Presentation on theme: "YOU AND OSBN Oregon State Board of Nursing Scope of Practice"— Presentation transcript:
1 YOU AND OSBN Oregon State Board of Nursing Scope of Practice Debra Buck, RN, MSNursing Assistant Program Consultant – OSBNMarilyn McGuire-Sessions, RN, MSNRN/LPN Practice Consultant - OSBNOCHE Meeting – April 20, 2012Samaritan Lebanon Hospital
2 Learning ObjectivesIdentify resources – OSBN website journey and National Council of State Boards of Nursing (NCSBN) websiteDiscuss 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 OregonIdentify the major differences between RN and LPN practiceReview types of circumstances that would be considered “conduct derogatory” to the Standard of NursingReview “mandatory reporting” section of Division 45
3 Learning ObjectivesReview Division 47 – Delegation in a Community-Based SettingDiscuss 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 StatementThe 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 LPN1 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 GOVENORBOARD OF NURSINGEXECUTIVE DIRECTOR OF OSBNHUMAN RESOURCESINVESTIGATIONSLICENSINGFISCAL SERVICESCOMMUNCATIONSNURSING 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, andClinical Nurse Specialists.The average age of RNs in Oregon is 47 and the average age of LPNs is 49.
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 DefinitionsStandards for All Licensed NursesScope of Practice Standards – LPNScope of Practice Standards – RNConduct Derogatory to the Standards of NursingCriminal Conviction HistoryMandatory ReportingCivil Penalties
17 Purpose of Division 45Start with the definitions -
18 Standards for ALL Licensed Nurses RNs and LPNs Client AdvocacyEnvironment of CareEthics – Professional Accountability & CompetenceNursing TechnologyResponsibility for Assigning and Supervising CareAccepting 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 IntegrityCommunicationAchieving and maintaining clinical competencyImpaired FunctionLicensure and CertificationRelationship with the Board of NursingClient FamiliesCo-WorkersAdvanced 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 45Omitting information on initial licensure or renewing license regarding conviction history can be grounds for revocation of licensure
30 Civil PenaltiesDivision 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 - IntroRules 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 AdministrationRN Delegation in the Community-Based SettingTeaching 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 atBoard 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, MSNursing Assistant Program Consultant
37 Be regularly supervised by a licensed nurse IntroductionORS (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 nurseWork in a setting where there is periodic supervision and evaluation under OAR through OARORS (4) defines the term “nursing assistant” as a person who assists licensednursing personnel in the provision of nursing care. Consistent with that definition, aCNA 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 noregularly scheduled presence of a licensed nurse provided there is periodicsupervision and evaluation of clients under the provisions of OAR0000 through OAR37
38 Introduction . Have current Oregon CNA 1 Certificate Listed on the Oregon CNA registryPrior to performing CNA 1 authorized dutiesA 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 IntroductionAn 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 TrainingFingerprintingState Competency ExamState Certification
41 Delegation & Supervision CNA/CMAs In settings other than community basedWhere 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 HydrationEliminationPersonal CarePositioning DevicesRestorative CareInfection Control: Standards/Transmission based PrecautionsSafety and Emergency ProceduresActivities of Daily Living (ADLs)Observation and ReportingDocumentationEnd-of-Life care(c) Tasks associated with nutrition and hydration:
46 Hold a current, unencumbered CNA 1 certificate Requirements forCNA 2 recognitionHold a current, unencumbered CNA 1 certificateComplete a level 2 training program and pass the program’s competency evaluation
47 CNA 2CNA 1Restorative CareAcute CareDementia CareLevel 2 TrainingAvailable 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 Core30Classroom/Lab hoursAcute Care10 Classroom/Lab&24Clinical hoursDementia Care18 Classroom/Lab &16Clinical hours
49 CNA 2 Core Skills Suctioning oral pharynx Urine dip-stick testing Testing Stool for occult bloodBladder ScanningAdding fluid toestablished post pyloric,J & G tube feedings &changingbagsCBG TestingPulse-electronicInterrupting & re-establishing NG suctionB/P-forearm,Upper arm, thigh,& lower legApplyingsequentialcompressiondevicesReinforcing useofincentive spirometerAssisting with warm & cold therapiesB/P-forearm, upper arm, thigh, & lower leg
50 B/P-forearm, upper arm, thigh, & lower leg CNA 2 Core SkillsDiscontinuingFoley cathetersAssist withcomplementarytherapies such asguided imagery &deep relaxationClean intermittentstraight urinarycatheterization for chronic conditionsChanging dressing or ostomy appliance/bag which adheres to the skinMeasuring& recording&/or emptyingoutput fromdrainage devices& closed drainagesystemsObtaining sterile urinespecimen from port ofcatheter50B/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.
54 CMA Authorized Duties Oral, sublingual, & buccal meds Eye, ear, nasal, rectal, vaginal, skin medsMeds via G & J tubesPre-measured meds via aerosol/nebulizerMeds 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 substancesJointly witness wasted controlled substances with LNCount controlled substances with LN or CMAPerform CBG
57 CMA Authorized Duties CMAs may: Add fluid to established J or G tube feedings & change bagsAccept 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 IntramuscularIntrathecal Intravenous NasogastricNonmetered inhaler SubcutaneousIntradermal Urethral EpiduralEndotracheal
59 CMA Authorized Duties CMAs may not: Administer the following kinds of meds:Barium & other diagnostic contrast mediaChemotherapeutic agents except oral maintenance chemotherapyMeds via medication pumps
60 Communication with Board of Nursing (971) 673-0636 (971)673-0684 17938 SW Upper Boones Ferry RdPortland, OR