Maintain a physical presence in the NI's practice setting; and

(C) Be readily available to the NI either in person or by other means.

(4) The RN must employ strategies that promote health and safety.

(a) Such strategies may include providing opportunity for the client to identify needed health promotion, disease prevention and self-management topics.

(b) The RN who engages in teaching to promote health and safety must apply evidence-based teaching and learning principles in the development, implementation and evaluation of teaching plans and the evaluation of learner outcomes.

(c) Based on the RN's context of care, teaching content may include but is not limited to:

(A) Teaching a client's family member how to execute a medical order;

(B) Teaching a designated caregiver how to execute a medical order per OAR Chapter 851, Division 48;

(C) Teaching a UAP how to perform a client's nursing procedure per OAR Chapter 851, Division 47;

(D) Teaching a practice team member how to administer a regularly scheduled or pro re nata (PRN) noninjectable medication to a client;

(E) Teaching a practice team member how to administer PRN injectable or noninjectable lifesaving medication to a specific client;

(F) Teaching a group of people how to administer noninjectable medications to other persons; and

(G) Teaching a group of people how to administer a lifesaving medication to another person per ORS 433.800 to 433.830, ORS 689.681, or ORS 339.869.

(d) The RN may teach and validate a CNA to perform one or more additional authorized duties as listed in OAR 851-063-0035(2).

(A) The RN must represent or be employed by the CNA's employment site.

(B) Once the RN validates the CNA is competent to perform the additional duty, the duty may then be assigned to the CNA by nurses in the employing organization.

Or. Admin. Code § 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; BN 3-2024, amend filed 06/20/2024, effective 7/1/2024

Statutory/Other Authority: ORS 678.150 & HB 4003 2022

Statutes/Other Implemented: ORS 678.150, 678.010 & ORS 339.869