1. YOU AND OSBN Oregon State Board of Nursing Scope of Practice
Debra Buck, RN, MS
Nursing Assistant Program Consultant – OSBN
Marilyn McGuire-Sessions, RN, MSN
RN/LPN Practice Consultant - OSBN
OCHE Meeting – April 20, 2012
Samaritan Lebanon Hospital

2. Learning Objectives
Identify resources – OSBN website journey and National Council of State Boards of Nursing (NCSBN) website
Discuss Division 45 – The Oregon Administrative Rule (OAR) of the Oregon Nurse Practice Act (NPA) for Standards and Scope of Practice for RNs and LPNs in Oregon
Identify the major differences between RN and LPN practice
Review types of circumstances that would be considered “conduct derogatory” to the Standard of Nursing
Review “mandatory reporting” section of Division 45

3. Learning Objectives
Review Division 47 – Delegation in a Community-Based Setting
Discuss C.N.A 1 & 2 ; C.M.A Authorized Duties, and Issues

4. Statutory Mandate to Regulate Nursing Practice
ORS
(7) The board shall:
(a) Exercise general supervision over the practice of nursing in this state.

5. Why Regulation of Nursing?
OSBN’s Mission Statement
The Oregon State Board of Nursing safeguards the public's health and well-being by providing guidance for, and regulation of, entry into the profession, nursing education and continuing safe practice.

6. What Is the Role of the Board of Nursing?
Public protection.
Determines requirements for licensure.
Sets standards and scope of practice.
Provides scope guidance for nurses and nursing assistants.
Identifies inappropriate conduct and performance & takes disciplinary action regarding licensure.
Approves nursing programs.
Proposes legislative concepts.
Influences public policy through testimony & public hearings.
Establishes public policy on nursing regulatory issues.

7. What the Board Doesn’t Do
Serve as a membership organization for nurses.
Regulate conditions of employment.
Regulate practice settings.
Independently change the Oregon Revised Statutes.
Make or change regulations without a public process.

8. OSBN Members Nine members appointed by the governor for 3 year terms.
5 RNs (2 in direct care, 1 manager, 1 educator, 1 nurse practitioner).
1 LPN
1 CNA (as of 2010)
2 consumer members.
In addition, represent different geographic regions – 2 from eastern Oregon, 3 from southern Oregon

9. OSBN Organizational Chart
GOVENOR
BOARD OF NURSING
EXECUTIVE DIRECTOR OF OSBN
HUMAN RESOURCES
INVESTIGATIONS
LICENSING
FISCAL SERVICES
COMMUNCATIONS
NURSING CONSULTANTS

10. Nursing Licensees in Oregon (Data current as of December, 2011)
Oregon licenses or certifies seven license types:
Registered Nurses;
Licensed Practical Nurses;
Certified Nursing Assistants;
Certified Medication Aides;
Nurse Practitioners (10 specialties);
Certified Registered Nurse Anesthetists, and
Clinical Nurse Specialists.
The average age of RNs in Oregon is 47 and the average age of LPNs is 49.

11. Tour: OSBN Website

12. Nursing: A Regulated Profession
What does “a regulated profession” mean for you?

13. Nursing As a Regulated Profession
Legislative decisions affect you.
You must meet standards to be licensed.
Your practice is regulated by the Nurse Practice Act and the OSBN.
You must practice within scope and standards set by law.
Failure to function within standards and scope may subject you to disciplinary action.

14. What is Scope of Practice?
All of the activities in which a nurse may engage at his/her level of licensure.
Each nurse has an individual scope within broader scope.
Individual scope determined by in-service education, continuing education, practice experience, etc.

15. Scope of Practice (cont’d.)
Documentation of how competency in new nursing activity is achieved and how it is maintained is required.
Activities within scope must be recognized by nursing profession as proper to be performed by Oregon nurse.
Scope, therefore, cannot be expanded by those outside of nursing (e.g. by physician).

16. Division 45: Standards and Scope of Practice for RNs and LPNs
Definitions
Standards for All Licensed Nurses
Scope of Practice Standards – LPN
Scope of Practice Standards – RN
Conduct Derogatory to the Standards of Nursing
Criminal Conviction History
Mandatory Reporting
Civil Penalties

17. Purpose of Division 45
Start with the definitions -

18. Standards for ALL Licensed Nurses RNs and LPNs
Client Advocacy
Environment of Care
Ethics – Professional Accountability & Competence
Nursing Technology
Responsibility for Assigning and Supervising Care
Accepting and Implementing Orders

19. RNs & LPNs Nursing Practice Implementation
LPNs practice under clinical direction of RN or other licensed provider who has authority to make changes in plan of care.
LPNs perform initial and ongoing focused assessments.
RNs perform initial and ongoing comprehensive and focused assessments.

20. RNs & LPNs (cont’d.) Nursing Practice Implementation
RNs establish nursing diagnostic statements; LPNs select them from available resources.
RN develops plan of care; LPN contributes to development.
Both responsible for implementation and evaluation.

21. RNs & LPNs (cont’d.) Collaboration with an Interdisciplinary Team
All licensed nurses responsible for collaborating, making referrals.
RN has additional language about ensuring follow-up on referrals.

22. RNs & LPNs (cont’d.) Leadership (includes Policy)
RN formulates, interprets, implements, evaluates policies, protocols, etc. LPN contributes to this.
RN assumes responsibility for development and mentoring of other staff. LPN assists.
RN uses evidence to identify needed changes in practice; LPN identifies changes in clients and practice environment requiring policy change.

23. RNs & LPNs (cont’d.) Quality of Care
Both identify factors which affect quality of care.
RN develops QI standards and processes. LPN contributes to this.
RN measures outcomes of nursing care and LPN participates in this.

24. RNs & LPNs (cont’d.) Health Promotion
RN develops and implements evidence-based health education plans; LPN selects or implements them.
Both RN and LPN responsible for evaluation of outcomes.

25. RNs & LPNs (cont’d.) Cultural Sensitivity
RN applies a broad knowledge of cultural differences; LPN applies a basic knowledge.

26. Conduct Derogatory to the Standards of Nursing
Conduct related to:
Client Safety and Integrity
Communication
Achieving and maintaining clinical competency
Impaired Function
Licensure and Certification
Relationship with the Board of Nursing
Client Families
Co-Workers
Advanced Nursing Practice

27. Mandatory Reporting Don’t need to report every nursing error.
Decision to report based on:
Past performance history.
Pattern of substandard practice.
Magnitude of occurrence for actual/potential harm to public.

28. Always Report Always report the following: A nurse imposter.
Practicing nursing with an expired license.
Arrest for or conviction of a crime which relates adversely to the practice of nursing.
Dismissal from employment due to unsafe practice or conduct derogatory.
Client abuse.
Substance abuse.
A pattern of conduct derogatory or a single serious occurrence

29. Criminal Conviction History: Denial of Licensure – Revocation of Licensure
List of Crimes that will not allow for licensure in Division 45
Omitting information on initial licensure or renewing license regarding conviction history can be grounds for revocation of licensure

30. Civil Penalties
Division 45 provides what the monetary penalty could be for certain violations of the Oregon Nurse Practice Act –
These are separate from any sanctions on licensure and/or criminal convictions

31. Exclusive to RN Practice
Delegation –
Division 47

32. Division 47 - Intro
Rules apply only in settings where RN not regularly scheduled and not available to provide direct supervision.
Purpose is to govern practice of nurses, not the practice setting.

33. Three Main Sections: Division 47
Teaching non-injectable Medication Administration
RN Delegation in the Community-Based Setting
Teaching for an Anticipated Emergency

34. Nurses’ Responsibilities to the Board
Know the statutes and rules that pertain to nursing.
For Oregon, practice 960 hours within 5 years.
Report unsafe practice through channels.
Keep current name, address and nursing employers on record with the Board.

35. Other OSBN Information
On-line web info at
Board Policies.
Nurse Practice Act.
Links to helpful sites.
Current topics.
Licensing information (on-line renewal now available).
Main #:
My direct #:

36. CNA 1 & 2; CMA: Authorized Duties & Issues
Provided by:
Debra K. Buck, RN, MS
Nursing Assistant Program Consultant

37. Be regularly supervised by a licensed nurse
Introduction
ORS (4) defines the term “nursing assistant” as a person who assists licensed nursing personnel in the provision of nursing care. Consistent with that definition, a CNA must either:
Be regularly supervised by a licensed nurse
Work in a setting where there is periodic supervision and evaluation under OAR through OAR
ORS (4) defines the term “nursing assistant” as a person who assists licensed
nursing personnel in the provision of nursing care. Consistent with that definition, a
CNA must either:
(a) Be regularly supervised by a licensed nurse; or
(b) Work in a community-based care setting or other setting where there is no
regularly scheduled presence of a licensed nurse provided there is periodic
supervision and evaluation of clients under the provisions of OAR
0000 through OAR 37

38. Introduction . Have current Oregon CNA 1 Certificate
Listed on the Oregon CNA registry
Prior to performing CNA 1 authorized duties
A CNA must have a current Oregon CNA 1 Certificate and be listed on the Oregon CNA Registry prior to performing CNA 1 authorized duties

39. Introduction
An individual who performs C.N.A.1 duties as an employee of a licensed nursing facility in Oregon must obtain C.N.A.1 certification no later than four months after date of hire

40. Certification Process
NA Level 1 Training
Fingerprinting
State Competency Exam
State Certification

41. Delegation & Supervision CNA/CMAs
In settings other than community based
Where nurse is present for supervision

42. Delegation to CNA Board position
Health, safety & welfare underpins all decisions.
Competent & supervised CNA/CMAs and UAPs have a role.
RNs may delegate tasks of nursing within the authorized duties.
Accountability remains with the health professional who delegated task.
Limitations to delegation.

43. Delegation to CNA RN Principles of delegation
May only delegate within the RN’s scope of practice.
May not delegate the nursing process.
Maintains responsibility, accountability, and authority for delegation.
Maintains sole responsibility as to whether to delegate or not.
May refuse to delegate.
Considers training, experience, & competence of caregiver.

44. Delegation to CNA RN Principles of delegation
Delegates only if individual has the necessary skills & competence.
Matches client needs with qualified personnel.
Communicates directions & expectations.
Supervises, monitors performance, progress, & outcomes.
Evaluates effectiveness.
Revises plan as needed.

45. AUTHORIZED DUTIES Division 63
C.N.A1 Tasks Associated With:
C.N.A.1 Assisting With:
Nutrition and Hydration
Elimination
Personal Care
Positioning Devices
Restorative Care
Infection Control: Standards/Transmission based Precautions
Safety and Emergency Procedures
Activities of Daily Living (ADLs)
Observation and Reporting
Documentation
End-of-Life care
(c) Tasks associated with nutrition and hydration:

46. Hold a current, unencumbered CNA 1 certificate
Requirements for
CNA 2 recognition
Hold a current, unencumbered CNA 1 certificate
Complete a level 2 training program and pass the program’s competency evaluation

47. CNA 2
CNA 1
Restorative Care
Acute Care
Dementia Care
Level 2 Training
Available to a CNA 1 to prepare them for a role in one or more of Board approved category areas

48. Training hours Restorative Care 16 Classroom/Lab & 16 Clinical hours
Core 30
Classroom/
Lab hours
Acute Care
10 Classroom/Lab
& 24
Clinical hours
Dementia Care
18 Classroom/Lab & 16
Clinical hours

49. CNA 2 Core Skills Suctioning oral pharynx Urine dip-stick testing
Testing Stool for occult blood
Bladder Scanning
Adding fluid to
established post pyloric,
J & G tube feedings &
changing
bags
CBG Testing
Pulse-electronic
Interrupting & re-establishing NG suction
B/P-forearm,
Upper arm, thigh,
& lower leg
Applying
sequential
compression
devices
Reinforcing use of
incentive spirometer
Assisting with warm & cold therapies
B/P-forearm, upper arm, thigh, & lower leg

50. B/P-forearm, upper arm, thigh, & lower leg
CNA 2 Core Skills
Discontinuing
Foley catheters
Assist with
complementary
therapies such as
guided imagery &
deep relaxation
Clean intermittent
straight urinary
catheterization for chronic conditions
Changing dressing or ostomy appliance/bag which adheres to the skin
Measuring
& recording
&/or emptying
output from
drainage devices
& closed drainage
systems
Obtaining sterile urine
specimen from port of
catheter 50
B/P-forearm, upper arm, thigh, & lower leg

51. CNA 2 Acute Care Assist in & out of CPM machines. Obtain rectal swab.
Place electrodes/leads & run EKG.
Place electrodes/leads for telemetry.
Remove cast in non-emergent situation.
Screen newborn hearing.
Set up traction equipment.
Test gastric contents for occult blood or pH.

52. CMA: Authorized Duties & Issues
CMA means a Certified Nursing Assistant who has had additional training in administration of noninjectable medication and holds a current unencumbered Oregon CMA Certificate.

53. CMA
A certified medication aide is not a CNA 2

54. CMA Authorized Duties Oral, sublingual, & buccal meds
Eye, ear, nasal, rectal, vaginal, skin meds
Meds via G & J tubes
Pre-measured meds via aerosol/nebulizer
Meds via metered hand-held inhalers

55. CMA Authorized Duties PRN meds In response to specific client requests
At the direction of the LN

56. CMA Authorized Duties CMAs may:
Administer regularly scheduled controlled substances
Jointly witness wasted controlled substances with LN
Count controlled substances with LN or CMA
Perform CBG

57. CMA Authorized Duties CMAs may:
Add fluid to established J or G tube feedings & change bags
Accept verbal or telephone orders for medication (in adult foster home, assisted living facility, or residential care facility) from a licensed health care professional who is authorized to independently diagnose & treat.

58. CMA Authorized Duties CMAs may not: Administer meds by:
Central lines Colostomy Intramuscular
Intrathecal Intravenous Nasogastric
Nonmetered inhaler Subcutaneous
Intradermal Urethral Epidural
Endotracheal

59. CMA Authorized Duties CMAs may not:
Administer the following kinds of meds:
Barium & other diagnostic contrast media
Chemotherapeutic agents except oral maintenance chemotherapy
Meds via medication pumps

60. Communication with Board of Nursing (971) 673-0636 (971)673-0684
17938 SW Upper Boones Ferry Rd
Portland, OR