Loading
 

 

Oregon Bulletin

January 1, 2014

Board of Nursing, Chapter 851

Rule Caption: Removal of NLNAC acronym and minor edits

Adm. Order No.: BN 9-2013

Filed with Sec. of State: 12-3-2013

Certified to be Effective: 1-1-14

Notice Publication Date: 11-1-2013

Rules Amended: 851-021-0005, 851-021-0010, 851-021-0025, 851-021-0050, 851-021-0120

Subject: Name change by a national nursing accreditation agency specifically referenced in rule required removal of this name from the definitions and some rule sections. While making this needed change, minor edits were made to other sections including changes in position titles, rule reference numbers, and a line missing from one section since the last revision. No changes are considered substantive. Accreditation agencies are now referred to using a more generic term to prevent the need for rule changes when organizations make name changes.

Rules Coordinator: Peggy A. Lightfoot—(971) 673-0638

851-021-0005

Definitions

As used in these rules:

(1) “Accreditation” is a voluntary, non-governmental peer review process by the higher education community. For the purpose of these rules, institutional accreditation applies to the entire institution, whereas nursing program accreditation applies to program accreditation by a national nursing accreditation organization recognized by the United States Department of Education.

(2) “Accrediting agency” means a regional accrediting association or national accrediting agency approved by the U.S. Department of Education (US DOE) and/or the Council on Higher Education Accreditation (CHEA).

(3) “Approval” is synonymous with accreditation as authorized in ORS 678.150(3), and means the process by which the Board evaluates and grants official recognition and status to nursing education programs that meet Board established uniform and reasonable standards. The status assigned may be Developmental Approval, Initial Approval or Approval.

(4) “Approval by the office of Degree Authorization” means the approval, under ORS 348.606, to provide any part of a program leading to the award of college credit or to an academic degree.

(5) “Articulation” refers to the process of comparing or matching the coursework completed in one educational institution with the courses or requirements of another institution. For the purpose of these rules, articulation specifically relates to courses completed or required within a nursing education program.

(6) “Basic Master’s Program” — A graduate program in nursing leading to initial licensure.

(7) “Board” refers to the Oregon State Board of Nursing.

(8) “Clinical Lab Teaching Assistant” refers to a member of the nursing faculty whose primary responsibility is to assist with the clinical lab teaching under the direction of the nurse educator.

(9) “Clinical Teaching Associate” refers to a nurse who has undergone specific education/training to serve as a role model, resource and coach for nursing students. The clinical teaching associate functions under the direction of the nurse educator or nurse educator associate.

(10) “Community-based nursing” is nursing practice that takes place in the context of family and the community.

(11) “Competencies” mean the knowledge, values, attitudes, and interpersonal, clinical reasoning, and psychomotor skills expected for safe and effective nursing practice.

(12) “Controlling Body” is an accredited educational agency planning to conduct or conducting a program in nursing. For purposes of these rules, “institution,” “Educational institution,” or “governing institution” is synonymous with “controlling body.”

(13) “Developmental approval” means approval of an application for establishing a new program and authorization to proceed with its development.

(14) “Distance nursing education” means the provision of nursing course(s) to students in settings physically separate from the faculty and the campus-based setting. Distance nursing education includes on-line and web-based portals, video-streaming, interactive television, and use of other electronic course delivery methods.

(15) “Extended campus site” means any location of an institution, other than the main campus, at which the institution offers at least 50 percent of a nursing education curriculum.

(16) “Faculty” means the nursing faculty as a whole, functioning as a collective body.

(17) “Faculty member” means an individual nurse educator, nurse educator associate, or clinical lab teaching assistant.

(18) “Home Board” means the approval or accrediting authority by which a particular nursing program is approved and to which it is accountable.

(19) “Initial Approval” means authorization by the Board to accept students for admission in a new nursing program, or in an extended campus site, when the Board deems the extended campus site to be the equivalent of a new program. Initial approval status continues until the first class has graduated and the Board has taken final action on the application for approval.

(20) “Major curriculum change” means a change that results in a refocus of purpose and objectives, a substantive change in program structure or method of instructional delivery, or a change that modifies 10% or more of the credit hours in the curriculum.

(21) “May” indicates permission.

(22) “National accreditation” means accreditation granted by a national nursing accreditation organization recognized by the United States Department of Education.

(23) “Nurse Administrator” refers to the registered nurse who is responsible and accountable for the nursing educational department, division or program, regardless of the official title assigned by any specific institution.

(24) “Nurse Educator” refers to a registered nurse who, as a member of the nursing faculty, is responsible for the development and/or implementation of the nursing program including curriculum, policies, student advising, and evaluation, mentoring and collaborating with nurse educator associates and clinical teaching associates. For the purpose of these rules, the term “nurse educator” includes all nurse faculty members regardless of rank who have responsibility for development and implementation of the program.

(25) “Nurse Educator Associate” refers to a registered nurse who may contribute to classroom and clinical instruction in collaboration with and under the direction of the nurse educator.

(26) “Nursing experience” means practice as a registered nurse. Specified years of nursing experience mean full time equivalence (FTE).

(27) “Organizing framework” means the mission, philosophy, and/or underlying assumptions upon which the curriculum is based.

(28) “Outcomes” are statements of the expected knowledge, skills, attitudes, values and abilities to be gained by students through completion of the nursing education program or a segment thereof.

(29) “Out-of-State Nursing Program” means a program in the United States that is approved or accredited by the licensing board for nurses in the particular state or U.S. territory, or the appropriate accrediting agency for that state or U.S. territory.

(30) “Population-focused nursing” is nursing practice that merges the body of knowledge from the public health sciences with nursing theories for the purpose of safeguarding and improving the health of populations.

(31) “Post-master’s certificate” means a certificate from an accredited graduate nursing education program that prepares licensed nurses who hold a master’s degree for an advanced nursing role.

(32) “Practice Site” is a location or situation in which nursing experience with actual patient/client individuals or groups is obtained.

(33) “Practicum” is a course or session in which a student obtains experience in nursing in either a laboratory or practice site.

(34) “Program” means a nursing education program that prepares graduates for licensure as registered or licensed practical nurses. The terms “nursing program,” or “nursing education program” as used in these rules, are synonymous with “Program.”

(35) “Representative of the Board” means the Board staff member or Board designee qualified to perform the necessary responsibilities.

(36) “Shall” indicates a requirement.

(37) “Significant increase” means an increase of more than 10% in the enrolled nursing students or an increase of one or more clinical cohorts, whichever is greater.

(38) “Site Visit” means that representative(s) of the Board go to the location of a program for specified purpose(s) which may include a survey for approval.

(39) “Standards for Approval” — Authoritative statements that set expectations for a program to achieve and maintain for approval status. (OAR 851-021-0040 through 0070).

(40) “Statewide Need” — Assessment and documentation of the need for the nursing program in relation to plans for total state resources and the need for entry level nurses in the state.

(41) “Survey visit” means that representative(s) of the Board go to the location of a program to review the program for compliance with Standards for Approval, and to prepare a report and recommendation regarding approval status.

(42) “Units or Credits” — For programs on academic quarters, one unit or credit is defined as one academic clock hour per week for ten to twelve weeks or three academic clock hours of practicum per week for ten to twelve weeks. For programs on academic semesters, one unit or credit is defined as one academic clock hour per week for fourteen to sixteen weeks or three academic clock hours of practicum per week for fourteen to sixteen weeks.

Stat. Auth.: ORS 678.150

Stats. Implemented: ORS 678.150

Hist.: NER 9, f. 8-15-62; NER 15, f. 1-4-71, ef. 1-25-71; NER 30, f. & ef. 1-27-76; NER 37, f. & ef. 7-18-77; NER 2-1985, f. & ef. 4-5-85; NB 1-1990, f. & cert. ef. 4-2-90; Renumbered from 851-020-0005; NB 2-1996, f. & cert. ef. 3-12-96; NB 4-1996, f. & cert. ef. 9-3-96; BN 7-1998, f. & cert. ef. 7-16-98; BN 1-2001, f. & cert. ef. 2-21-01; BN 3-2008, f. & cert. ef. 6-24-08; BN 17-2010, f. & cert. ef. 11-29-10; BN 9-2013, f. 12-3-13, cert. ef. 1-1-14

851-021-0010

Approval of Nursing Education Programs

(1) Letter of Intent and Preliminary Application:

(a) An institution or consortium of accredited institutions wishing to establish a new program in nursing shall submit a letter of intent and preliminary application to develop the program to the Board in advance of anticipated opening date.

(b) The letter of intent and preliminary application shall address at least the following information:

(A) Purpose, size, and type of program proposed

(B) Studies documenting the statewide need for graduates of the program. The study should also specifically address the need for the program in relation to the nursing needs of the geographical area to be served;

(C) An analysis of potential impact on other nursing programs in the state including:

(i) An analysis of current usage of potential clinical sites in area(s) proposed for student placements including impact on other programs placing students in clinical sites; and

(ii) Projected number of faculty positions and availability of qualified faculty in the area(s) proposed for clinical placements.

(D) Evidence of administrative and financial support for development of a nursing program;

(E) Anticipated student enrollment and proposed date of enrollment;

(F) For consortium applicants, any charters, contracts and other documents that show:

(i) Relationships among member institutions;

(ii) Member institution commitment to the consortium and the proposed nursing program; and

(iii) Mechanisms within the consortium for attainment and maintenance of Board standards for nursing education programs.

(G) The applicant shall respond to any Board requests for additional information;

(H) The Board, after timely review and consideration of the information contained in the letter of intent and any supplementary information, shall either grant or deny permission to begin development of a nursing program, including rationale for the decision;

(I) The Board shall provide notice to the nurse administrator and academic administrator of all Oregon-approved nursing education programs within 30 days of Board decision regarding approval to develop a nursing program;

(J) The nurse administrator and academic administrator of an Oregon-approved nursing education program shall have 30 days from notification of new program development to respond to the Board addressing potential adverse impact to their program;

(K) If the applicant is denied permission to begin development of a nursing program, the program may submit a revised letter of intent and preliminary application no sooner than six months from the previous submission;

(L) If the applicant is denied permission to begin development of a nursing program, a hearing before the Board may be requested and the provisions of the Administrative Procedures Act shall apply; and

(M) If the applicant does not submit a complete developmental approval application within twelve months after the date of the Board granting permission to proceed, the permission to begin program development shall expire.

(2) Application for Developmental Approval:

(a) An institution or consortium of accredited institutions that has received approval of their letter of intent to develop a nursing program may make application for developmental approval.

(b) The developmental approval application shall include at least the following:

(A) Evidence of accreditation of the institution, or of all member institutions in a consortium, by an appropriate regional or national accrediting association or agency; institutions seeking to establish a registered nursing program shall show evidence of;

(i) Approval as a degree-granting institution of higher education in Oregon; and

(ii) Accreditation by a regional association or national agency recognized by the Council on Higher Education Accreditation (CHEA).

(B) Letters of response from Oregon-approved nursing programs addressing specific concerns regarding adverse impact on current programs,

(C) Evidence of the appointment of a qualified nurse administrator and sufficient administrative support for program development;

(D) Administration and organizational plan delineating lines of authority and decision making impacting the nursing program;

(E) Description of proposed instructional modalities and resources to support these modalities with dates of availability;

(F) Availability of adequate practice sites for the program with supporting documentation from persons assigned to coordinate clinical placements for each facility;

(G) Availability of adequate educational facilities, services, and resources for the program;

(H) Evidence of financial resources adequate for planning, implementation and continuation of the program, including proposed operating costs;

(I) Tentative timetable for planning the program;

(J) Tentative start date for the program; and

(K) Current institution catalog(s).

(c) The applicant shall respond to the Board’s request(s) for additional information.

(d) If the Board, after timely review and consideration of the information contained in the application and any supplementary information, including response statements from other programs, shall either approve or deny the application and notify the applicant, including rationale for the decision.

(e) If developmental approval is denied, the program may submit a revised developmental application no sooner than six months from the previous submission.

(f) If developmental approval is denied, the applicant may request a hearing before the Board and the provisions of the Administrative Procedures Act shall apply; and

(g) If the applicant does not submit an application for initial approval within twelve months after the date designated for initiating the program in the approved plan, the developmental approval shall expire.

(3) Initial Approval:

(a) Initial approval status may be applied for when the following conditions have been met:

(A) Application as described in OAR 851-021-0010(2) has received Board approval;

(B) Evidence of approval for the new program has been obtained from the appropriate agencies or bodies that review and approve new programs for public and private educational institutions.

(i) An institution shall provide one copy of the report that was submitted to each agency and a copy of the letter(s) indicating that approval for the program have been granted;

(ii) A consortium shall provide documentation that each member institution has approved the program, as well as documentation of agency approval as above; and

(iii) An institution licensed by the Oregon Department of Education, Private Career Schools section shall provide documentation of current licensure.

(C) There are sufficient qualified nurse educators, other required educators and administrative support services to initiate the program a minimum of six months prior to the beginning of the courses;

(D) A tentative written proposed program plan, including curriculum developed in accordance with the Standards for Approval, has been submitted a minimum of three months prior to the offering of the first course to nursing students;

(E) There is evidence of readiness for admission of students in educational and clinical facilities including clinical placement sites for the maximum number of students enrolled at one time a minimum of three months prior to the offering of the first course to nursing students;

(F) Policies for admission and progression are in place a minimum of three months prior to the offering of the first course to nursing students;

(G) There is a comprehensive plan for evaluation of the nursing program that addresses key outcomes a minimum of three months prior to the offering of the first course to nursing students; and

(H) There is a signed agreement(s) for the articulation of program graduates into the next level of nursing education a minimum of three months prior to the offering of the first course to nursing students:

(i) Programs leading to a certificate or degree in practical nursing shall have an agreement with an Oregon-approved program preparing candidates for licensure as a registered nurse; and

(ii) Programs leading to an associate degree in nursing shall have an agreement with an Oregon-approved program leading to a baccalaureate or higher degree in nursing.

(b) Following Board receipt and review of the information required in OAR 851-021-0010(3)(a), the Board may grant or deny initial approval;

(c) A site visit may be conducted by a representative(s) of the Board;

(d) Initial approval must be received by a program prior to publication of the program and recruitment or acceptance of students for admission to the first class of nursing students;

(e) If initial approval is denied, the applicant may request a hearing before the Board and the provisions of the Administrative Procedures Act shall apply;

(f) Interim visits and/or progress reports may be requested by the Board at any time during the initial approval phase and/or following initial approval as deemed necessary by the Board; and

(g) If the institution or consortium does not admit a class within twelve months after the date designated for initiating the program the initial approval shall expire.

(4) Approval:

(a) Eligibility for approval occurs after the graduation of the first class of students;

(b) Within six months following graduation of the first class, the program shall submit a self study report addressing compliance with the Standards for Approval (OAR 851-021-0040 through 851-021-0070) and a survey visit shall be made for consideration of approval of the program;

(c) The decision of the Board to grant or deny approval shall be based upon review of a self study report submitted by the program addressing compliance with Board standards, of the success rate of graduates on the national licensure examination, and of a survey report by a representative(s) of the Board; and

(d) If approval is denied, the applicant may request a hearing before the Board and the provisions of the Administrative Procedures Act shall apply.

Stat. Auth.: ORS 678.150, 678.340 & 678.360

Stats. Implemented: ORS 678.150 & 678.360

Hist.: NER 30, f. & ef. 1-27-76; NER 37, f. & ef. 7-18-77; NB 3-1988, f. & cert. ef. 7-5-88; NB 1-1990, f. & cert. ef. 4-2-90; Renumbered from 851-020-0021; NB 4-1996, f. & cert. ef. 9-3-96; BN 1-2001, f. & cert. ef. 2-21-01; BN 7-2003, f. & cert. ef. 7-7-03; BN 11-2003, f. & cert. ef. 12-9-03; BN 3-2008, f. & cert. ef. 6-24-08; BN 17-2010, f. & cert. ef. 11-29-10; BN 9-2013, f. 12-3-13, cert. ef. 1-1-14

851-021-0025

Reports

(1) Program Changes Requiring Notification to the Board. The program shall notify the Board in writing within 30 days of development of the following circumstances:

(a) Change in the nurse administrator of the program;

(b) A significant increase or decrease in planned enrollment that may affect the overall faculty-student ratio or the capacity of institutional facilities or regional practice sites;

(c) Major changes in availability of adequate practice sites for the program that results in reduction in student enrollment or faculty positions;

(d) Change in accreditation status of the controlling body;

(e) Major reductions in the financial support for the program;

(f) Appointment of new faculty members.

(2) Program Changes Requiring Board of Nursing Approval:

(a) Change of Administrative Control:

(A) When control of an educational program is transferred from one institution to another, a report must be submitted to the Board by the receiving institution containing the following information:

(i) Rationale for change;

(ii) Anticipated effects on students, faculty and resources;

(iii) Administrative and organizational plans, including a sound operational budget;

(iv) Plans for the orderly transition of the program;

(v) Application for new program as delineated in OAR 851-021-0010, unless this requirement is waived by the Board of Nursing.

(B) The institution relinquishing the program shall notify the Board of Nursing in writing of the intent to transfer the program, and shall submit to the Board the information requested of programs undergoing voluntary termination (OAR 851-021-0035(1)).

(b) Major Curriculum Change:

(A) When a nursing education program anticipates a major curriculum change, such change shall be submitted to the Board for approval at least three months prior to implementation.

(B) The following materials shall be submitted with the request for curriculum changes:

(i) Rationale for proposed changes including the anticipated effect on faculty, students, resources and facilities;

(ii) Presentation of the differences between the current curriculum and the proposed curriculum;

(iii) A timetable for implementation of change;

(iv) Methods of evaluation that will be used to determine the effects of the change.

(c) Exceptions to qualified faculty members under OAR 851-021-0045(8);

(d) Addition of an extended campus site or distance nursing education option:

(A) The program shall submit a letter of intention to expand offerings to an extended campus site or using distance education technology at least six months prior to planned implementation;

(B) The letter of intent shall include at least the following information:

(i) Plan for qualified faculty for the program at the extended site or with addition of distance education technology;

(ii) Description of available and proposed education facilities and delivery modalities, services and resources with dates of availability;

(iii) Availability of adequate practice sites and provisions for faculty supervision of clinical experiences;

(iv) Tentative time schedule for planning, initiating, and evaluating the program.

(C) The Board may deem the addition of an extended campus site or distance nursing education option as the equivalent of a new program, and require application under OAR 851-021-0010. Notice to the applicant shall include the rationale for the Board decision.

(e) Proposed demonstration project(s) that significantly alter the approved curriculum, model of clinical practica or faculty-to-student ratio.

(A) The program shall submit a letter of intention to implement such a project at least three months prior to the planned implementation.

(B) The letter of intention shall include at least the following information:

(i) Description of the proposed project, including purpose;

(ii) Description of mechanisms and procedures for and student safety and learning effectiveness;

(iii) Plan for evaluation of the project and reporting findings back to the Board; and

(iv) Tentative time schedule for planning, initiating, and evaluating the program.

(3) NCLEX first attempt pass rate standards and reports.

(a) The pass rate will be calculated annually on the basis of a program’s pass rate for the total number of first attempt candidates examined over a one year period and a revolving two year period of time.

(b) A program shall present a written plan, in conformance with Board policy, to evaluate and improve graduate performance on the licensing examination in the event that the program fails to maintain an average of

(A) An 85% pass rate or higher over a two year period, or

(B) A 70% pass rate or higher over a one year period.

(4) Annual Reports:

(a) Statistical data and qualitative program information shall be required to be submitted to the Board annually on a form supplied by the Board;

(b) The annual report shall include information to enable monitoring of continued compliance with the Board’s rules. Required reports may include data for aggregate and trend analysis.

(5) General Guidelines for Reports:

(a) The Board shall review reports for approval, or continued approval of nursing education programs or proposals for major curriculum change only at times when the Board is in formal session;

(b) A copy of the report(s) shall be in the Board Office at least six weeks prior to the Board meeting.

Stat. Auth.: ORS 678.150

Stats. Implemented: ORS 678.150

Hist.: NER 4-1985, f. & ef. 7-10-85; NB 1-1990, f. & cert. ef. 4-2-90; Renumbered from 851-020-0071; NB 1-1993(Temp), f. & cert.e f. 2-8-93; NB 6-1993, f. & cert. ef. 6-22-93; NB 2-1996, f. & cert. ef. 3-12-96; NB 4-1996, f. & cert. ef. 9-3-96; BN 1-2001, f. & cert. ef. 2-21-01; BN 3-2008, f. & cert. ef. 6-24-08; BN 9-2013, f. 12-3-13, cert. ef. 1-1-14

851-021-0050

Standards for Approval: Curriculum

(1) Curriculum shall:

(a) Prepare the student to achieve the nursing competencies necessary for safe practice based on current standards of care;

(b) Reflect the identified mission, goals, and learning outcomes of the nursing education program; and

(c) Be consistent with the law governing the practice of nursing.

(2) Curriculum plan shall identify:

(a) Competencies or learning outcomes at the course and program level;

(b) Learning activities to develop identified competencies. Courses, learning activities and clinical practicum shall be organized in such a manner to have sufficient proximity in time to allow the student to form necessary links of theoretical knowledge, clinical reasoning, and deliberate practice;

(A) Clinical practica shall include sufficient direct patient care hours to achieve identified competencies, course and program outcomes.

(B) All clinical practica shall be directed and supervised by a nurse educator or nurse educator associate.

(C) All programs shall include no less than six (6) contact hours of learning activities related to pain management.

(c) Requirements of the educational institution for graduation; and

(d) Total units required for graduation.

(3) Practical Nurse Programs:

(a) In practical nursing programs, the course content and clinical experience required shall be a minimum of 42 quarter units or 28 semester units including:

(A) Biological, applied, social, and behavioral sciences and humanities: minimum of 18 quarter units or 12 semester units; and

(B) Practical Nursing: minimum of 24 quarter units or 16 semester units of which no less than 12 quarter or eight semester units shall be clinical practicum.

(b) The Practical Nurse program shall provide theory and faculty-supervised clinical practice in nursing to achieve competencies within the practical nurse scope of practice, including those related to:

(A) Creating and maintaining a safe environment of care;

(B) Demonstrating professional, legal, and ethical behavior in nursing practice;

(C) Applying knowledge and problem-solving skills;

(D) Providing safe, clinically competent, culturally sensitive, and client-centered care for the promotion, restoration and maintenance of wellness or for palliation across the lifespan and settings of care;

(E) Functioning as a member of the interdisciplinary healthcare team;

(F) Applying leadership and management skills to assign, direct and supervise care provided by nursing assistive personnel;

(G) Using technology to facilitate communication, manage information, and document care; and

(H) Providing cost-effective nursing care and participating in quality improvement strategies.

(4) Registered Nurse Program:

(a) Registered nurse curricula shall meet all institutional requirements for and culminate in the award of an associate, baccalaureate, masters, or doctoral degree.

(b) In registered nurse programs, the course content and clinical experience required shall be a minimum of 84 quarter units or 56 semester units including:

(A) Physical, biological, social and behavioral sciences and humanities: minimum of 36 quarter units or 24 semester units; and

(B) Nursing: minimum of 48 quarter units or 32 semester units of which no less than 24 quarter units or 16 semester units shall be clinical practicum.

(c) The Registered Nurse program shall provide theory and faculty-supervised clinical practice in nursing to develop competencies at the registered nursing scope of practice related to:

(A) Creating and maintaining a safe environment of care;

(B) Demonstrating professional, ethical and legal behavior in nursing practice

(C) Using problem-solving skills, reflection, and clinical judgment in nursing practice;

(D) Prescribing/directing, managing, delegating and supervising nursing care for individuals, families, or groups;

(E) Providing safe, clinically competent, culturally sensitive, client-centered and evidence-based care to promote, restore and maintain wellness or for palliation across the lifespan and settings of care;

(F) Providing culturally sensitive and evidence-based teaching, counseling, and advocacy for individuals, families and groups;

(G) Participating within and providing leadership for an interdisciplinary team;

(H) Applying leadership skills to identify the need for and to promote change;

(I) Using communication and information technology effectively and appropriately;

(J) Applying and integrating principles of community health and community-based care into practice; and

(K) Integrating concepts of resource utilization, quality improvement and systems to enhance care delivery.

(L) Baccalaureate and basic masters or doctoral programs shall also include competencies related to:

(i) Applying epidemiological, social, and environmental data and principles to identify and implement health promotion goals and strategies for communities and populations;

(ii) Assuming leadership and effecting change through participation in teams and beginning application of management knowledge.

(iii) Identifying and implementing measures to improve access to healthcare for individuals and underserved groups;

(iv) Using the principles and practice of research to validate and improve nursing care for individuals, families, and groups; and

(v) Using teaching-learning principles to assist colleagues and healthcare providers to improve nursing care quality.

(5) Programs providing distance nursing education shall:

(a) Deliver the approved curriculum through learning activities designed to allow students to achieve stated learning outcomes or competencies;

(b) Provide learning activities that are sufficiently comprehensive to achieve stated program outcomes and competencies; and

(c) Support instructor-student interaction and meaningful student interaction.

(6) Programs that provide for advanced placement of students shall develop and use policies designed to assure that such students meet the equivalent of the program’s current curriculum and competencies.

Stat. Auth.: ORS 678.150, 678.340 & 678.360

Stats. Implemented: ORS 678.150 & 678.360

Hist.: NER 30, f. & ef. 1-27-76; NER 37, f. & ef. 7-18-77; NER 2-1985, f. & ef. 4-5-85; NB 3-1988, f. & cert. ef. 7-5-88; NB 1-1990, f. & cert. ef. 4-2-90; Renumbered from 851-020-0056; NB 4-1996, f. & cert. ef. 9-3-96; BN 1-2001, f. & cert. ef. 2-21-01; BN 3-2008, f. & cert. ef. 6-24-08; BN 9-2013, f. 12-3-13, cert. ef. 1-1-14

851-021-0120

Nursing-Critical Shortage Area Defined for the Purpose of the Oregon Nursing Services Program

(1) For the purposes of the Oregon Nursing Services Program, a student loan repayment program administered by the Oregon Student Assistance Commission, a “nursing-critical shortage area” means:

(a) A locality or practice setting defined by the Office of Rural Health as “frontier” or “rural”; and/or

(b) A practice specialty determined to be “critical” by the Board of Nursing, in consultation with the Office of Rural Health.

(2) A complete list of practice settings and/or practice specialties considered to be “critical” will be identified annually in Board policy.

Stat. Auth: ORS 678.031 & 678.150

Stats. Implemented: ORS 678.031

Hist.: BN 1-2002, f. & cert. ef. 3-5-02; BN 3-2003, f. & cert. ef. 4-23-03; BN 3-2008, f. & cert. ef. 6-24-08; BN 9-2013, f. 12-3-13, cert. ef. 1-1-14


Rule Caption: Correct accreditation agency language, standardize language with Division 56

Adm. Order No.: BN 10-2013

Filed with Sec. of State: 12-3-2013

Certified to be Effective: 1-1-14

Notice Publication Date: 11-1-2013

Rules Amended: 851-050-0000, 851-050-0001, 851-050-0002

Subject: Name change by a national nursing accreditation agency specifically referenced in rule required removal of this name from the definitions and some rule sections. Accreditation agencies are now referred to using a more generic term to prevent the need for rule changes when organizations make name changes. Work on a related Division showed need to standardize some definitions and language to provide clarity.

Rules Coordinator: Peggy A. Lightfoot—(971) 673-0638

851-050-0000

Definitions

(1) “Assessment” means a process of collecting information regarding a client’s health status including, but not limited to, illness; response to illness; health risks of individuals, families and groups; resources; strengths and weaknesses, coping behaviors; and the environment. The skills employed during the assessment process may include, but are not limited to: obtaining client histories, conducting physical examinations, ordering, interpreting and conducting a broad range of diagnostic procedures (e.g., laboratory studies, EKGs, and x rays).

(2) “Asynchronous learning” means learning experiences, usually delivered through online technology where the interactions between the faculty and students is not constrained by time or place.

(3) “Client(s) or patient(s)” means a family, group or individual who has been assessed by and has a client/patient record established by the nurse practitioner.

(4) “Clinical Practice Experience” means the supervised provision of direct patient care in a clinical setting that complements course work and ensures acquisition of advanced practice nursing skills.

(5) “Clinical Preceptor” means health care provider qualified by education and clinical competency to provide direct supervision of the clinical practice experience of students in an Oregon nurse practitioner program.

(6) “Collaboration” means working with another health care provider to jointly provide client care.

(7) “Consultation” means discussion with another health care provider for the purpose of obtaining information or advice in order to provide client care.

(8) “Counseling” means a mutual exchange of information through which advice, recommendations, instruction, or education is provided to the client.

(9) “Delinquent Renewal” means the renewal of a nurse practitioner certificate previously held in Oregon which is expired.

(10) “Diagnosis” means identification of actual or potential health problems or need for intervention, based on analysis of the data collected.

(11) “Direct Supervision” means the clinical preceptor or faculty member physically present at the practice site who retains the responsibility for patient care while overseeing the student and if necessary, redirecting or intervening in patient care and is able to intervene if necessary.

(12) “Distance learning” means using multiple media for students to access the curriculum without the need to be physically present at the education site.

(13) “Evaluation” means the determination of the effectiveness of the intervention(s) on the client’s health status.

(14) “Holistic Health Care” means an approach to diagnosis and treatment of clients, which considers the status of the whole person (physical, emotional, social, spiritual, and environmental).

(15) “Initial certification” means the first certification granted by the Board. This may follow the applicant’s completion of a nurse practitioner program or be granted to an applicant in Oregon who has been recognized by and has practiced as a nurse practitioner in another state or jurisdiction.

(16) “Interprofessional educator” means a professional faculty member licensed, certified, or otherwise recognized in a field other than nursing.

(17) “Intervention” means measures to promote health, to protect against disease, to treat illness in its earliest stages, and to manage acute and chronic conditions and/or illness. Interventions may include, but are not limited to: issuance of orders, direct nursing care, prescribing or administering medications or other therapies, and consultation or referral.

(18) “Major curriculum change” means a change that results in a refocus of purpose and objectives; or a substantive change in program structure or method of clinical or instructional delivery, or clinical hours and content.

(19) “Management” means the provision and/or coordination of the care that the client receives related to physical and psycho-social health-illness status;

(20) “National Board Certification” means current certification as an advanced Nurse Practitioner in a role and population focus through testing accredited by the National Commission on Certifying Agencies or the American Boards of Nursing Specialties, as approved by the Board.

(21) “Non-Oregon Based Graduate Program” means an academic program accredited by a nursing organization recognized by the United States Department of Education or the Council of Higher Education Accreditation that offers a graduate degree or graduate level certificate to qualified students for licensure as an advanced practice registered nurse (Clinical Nurse Specialist, Certified Registered Nurse Anesthetist, Nurse Practitioner) and does not have a physical location in Oregon.

(22) “Nurse Practitioner Educator” refers to a licensed Nurse Practitioner faculty member, who has responsibility for developing and implementing the curriculum, policies, and practices associated with student advising and evaluation, mentoring and collaborating with clinical preceptors and other health care professionals.

(23) “Nurse Practitioner Program Administrator” refers to a licensed Nurse Practitioner appointed by the Dean or Director of the Nursing school who is assigned the responsibility and accountability for the nursing educational program within an accredited academic institution, including those functions aligned with program and curricular design and resource acquisition and allocation.

(24) “Nurse Practitioner” (NP) means an advanced practice registered nurse who is certified by the Board to independently assume responsibility and accountability for the care of clients. The title nurse practitioner and population foci of practice shall not be used unless the individual is certified by the Board.

(25) “Nurse Practitioner Orders” means written or verbal instructions or directions by the nurse practitioner for interventions, diagnostic tests, evaluations, drugs, or treatment modalities. Nurse practitioners may establish protocols and standing orders.

(26) “Oregon Based Nurse Practitioner Program” means Board approved academic program meeting NP state certification criteria that is physically located in Oregon and accredited by a nursing organization recognized by the United States Department of Education or the Council of Higher Education Accreditation that offers a graduate degree or graduate level certificate to qualified students.

(27) “Practice requirement” in an expanded specialty role means independent clinical practice in the specialty role of certification providing health care or other such activities, which have a clinical focus and are at an advanced nursing level. These activities include, but are not limited to, teaching, consulting, supervision and research related to the specialty area of certification.

(28) “Provision of Care” means holistic health care, which is continuous and comprehensive. Health care includes:

(a) Health promotion;

(b) Prevention of disease and disability;

(c) Health maintenance;

(d) Rehabilitation;

(e) Identification of health problems;

(f) Management of health problems;

(g) Referral.

(29) “Referral” means directing the client to other resources for the purpose of assessment or intervention.

(30) “State Certification” means certification to practice as a Nurse Practitioner authorized by the Oregon State Board of Nursing.

Stat. Auth.: ORS 678.375, 678.380, 678.385, 678.390

Stats. Implemented: ORS 678.375, 678.380, 678.385

Hist.: NB 3-1987, f. & ef. 3-12-87; NB 3-1990, f. & cert. ef. 4-2-90; NB 7-1996, f. & cert. ef. 10-29-96; BN 5-2000, f. & cert. ef. 4-24-00; BN 6-2001, f. & cert. ef. 4-24-01; BN 10-2003, f. & cert. ef. 10-2-03; BN 8-2004, f. 5-4-04, cert. ef. 5-12-04; BN 13-2006, f. & cert. ef. 10-5-06; BN 9-2009, f. 12-17-09, cert. ef. 1-1-10; BN 14-2012(Temp), f. & cert. ef 11-15-12 thru 5-1-13; BN 3-2013, f. 2-28-13, cert. ef. 4-1-13; BN 10-2013, f. 12-3-13, cert. ef. 1-1-14

851-050-0001

Standards for Nurse Practitioner Programs

The Board’s standards for all nurse practitioner programs for initial applicants are as follows:

(1) The nurse practitioner program shall be a minimum of one academic year in length; however, programs completed before January 1, 1986 and post-Masters programs completed for the purpose of changing category of nurse practitioner certification may be less than one academic year in length if the program otherwise meets all requirements.

(2) Faculty who teach within the nurse practitioner program shall be educationally and clinically prepared in the same specialty area(s) as the theory and clinical areas they teach and shall include advanced practice nurses.

(3) The curriculum content shall contain theory and clinical experience in the nurse practitioner population focus specified in OAR 851-050-0005(6) for which application is being made, preparing the graduate to meet all competencies within the scope including physical assessment, pharmacology, pathophysiology, differential diagnosis and clinical management.

(4) The number of contact hours of clinical experience shall be equal to or greater than the number of contact hours of nurse practitioner theory. The clinical experience must consist of full scope preparation in the population focus for which application is being made.

(5) Post-graduate Nurse Practitioner programs which prepare an individual for dual role or population focus certification must meet all competencies designated for the Nurse Practitioner role including supervised clinical hours of no less than 500 hours for each role or population focus.

(6) Programs must provide documentation that students meet the program’s curriculum requirements in effect at the time of enrollment.

(7) Written program materials shall accurately reflect the mission, philosophy, purposes, and objectives of the program.

(8) Programs shall demonstrate appropriate course sequencing and requirements for matriculation into the program, including completion of all pre-licensure nursing curriculum requirements before advancement into nurse practitioner clinical coursework.

(9) Preceptors shall meet clinical and licensure qualifications for the state in which they practice.

(10) Distance and asynchronous learning programs shall meet all standards of OAR 851-050-0001.

(11) All courses required for completion of the nurse practitioner program must be at the graduate level, if completed after January 1, 1986.

(12) Nurse practitioner programs outside of the United States must meet all standards of OAR 851-050-0001. Such programs shall be determined by Board approved or directed credentials review to be equivalent to graduate nurse practitioner programs offered in the United States which prepare the nurse practitioner for practice within the advanced nursing specialty scope. Nationally recognized nursing accreditation standards or guidelines may be applied by the Board at the Board’s discretion, in accordance with the Oregon Office of Degree Authorization regulations.

(13) The Board’s additional requirements for Oregon based Nurse Practitioner programs are as follows. The Dean or Director of the Nursing school which provides one or more Nurse Practitioner programs/tracks shall ensure that one or more qualified faculty are appointed and have defined position responsibility to address the administrative functions of the program/track. Administrative functions include budget and resource preparation, curricular design, oversight of program implementation and evaluation. The appointed faculty and preceptor(s) in the program shall meet the following requirements:

Nurse Practitioner Program Faculty, Administration and Preceptors

(a) Nurse Practitioner Program Administrator who has overall responsibility for one or more NP tracks shall meet the following requirements:

(A) A current active unencumbered Oregon Nurse Practitioner state certificate;

(B) National certification as a Nurse Practitioner in at least one population focus area;

(C) A doctoral degree in a health-related field;

(D) Educational preparation or experience in teaching and learning principles for adult education, including curriculum development and administration and at least two years of current clinical experience which meets Oregon’s practice requirements;

(E) In a multi-track program, where only one Program Administrator is appointed by the Dean or Director of the school, there must be evidence of additional program administrators or lead Nurse Practitioner faculty to provide oversight for student supervision who are nationally certified in that specific program’s population focus.

(b) The Nurse Practitioner Program Educator shall meet the following requirements:

(A) A current active unencumbered Oregon Nurse Practitioner state certificate;

(B) An earned doctoral degree in nursing; or

(C) A masters degree with a major in nursing and an appropriate advanced practice nurse credential; and

(D) Two years of clinical experience as a Nurse Practitioner; and

(E) Current knowledge, competence, and certification as a Nurse Practitioner in the population foci consistent with teaching responsibilities;

(F) Adjunct clinical faculty employed solely to supervise clinical nursing experiences of students shall meet all the faculty requirements.

(G) Inter-professional educators who teach non-clinical nursing courses shall have advanced preparation appropriate to the area of content.

(c) Clinical Preceptors in the Nurse Practitioner program shall meet the following requirements:

(A) Student preceptor ratio shall be appropriate to accomplishment of learning objectives, to provide for patient safety, and to the complexity of the clinical situation;

(B) Oregon licensure or certification appropriate to the health professional area of practice;

(C) Functions and responsibilities for the preceptor shall be clearly documented in a written agreement between the agency, the preceptor, and the clinical program

(D) Initial experiences in the clinical practicum and a majority of the clinical experiences shall be under the supervision of clinical preceptors who are licensed advanced practice registered nurses.

(d) Nurse Practitioner Educator responsibilities shall include:

(A) Making arrangements with agency personnel in advance of the clinical experience which provides and verifies student supervision, preceptor orientation, and faculty defined objectives;

(B) Monitoring student assignments, making periodic site visits to the agency, evaluating students’ performance on a regular basis with input from the student and preceptor, and availability for direct supervision during students’ scheduled clinical time;

(C) Providing direct supervision by a qualified faculty or experienced licensed clinical supervisor as required for patient safety and student skill attainment.

(e) Nurse Practitioner Program Administrator responsibilities shall include:

(A) Ensuring appropriate student faculty ratios to meet program goals and objectives;

(B) Provision of leadership and accountability for the administration, planning, implementation and evaluation of the program;

(C) Preparation and administration of the program budget;

(D) Facilitation of faculty recruitment, development, performance review, promotion and retention;

(E) Assurance that cooperative agreements with clinical practice sites are current.

Program Accreditation Required and Board Notification Process

(f) Currently accredited programs that prepare nurse practitioners for state certification under these rules and requirements shall submit to the Board:

(A) A copy of their most recent program self-evaluation reports;

(B) Current accreditation and survey reports from all nursing accrediting agencies; and

(C) Interim reports submitted to the national nursing accreditation agency.

(D) These documents must be submitted to the Board upon receipt to or release from the accrediting agency.

(g) Programs which prepare nurse practitioners for state certification under development or pre-accreditation review shall submit the following for review by the Board:

(A) Copies of the curricula within 30 days of sending the information to the accrediting agency;

(B) Copies of self-evaluation reports and any interim reports provided to all national nursing accreditation agencies, at the time of notification from the accrediting agency that the program has not been fully accredited;

(C) Verification of accreditation from all accrediting agencies within 30 days of receipt by the program;

(D) Annual reports which enable the monitoring of continued compliance with Board requirements.

(h) Grounds for denial of graduate nurse practitioner applicants for initial certification include failure of the Oregon based Nurse Practitioner program to:

(A) Maintain accreditation status through a US Department of Education recognized national accrediting body;

(B) Submit curricula, self-evaluation reports, interim reports or notice of accreditation reports as required by the Board;

(i) Students who graduate from a program which was accredited at the time of their completion shall be considered to have graduated from an accredited program regardless of the current program status for the purpose of licensure. Approval of a New Nurse Practitioner Educational Program

(j) Any university or college wishing to establish a Nurse Practitioner education program must make application to the Board on forms supplied by the Board no later than one year before proposed enrollment of students.

(k) The following information must be included with the initial application along with supporting documentation:

(A) Purpose for establishing the nursing education program;

(B) Community needs and studies made as the basis for establishing a nursing education program;

(C) Type of program including clear identification of proposed licensure role and population foci for graduates;

(D) Accreditation status, relationship of educational program to parent institution;

(E) Financial provision for the educational program;

(F) Potential student enrollment;

(G) Provision for qualified faculty;

(H) Proposed clinical facilities and other physical facilities;

(I) Proposed time schedule for initiating the program. If initial approval is denied, the applicant may request a hearing before the Board and the provisions of the Administrative Procedures Act shall apply.

Survey of Nurse Practitioner Programs, Survey Criteria

(l) Board representatives will conduct in person visits to nursing programs for the following purposes:

(A) Review of application for initial program approval;

(B) Initial and continuing full approval of an educational program;

(C) Receipt by the Board of cause for review including but not limited to:

(i) Significant curricular change which includes addition of a new state certification recognized population focus or role;

(ii) Evidence that graduates fail to meet national certification criteria;

(iii) Violation of Board standards.

(D) If approval is denied or withdrawn, the applicant may request a hearing before the Board and the provisions of the Administrative Procedures Act shall apply.

(m) Board representatives will contact nursing programs to schedule site visits:

(A) Within 60 days of receipt of an application for initial program approval;

(B) Upon receipt of national accreditation report for existing programs; one year after implementation of new programs, every 3-5 years for continuing approval;

(C) Within 30 days of receipt of a complaint.

(D) For purposes of reviewing a major curriculum change.

Stat. Auth.: ORS 678.380, 678.150

Stats. Implemented: ORS 678.380, 678.150

Hist.: NB 3-1990, f. & cert. ef. 4-2-90; NB 8-1993, f. & cert. ef. 8-23-93; BN 10-2003, f. & cert. ef. 10-2-03; BN 13-2006, f. & cert. ef. 10-5-06; BN 9-2009, f. 12-17-09, cert. ef. 1-1-10; BN 10-2013, f. 12-3-13, cert. ef. 1-1-14

851-050-0002

Application for Initial Certification as a Nurse Practitioner

(1) An applicant for initial certification in Oregon as a nurse practitioner shall:

(a) Hold a current unencumbered registered nurse license in the State of Oregon, and

(b) Meet the following educational requirements:

(A) A Master’s Degree in Nursing or a Doctorate in Nursing accredited by a national nursing organization recognized by the US Department of Education or a credentials evaluation from a Board approved or directed credentials service for graduate nursing degrees obtained outside the U.S. which demonstrates educational equivalency to U.S. graduate nursing degree accredited by a national nursing organization recognized by the US Department of Education; and

(B) Satisfactory completion of a Nurse Practitioner Program that meets OAR 851-050-0001 requirements and is specific to the role and role population focus for which application is made.

(C) Nurse practitioner programs completed after January 1, 2005 shall be formally affiliated within an accredited graduate level program accredited by a national nursing organization recognized by the US Department of Education at the Masters or post-masters graduate level; or an equivalent non-U.S. graduate program as specified in OAR 851-050-0001(11); and

(c) Meet the practice requirement in OAR 851-050-0004; and

(d) As of January 1, 2011 provide verification of current accredited national board certification from a Nurse Practitioner national certification examination which meets criteria in OAR 851-050-0008, congruent with a Board recognized nurse practitioner role and population focus.

(2) An applicant for initial certification in Oregon who has been certified in another state as an advanced practice nurse, and who meets all other requirements for certification, may be certified in Oregon if their program meets the standards of OAR 851-050-0001 and was completed within the following time frames:

(a) Prior to January 1, 1981, completion of a nursing educational program leading to licensure as a registered nurse and subsequent completion of a nurse practitioner program.

(b) As of January 1, 1981, a nurse obtaining Oregon certification shall have a minimum of a baccalaureate degree with a major in nursing and, in addition, satisfactory completion of an educational program in the nurse practitioner specialty area. Specialty preparation obtained within a baccalaureate nursing program does not meet this requirement.

(c) As of January 1, 1986, the minimum educational requirement for Oregon shall be a Masters degree in Nursing accredited by a national nursing organization recognized by the US Department of Education with satisfactory completion of an educational program in the nurse practitioner specialty area.

(d) Graduates of schools of nursing outside of the U.S. must submit a credentials evaluation through a Board approved or directed credentials service demonstrating educational equivalency to a U.S. accredited graduate level Masters or Doctoral Degree in Nursing. Nationally recognized nursing accreditation standards or guidelines may be applied by the Board at the Board’s discretion, in accordance with Oregon Office of Degree Authorization regulations.

(3) The graduate degree requirement may be met prior to, concurrent with, or after completion of the nurse practitioner program.

(4) The following documents shall be submitted as part of the initial application process:

(a) An official transcript of the graduate program, showing degree granted and received directly from the registrar of the university or college.

(b) An official transcript, or other evidence of satisfactory completion of the nurse practitioner program showing all courses, grades, quality points, grade point average, degree granted, date of graduation, and appropriate registrar’s signature received by the Board directly from the program or registrar.

(c) Evidence that the nurse practitioner program meets the Board’s standards as described in OAR 851-050-0001, including documentation of credentials evaluation as indicated for graduates of programs outside of the U.S.

(5) An applicant for initial state certification in Oregon as a nurse practitioner shall meet all requirements for prescriptive authority described in Division 56 and obtain prescribing authority under the provisions of Division 56 of the Oregon Nurse Practice Act.

(6) Revocation, suspension, or any other encumbrance of a registered nurse license held in another state, territory of the United States, or any foreign jurisdiction may be grounds for denial of certification in Oregon.

(7) The applicant shall submit all fees required by the Board with the application. The fees are not refundable. An application for initial certification, which remains incomplete after one calendar year, shall be considered void.

Stat. Auth.: ORS 678.375, 678.380 & 678.390

Stats. Implemented: ORS 678.380 & 390

Hist.: NER 34, f. & ef. 10-1-76; NER 8-1985, f. & ef. 12-9-85; NB 3-1990, f. & cert. ef. 4-2-90; Renumbered from 851-020-0300; NB 12-1990, f. & cert. ef. 12-28-90; NB 3-1993(Temp), f. & cert. ef. 2-26-93; NB 8-1993, f. & cert. ef. 8-23-93; NB 7-1996, f. & cert. ef. 10-29-96; Administrative correction 3-23-98; BN 10-2003, f. & cert. ef. 10-2-03; BN 1-2005, f. & cert. ef. 2-17-05; BN 1-2007, f. & cert. ef. 3-13-07; BN 8-2009, f. 12-17-09, cert. ef. 7-1-10; BN 10-2013, f. 12-3-13, cert. ef. 1-1-14


Rule Caption: Incorporation of rules to review/approved CNS education programs based on national standards and criteria

Adm. Order No.: BN 11-2013

Filed with Sec. of State: 12-3-2013

Certified to be Effective: 1-1-14

Notice Publication Date: 11-1-2013

Rules Adopted: 851-054-0030, 851-054-0035

Rules Amended: 851-054-0010, 851-054-0020, 851-054-0021, 851-054-0040

Subject: Rules for the review/approval of clinical nursing specialist programs are defined based on national standards and criteria for such programs at the graduate level. Name change by a national nursing accreditation agency specifically referenced in rule required removal of this name from the definitions and some rule sections. Accreditation agencies are now referred to using a more generic term to prevent the need for rule changes when organizations make name changes. Requirements for re-entry into this area of practice for those without an adequate number of practice hours were made more explicit.

Rules Coordinator: Peggy A. Lightfoot—(971) 673-0638

851-054-0010

Purposes and Definitions

(1) Purposes of these rules:

(a) To implement the provisions of ORS 678.370 to 678.372 governing the state certification of Clinical Nurse Specialists (CNS) by the Oregon State Board of Nursing (the Board).

(b) To define the scope of practice of the CNS.

(c) To establish standards for safe practice for the CNS.

(d) To serve as a guide for the Board to evaluate CNS practice.

(e) To establish standards for the initial and ongoing approval of CNS education programs operating in the state of Oregon; and

(f) To establish educational standards for state certification of applicants completing CNS education programs operating outside of the state of Oregon.

(2) Definitions as used in these rules:

(a) “Assessment” means a process of collecting information regarding a client’s health status using tools, techniques, and methodologies based on nursing theory and research. The skills employed during the assessment process include collecting, analyzing and evaluating data in order to diagnose symptoms, functional problems, risk behaviors and health status, and to develop interventions and plans of care.

(b) “Asynchronous learning” means learning experiences usually delivered through online technology where the interactions between the faculty and students are not constrained by time or place.

(c) “Client” means the recipient of CNS services for whom the CNS has established a provider relationship. A provider relationship is established through assessment and planning for the recipient.

(d) “Clinical Nurse Specialist” (CNS) is a registered nurse who has been approved and certified by the Board to provide health care in an expanded specialty role.

(e) “Clinical Nurse Specialist Educator” refers to a licensed CNS faculty member approved by the Board who has responsibility for input into the ongoing development, evaluation and revision of the CNS program curriculum. CNS Educators are responsible for student advising, supervision, evaluation, mentoring and collaborating with clinical preceptors and other health care professionals.

(f) “Clinical Nurse Specialist Program Administrator” refers to a licensed CNS approved by the Board and appointed by the Dean or Director of the Nursing school who is assigned the responsibility and accountability for the CNS education program within an accredited academic institution, including those functions aligned with program and curricular design and resource acquisition and allocation.

(g) “Clinical Practice Experience” means the supervised provision of care in a clinical setting that complements CNS course work and ensures acquisition of advanced practice nursing skills.

(h) “Clinical Preceptor” means a licensed independent health care provider qualified by education and clinical competency to provide direct supervision of the clinical practice experience of students in a CNS program under CNS educator direction.

(i) “Collaboration” is a process involving the CNS and one or more members of the health care team working together to achieve common goals, each responsible for their particular area of expertise.

(j) “Consultation” means interaction between the CNS and the consultee for the purpose of transmitting or obtaining information or advice.

(k) “Continuing Education hours” are contact hours of education. One contact hour is equal to 60 minutes of instruction. Ten contact hours are equal to one Continuing Education Unit (CEU).

(l) “Core Competencies” means the knowledge, skills and abilities required for performance in a CNS role identified and nationally validated by the nursing profession.

(m) “Diagnosis” means identification of actual or potential health problems or need for intervention, based on analysis of the data collected.

(n) “Direct supervision” means the clinical preceptor or faculty member is physically present at the practice site; retains the responsibility for CNS practice; oversees the student; and, if necessary, redirects or intervenes in CNS practice as well as being able to intervene if necessary.

(o) “Distance learning” means using multiple media for students to access the curriculum without the need to be physically present at the education site.

(p) “Interprofessional educator” means a professional faculty member licensed, certified, or otherwise recognized in a field other than nursing.

(q) “Major curriculum change” means a change that results in a refocus of purpose and objectives; or a substantive change in program structure, method of clinical or instructional delivery, or clinical hours and content.

(r) “Medical equipment” means medical supplies and durable or disposable equipment ordered by the CNS which are related to or required for self-care, or the plan of care.

(s) “National Certification” means a certificate of recognition in a specialty area issued by a national nursing organization.

(t) “Non-Oregon Based Graduate Program” means an academic program accredited by a nursing organization recognized by the United States Department of Education or the Council of Higher Education Accreditation that offers a graduate degree or graduate level certificate to qualified students for licensure as an advanced practice registered nurse (Clinical Nurse Specialist, Certified Registered Nurse Anesthetist, Nurse Practitioner) and does not have a physical location in Oregon.

(u) “Order” means written or verbal directives by the CNS to other members of the health care team.

(v) “Oregon Based Clinical Nurse Specialist Program” means a Board approved academic program meeting CNS licensing criteria that is physically located in Oregon and accredited by a nursing organization recognized by the United States Department of Education or the Council of Higher Education Accreditation which offers a graduate degree or graduate level certificate to qualified students.

(w) “Organization” means a system or network that provides patient care.

(x) “Population” means the collection of individuals in a community or a group of individuals defined by age, health status, lifestyle, disease and/or geographic location.

(y) “Prescribe” means written, verbal, or electronic legal directive to procure or designate for use legend drugs or controlled substances.

(z) “State Certification” means certification to practice advanced nursing as authorized by the Oregon State Board of Nursing.

(aa) “Three spheres of influence” means domains that denote the scope or breadth of practice activities and the target outcomes associated with a particular sphere (patient/population, nursing practice or health care system).

Stat. Auth.: ORS 678.150

Stats. Implemented: ORS 678.370 & 678.372

Hist.: BN 4-2001, f. & cert. ef. 2-21-01; BN 11-2006, f. & cert. ef. 10-5-06; BN 14-2010, f. & cert. ef. 9-30-10; BN 11-2013, f. 12-3-13, cert. ef. 1-1-14

851-054-0020

Clinical Nurse Specialist Scope of Practice

The Clinical Nurse Specialist (CNS) independently provides evidence-based advanced nursing care to clients, and facilitates attainment of health goals. Within the practice of advanced nursing, the CNS provides innovation in nursing practice, based upon clinical expertise, evidence-based decision making, and leadership skills. The CNS practices within three spheres of influence. These three spheres are: individual clients and populations; nurses and other multidisciplinary team members; and organizations. Practice may target one or more spheres of influence.

(1) The CNS may practice with individual clients and populations of clients.

(a) Individual client care includes, but is not limited to:

(A) Assessing the client using tools, techniques, and methodologies based on theory and research;

(B) Diagnosing symptoms, functional problems, risk behaviors, and health status of the client;

(C) Developing a mutually derived therapeutic plan of care with the client;

(D) Designing, implementing, and evaluating nursing interventions by using data, research, and theoretical knowledge;

(E) Selecting, recommending, and ordering medical equipment, laboratory and screening or diagnostic tests for the client;

(F) Selecting, recommending and ordering prescription medications and devices as authorized per division 56 consistent with specialty and scope of practice;

(G) Establishing standing orders, protocols, algorithms, or electronic order sets related to nursing interventions and specific plans of care;

(H) Encouraging disease prevention, health promotion and health maintenance;

(I) Referring the client to other health care services or providers as indicated.

(b) Population care includes, but is not limited to:

(A) Planning, implementing and evaluating data collection;

(B) Selecting, ordering, and recommending screening and diagnostic tests for individuals within the population;

(C) Interpreting and analyzing population data to formulate diagnoses in the area of needs, functional problems, risks, and health issues;

(D) Reviewing and revising diagnoses based on subsequent data collection;

(E) Innovating, implementing, guiding, evaluating, and revising population-focused plans and programs;

(F) Encouraging disease prevention, health promotion and health maintenance;

(G) Establishing criteria for referral within a population;

(H) Establishing algorithms, standing orders, or practice guidelines related to specific populations;

(I) Informing the population about its health and promoting other community systems that influence health;

(J) Assessing need for and participating in activities to change health and social policies that affect the health of the community.

(2) The CNS may practice with nurses and other members of the multidisciplinary care team to advance the practice of nursing and improve client care. This practice includes, but is not limited to:

(a) Consulting and collaborating to identify and manage health care issues;

(b) Providing leadership in the utilization of research in practice;

(c) Coaching nursing staff in clinical practice development;

(d) Identifying knowledge deficits of target groups providing health care;

(e) Developing, providing and evaluating educational and other programs that enhance the practice of nursing personnel and/or other members of the health care team.

(3) The CNS may practice with organizations to provide clinical expertise and guidance. This practice includes, but is not limited to:

(a) Using system-wide change strategies based on an assessment of the needs and strengths of the organization;

(b) Initiating collaborative relationships among teams to facilitate interdisciplinary practice;

(c) Collaboratively developing and evaluating research-based and client-driven systems and processes;

(d) Creating, advising, and influencing system-level policy that affects programs of care;

(e) Evaluating and recommending equipment and products being used in patient care for efficacy, efficiency, cost-effectiveness, and client/consumer satisfaction.

(4) The CNS may provide expertise that includes, but is not limited to:

(a) Summarizing, interpreting, and applying research results;

(b) Teaching, coaching, and mentoring health care members in the evaluation and use of research;

(c) Providing leadership through practice in a CNS Program as a CNS Program Administrator, CNS Educator, or CNS Clinical Preceptor with CNS students;

(d) Planning, directing, and evaluating multidisciplinary programs of care for clients;

(e) Evaluating client outcomes and cost effectiveness of care to identify needs for practice improvement;

(f) Conducting and participating in research and research protocols;

(g) Designing and establishing standing orders related to nursing interventions.

(5) The CNS scope of practice may include:

(a) Prescribing, ordering, administering and dispensing medications per division 56 regulations and requirements.

(b) Receiving and distributing drug samples.

(c) Obtaining DEA registration for controlled substances in Schedule II-V.

Stat. Auth.: ORS 678.150

Stats. Implemented: ORS 678.370, 678.372

Hist.: BN 4-2001, f. & cert. ef. 2-21-01; BN 11-2006, f. & cert. ef. 10-5-06; BN 11-2013, f. 12-3-13, cert. ef. 1-1-14

851-054-0021

Standards for Clinical Nurse Specialist Scope of Practice

The Clinical Nurse Specialist (CNS), shall meet the standards for Registered Nurse practice, and shall also meet the practice standards of advanced practice, including but not limited to:

(1) Recognizing and practicing within the limits of knowledge and experience of the individual CNS, and consulting with or referring clients to other health care providers when indicated;

(2) Providing and documenting nursing services within the scope of practice and specialty for which the individual CNS is educationally prepared, and for which competency has been established and maintained. Educational preparation includes academic coursework, workshops or seminars, or other supervised, planned learning, provided both theory and clinical experience are included.

(3) Teaching, coaching, mentoring and providing leadership using professional standards of CNS practice.

Stat. Auth.: ORS 678.370, 678.372 & 678.150

Stats. Implemented: ORS 678.370, 678.372 & 678.150

Hist.: BN 4-2001, f. & cert. ef. 2-21-01; BN 11-2013, f. 12-3-13, cert. ef. 1-1-14

851-054-0030

Standards for Clinical Nurse Specialist Programs

The Board’s standards for all Clinical Nurse Specialist programs for initial applicants are as follows:

(1) The CNS program shall be a minimum of 30 semester hours or 45 quarter hours in length. Post graduate advanced practice registered nurse applicants who obtained CNS preparation in a different role or population focus may complete less than 30 semester hours or 45 quarter hours with documentation of the following:

(a) Completion of directly supervised clinical hours in the applicable CNS role;

(A) 500 minimum supervised clinical (clock) hours of clinical experience for master’s and post-graduate preparation if completed after January 1, 2007; or

(B) 1,000 minimum supervised clinical (clock) hours for post-baccalaureate practice doctorate preparation.

(b) Completion of curriculum requirements in place for the CNS program at the time of matriculation with evidence of any advanced placement or credit for prior learning; and

(c) Specialty and population specific competencies as required for practice in the CNS role and three spheres of influence.

(2) CNS Educators who teach within the CNS program shall be educationally and clinically prepared in the same population focus and clinical areas they teach and shall include state certified advanced practice registered nurses.

(3) The curriculum content shall contain theory and clinical experience in the CNS population focus for which application is being made, preparing the graduate to meet all core competencies within the CNS scope including the three spheres of influence. Graduates as of June 30, 2015 need to demonstrate successful completion of discrete graduate level courses in advanced level physical assessment, pharmacology, and pathophysiology.

(4) The clinical experience must consist of full scope preparation in the CNS population focus for which application is being made as well as the three spheres of influence.

(5) In the event of program revision, programs must maintain and provide upon request documentation that students met the program’s curriculum requirements at the time of enrollment and matriculation into the program. Any discrepancies must be justified.

(6) Written program materials shall accurately reflect the mission, philosophy, purposes, and objectives of the program.

(7) Programs shall demonstrate appropriate course sequencing and requirements for matriculation into the program, including completion of all pre-licensure nursing curriculum requirements before advancement into CNS clinical coursework.

(8) Clinical preceptors shall meet clinical and licensure qualifications for the state in which they practice.

(9) Distance and asynchronous learning programs shall meet all standards of OAR 851-054-0030.

(10) Clinical Nurse Specialist programs outside of the United States shall meet all standards of OAR 851-054-0030. Such programs shall be determined by Board approved or directed credentials review to be equivalent to graduate nursing programs offered in the United States that prepare the graduate for practice within the CNS scope. Nationally recognized nursing accreditation standards or guidelines may be applied by the Board at the Board’s discretion, in accordance with the Oregon Office of Degree Authorization regulations.

Stat. Auth.: ORS 678.050, 678.150, 678.370, 678.372

Stats. Implemented: ORS 678.050, 678.150, 678.370, 678.372

Hist.: BN 11-2013, f. 12-3-13, cert. ef. 1-1-14

851-054-0035

Standards for Approval of Oregon Based Programs

The Board of Nursing holds the Dean or Director of the School of Nursing accountable for identification and appointment of qualified nurse administrators, educators and preceptors. The Dean or Director shall ensure that programs which prepare CNSs in one or more programs/tracks have CNS program administrators with defined position responsibility for budget and resource preparation, curricular design and implementation, and program evaluation.

(1) CNS Program Administrators:

(a) Qualifications: A CNS program administrator who has overall responsibility for one or more CNS tracks shall meet the following requirements:

(A) An active unencumbered Oregon CNS state certificate;

(B) National certification as a CNS in at least one population focus area or specialty is preferred;

(C) A doctoral degree in an education or health-related field;

(D) Educational preparation or experience in teaching and learning principles for adult education, including curriculum development and administration and at least two years (2,080 hours) of CNS practice which meets Oregon’s requirements;

(E) In a multi-track program, where only one program administrator is appointed by the Dean or Director of the school, there must be evidence of additional program administrators or lead CNS faculty to provide oversight for student supervision who are qualified in that specific program’s population focus and spheres of influence.

(b) Responsibilities: The principle responsibilities of the CNS program administrator shall be:

(A) Ensuring appropriate student faculty ratios to meet program goals and objectives;

(B) Providing leadership and accountability for the administration, planning, implementation and evaluation of the program;

(C) Preparing and administering the program budget;

(D) Facilitating faculty recruitment, development, performance review, promotion and retention;

(E) Confirming that cooperative agreements with clinical practice sites are current.

(c) CNS program administrator responsibilities may include functioning as program faculty with appropriate workload assignment to fulfill administrative duties and responsibilities.

(2) CNS Educators:

(a) Qualifications: The CNS Educator shall meet the following requirements:

(A) An active unencumbered Oregon CNS state certificate; and

(B) A minimum of a masters degree in nursing with at least 2,080 hours of prior CNS practice which meets Oregon’s requirements;

(C) National certification as a CNS in at least one population focus area or specialty is preferred;

(D) In a doctoral program, a majority (greater than 50%) of CNS educators must be doctorally prepared;

(E) Current knowledge and competence as a CNS in the population focus area and the spheres of influence consistent with teaching responsibilities;

(F) Adjunct clinical faculty employed solely to supervise clinical nursing experiences of students shall meet all the faculty requirements;

(G) Inter-professional educators who teach non-clinical nursing courses shall have advanced preparation appropriate to the area of content.

(b) Responsibilities: The principle responsibilities of the CNS Educator shall be to:

(A) Enable each student to meet faculty developed objectives and competencies by:

(i) Verifying and approving arrangements with a clinical agency for each student’s clinical practicum consistent with their learning objectives;

(ii) Coordinating preceptor selection and orientation(s); and

(iii) Providing and verifying direct student supervision;

(B) Monitor clinical practice experiences, make periodic site visits to the clinical practice location, evaluate students’ performance on a regular basis with input from the student and preceptor;

(C) Provide direct student supervision of clinical experiences as required for patient safety and student skill attainment;

(D) Assure appropriate use of preceptors for clinical instruction by verifying that:

(i) The student to preceptor ratio is appropriate to the accomplishment of learning objectives, to provide for patient safety, and to the complexity of the clinical situation;

(ii) Oregon licensure or certification is current and appropriate to the health professional’s area of practice;

(iii) Functions and responsibilities for the preceptor are clearly documented in a written agreement between the agency, the preceptor, and the clinical program;

(iv) Initial experiences in the clinical practicum and a majority of the clinical experiences shall be under the supervision of clinical preceptors who are state certified CNSs.

(3) CNS Clinical Preceptors: The CNS clinical preceptor shall meet the following standards:

(a) Licensure as an independent health care provider qualified by education and clinical competency to provide direct supervision of the clinical practice experience of students in a CNS program;

(b) Clinical preceptors may be used to enhance, but not replace, faculty-directed clinical learning experiences.

(4) Program accreditation requirements and Board notification process:

(a) Currently accredited programs that prepare Clinical Nurse Specialists for state certification under these rules and requirements shall submit to the Board:

(A) A copy of their most recent program self-evaluation reports;

(B) Current accreditation and survey reports from all nursing accrediting agencies; and

(C) Interim reports submitted to the nursing accreditation agency.

(D) These documents must be submitted to the Board upon receipt to or release from the accrediting agency or no later than 90 days from enactment of these rules.

(b) Programs which prepare Clinical Nurse Specialists for state certification under development or pre-accreditation review shall submit the following for review by the Board:

(A) Copies of the curricula within 30 days of sending the information to the accrediting agency;

(B) Copies of self-evaluation reports and any interim reports provided to all national nursing accreditation agencies at the time of notification from the accrediting agency that the program has not been fully accredited;

(C) Verification of accreditation from all accrediting agencies within 30 days of receipt by the program;

(D) Annual reports which enable the monitoring of continued compliance with Board requirements.

(5) Approval of a New Oregon Based Clinical Nurse Specialist Educational Program

(a) Any university or college wishing to establish a Clinical Nurse Specialist education program must make application to the Board no later than one year before proposed enrollment of students.

(b) The following information must be included with the initial application along with supporting documentation:

(A) Purpose for establishing the nursing education program;

(B) Community needs and studies made as the basis for establishing a nursing education program;

(C) Type of program including clear identification of proposed licensure role and population foci for graduates including eligibility for national certification as indicated;

(D) Accreditation status, relationship of educational program to parent institution;

(E) Financial provision for the educational program;

(F) Potential student enrollment;

(G) Provision for qualified faculty;

(H) Proposed clinical facilities and other physical facilities;

(I) Proposed time schedule for initiating the program. If initial approval is denied, the applicant may request a hearing before the Board and the provisions of the Administrative Procedures Act shall apply.

(6) Survey of Oregon Based Clinical Nurse Specialist Educational Programs

(a) Board representatives will conduct in person visits to nursing programs for the following purposes:

(A) Review of application for initial program approval;

(B) Initial and continuing full approval of an educational program;

(C) Receipt by the Board of cause for review including but not limited to:

(i) Significant curricular change which includes addition of a new state certification recognized population focus or role;

(ii) Evidence that graduates fail to meet national certification eligibility criteria, if applicable;

(iii) Violation of Board standards.

(D) If approval is denied or withdrawn, the applicant may request a hearing before the Board and the provisions of the Administrative Procedures Act shall apply.

(b) Board representatives will contact nursing programs to schedule site visits:

(A) Within 60 days of receipt of an application for initial program approval;

(B) Upon receipt of national accreditation report for existing programs; one year after implementation of new programs; every 3-5 years for continuing approval;

(C) Within 30 days of receipt of a complaint.

(D) For purposes of reviewing a major curriculum change.

Stat. Auth.: ORS 678.050, 678.150, 678.370, 678.372

Stats. Implemented: ORS 678.050, 678.150, 678.370, 678.372

Hist.: BN 11-2013, f. 12-3-13, cert. ef. 1-1-14

851-054-0040

Eligibility for Initial State Certification

(1) An applicant for certification as a Clinical Nurse Specialist (CNS) shall:

(a) Hold or obtain an active unencumbered registered nurse license in Oregon;

(b) Hold a graduate degree in nursing, or a post-masters certificate with evidence of CNS theory and clinical concentration. The program shall meet the following educational standards:

(A) The program shall be at least one academic year in length;

(B) There shall be faculty and/or clinical instructors who are academically and experientially qualified in nursing, and who maintain expertise within the CNS scope of practice;

(C) Accreditation of the graduate nursing degree by a national nursing organization recognized by the US Department of Education or documentation of a Board approved or directed credentials evaluation for graduates of programs outside of the U.S. which demonstrates education equivalency to a graduate degree in nursing accredited by the national nursing organization recognized by the US Department of Education.

(D) Applicants who graduate or obtain a post-masters CNS certificate on or after January 1, 2007 shall have completed 500 hours of clinical practice within the program.

(c) Meet the practice requirement through verification of:

(A) Graduation from a CNS educational program which meets the requirements of OAR 851-054-0030 within the past one year; or

(B) Practice of at least 192 hours in the two years following graduation from a CNS program; or

(C) Practice within the CNS scope of practice for at least 960 hours within the five years preceding the application. Verification of practice hours is subject to random audit.

(2) If an applicant does not meet the practice requirement in 851-054-0040(1)(c), the applicant shall:

(a) Obtain a limited license as a registered nurse in the State of Oregon; or hold an active Oregon registered nurse license;

(b) Submit for Board approval, a detailed plan for precepted practice that includes: a plan for demonstrating core, population, and specialty competencies that support the CNS role; names and qualifications of all CNS preceptor(s) at least one of whom must be an Oregon state certified CNS skilled in the population focus or specialty care; and a description of the nature of the proposed unpaid, voluntary, precepted clinical experience.

(A) If the applicant has practiced at least 960 hours within the six years prior to the date of application, the practice plan shall provide for 250 hours of preceptorship. Documented practice hours within the CNS scope for the past two years may be recognized and may reduce the required hours, except that, in no case shall the precepted practice be less than 120 hours.

(B) If the applicant has practiced at least 960 hours within the CNS scope for the ten years prior to the date of application, the practice plan shall provide for 400 hours.

(C) If the applicant has not practiced at least 960 hours within the CNS scope for the last ten years, the re-entry requirement shall be met through:

(i) Successful completion of a CNS post masters certificate program which meets the requirements of OAR 851-054-0030, or;

(ii) A comprehensive series of CNS courses within a US Department of Education recognized nationally accredited CNS program in the population or specialty sought.

(iii) The plan of study shall be submitted in advance for Board approval before enrollment. The plan of study shall cover the entire scope of the population or specialty area under which the applicant was previously state certified, and must include both clinical and didactic hours. The program of study shall include advanced pharmacology, pathophysiology, physical assessment, and theory and clinical experience in the CNS population focus for which renewal is being made, preparing the applicant to meet all core competencies within the CNS scope including the three CNS spheres of influence in order to meet the requirements of OAR 851-054-0030.

(iv) The institution shall provide documentation which demonstrates previous credits, courses, or competency testing applied to meet final completion. Proof of completion of this plan of study shall be provided to the Board in the form of official transcripts documenting completion of all required coursework.

(c) Obtain a limited CNS state certification for precepted practice. The limited state certification shall be issued only upon receipt of a completed CNS application, application for limited state certification, Board approval of the plan for supervised practice, and payment of all applicable fees. The limited state certification is valid only for precepted practice that has been approved in advance by the Board, and will be valid for one year from the date of issue. One extension of the limited state certificate may be granted upon approval and payment of fee, provided there is a current valid application for state certification on file and no disciplinary action has been taken against the applicant. This extension will be valid for one year from date of approval.

(d) Successfully complete the precepted hours of practice supervised by the CNS preceptor. Successful completion shall be verified by a final evaluation submitted by the supervising CNS to the Board to verify that the applicant is competent to practice in the CNS scope at a safe and acceptable level, and that the number of required hours of precepted practice was completed.

(e) Submit evidence of continuing education related to the CNS role to total 20 contact hours for each year out of practice with no less than 50% obtained from accredited providers of continuing nursing education (CNE), continuing medical education (CME), or continuing pharmacology education (CPE). Continuing education taken concurrent with the reentry plan may be applied towards the total continuing education requirement, provided all hours are complete by the end of the preceptorship.

(3) The applicant shall submit all fees required by the Board with the application. The fees are not refundable. An application that remains incomplete after one year shall be considered void.

(4) Clinical Nurse Specialists seeking prescriptive authority will need to meet all additional requirements in Division 56. These requirements may be obtained as part of a re-entry program plan approved by the Board.

(5) Grounds for denial of graduate Clinical Nurse Specialist applicants for initial state certification include failure of CNS program to:

(A) Maintain accreditation status through a US Department of Education recognized national nursing accrediting body;

(B) Submit curricula, self-evaluation reports, interim reports or notice of accreditation reports as required by the Board until such reports are received and reviewed by the Board;

(6) Students who graduate from a program which was accredited at the time of their completion shall be considered to have graduated from an accredited program regardless of the current program status for the purpose of licensure.

Stat. Auth: ORS 678.050, 678.370 & 678.372

Stats. Implemented: ORS 678.050, 678.370 & 678.372

Hist.: BN 4-2001, f. & cert. ef. 2-21-01; BN 10-2001, f. & cert. ef. 7-9-01; BN 6-2006, f. & cert. ef. 5-8-06; BN 11-2006, f. & cert. ef. 10-5-06; BN 3-2007, f. & cert. ef. 3-13-07; BN 14-2010, f. & cert. ef. 9-30-10; BN 8-2013, f. 5-6-13, cert. ef. 6-1-13; BN 11-2013, f. 12-3-13, cert. ef. 1-1-14


Rule Caption: Changes to dispensing rules based on statute changes from 2013 session

Adm. Order No.: BN 12-2013

Filed with Sec. of State: 12-3-2013

Certified to be Effective: 1-1-14

Notice Publication Date: 11-1-2013

Rules Amended: 851-056-0020, 851-056-0022

Subject: Passage of a bill directly applicable to dispensing by advanced practice nurses required changes in Division 56 Rules. Specific criteria for dispensing authority were removed as they have been removed from statute. A few minor changes were made to correct dates and/or names of publications referred to in the rule.

Rules Coordinator: Peggy A. Lightfoot—(971) 673-0638

851-056-0020

Dispensing Authority for Nurse Practitioners and Clinical Nurse Specialists

(1) An “applicant” for dispensing authority must be an unencumbered Oregon state certified nurse practitioner or clinical nurse specialist with prescriptive authority in good standing with the Oregon State Board of Nursing.

(2) Applicants shall submit an application and information as required by the Board.

(3) The applicant shall show evidence of completion of the following dispensing program:

(a) Documented review of content regarding safe dispensing listed below:

(A) Board of Nursing handbook “Nurse Practitioner and Clinical Nurse Specialist Prescriptive Authority in Oregon”;

(B) The Drug Enforcement Administration Pharmacist’s Manual (2010);

(C) OAR 851 division 56;

(D) ORS Chapter 689 and OAR Chapter 855;

(E) U.S. Consumer Product Safety Commission publication “Poison Prevention Packaging: A Guide for Healthcare Professionals” and;

(F) The Institute for Safe Medication Practices (ISMP) “List of Error-Prone Abbreviations, Symbols, and Dose Designations” (2013); and

(G) Information on available electronic or hard copy prescription drug references which provide information to professionals authorized to dispense prescription medications.

(b) Successful self-examination as provided by the Board on these materials.

(4) The staff of the Board shall provide written notice to the Oregon Board of Pharmacy upon receipt and again upon approval of such application.

(5) Applicants must provide complete and accurate information requested by the Board. Failure to complete application material as requested or failure to meet criteria in this rule shall be grounds for denial, suspension, or revocation of dispensing authority.

[Publications: Publications referenced are available from the agency.]

Stat. Auth.: ORS 678.390

Stats. Implemented: ORS 678.670, 678.375, 678.385, 678.390

Hist.: BN 10-2006, f. & cert. ef. 10-5-06; BN 13-2009, f. 12-17-09, cert. ef. 1-1-10; BN 12-2013, f. 12-3-13, cert. ef. 1-1-14

851-056-0022

Renewal of Dispensing Authority

Dispensing authority may be renewed with each renewal of prescriptive authority upon submission of application, and documentation that the nurse practitioner or clinical nurse specialist and their patients continue to meet criteria. Failure to complete application material as requested or failure to meet criteria in this rule shall be grounds for denial, suspension, inactivation or revocation of dispensing authority.

Stat. Auth.: ORS 678.390

Stats. Implemented: ORS 678.670, 678.675, 678.385 & 678.390

Hist.: BN 10-2006, f. & cert. ef. 10-5-06; BN 7-2008, f. & cert. ef. 11-26-08; BN 12-2013, f. 12-3-13, cert. ef. 1-1-14


Rule Caption: Deletion of Department of Education exemption requirement and expanding Board options related to faculty qualifications

Adm. Order No.: BN 13-2013

Filed with Sec. of State: 12-4-2013

Certified to be Effective: 1-1-14

Notice Publication Date: 11-1-2013

Rules Amended: 851-061-0020, 851-061-0030, 851-061-0080, 851-061-0090

Subject: HB 2187A passed during the 2013 Legislative Session making the requirement for nursing assistant or medication aide training programs to apply for an exemption from the Department of Education no longer necessary. Thus this requirement is proposed to be removed from the current rules. Language is proposed to be added that gives the Board its full range of options related to approving licensed nurses for faculty positions. In addition, the program director’s responsibility related to verifying student eligibility for medication aide or CNA 2 training is clarified.

Rules Coordinator: Peggy A. Lightfoot—(971) 673-0638

851-061-0020

Definitions

As used in these rules:

(1) “Assisted Living Facility” means a facility that is licensed by the State of Oregon and as defined by the Oregon Department of Human Services.

(2) “Board-approved Curriculum” means content required in nursing assistant and medication aide training programs established by Board policy.

(3) “Certified Medication Aide (CMA)” means a Certified Nursing Assistant who has had additional training in administration of noninjectable medication and holds a current Oregon CMA certificate.

(4) “Certified Nursing Assistant (CNA)” means a person who holds a current Oregon CNA certificate by meeting the requirements specified in these rules; whose name is listed on the CNA Registry; and who assists licensed nursing personnel in the provision of nursing care. The phrase Certified Nursing Assistant and the acronym CNA are generic and may refer to CNA 1, CNA 2 or all CNAs.

(5) “Certified Nursing Assistant 1 (CNA 1)” means a person who holds a current Oregon CNA certificate and who assists licensed nursing personnel in the provision of nursing care.

(6) “Certified Nursing Assistant 2 (CNA 2)” means a CNA 1 who has met requirements specified in these rules for one or more of the CNA 2 categories.

(7) “Client” means the individual who is provided care by the CNA or CMA including a person who may be referred to as “patient” or “resident” in some settings.

(8) “Clinical Instructor” means a registered nurse whose role is education of students in the skills laboratory or clinical site and who may participate in classroom teaching under the direction of the program director or primary instructor.

(9) “Clinical Preceptor” means a licensed nurse who provides direct clinical supervision of students during their clinical experience under the direction of the program director or a primary instructor.

(10) “Clinical Site” is a location or situation in which hands on experience with actual clients is obtained.

(11) “CNA Registry” means the listing of Oregon Certified Nursing Assistants maintained by the Board.

(12) “Competency evaluation” means the Board approved process for determining competency.

(13) “Criminal History Check” means the Oregon Criminal History Check and when required, a National Criminal History Check and/or a State-Specific Criminal History Check, and processes and procedures equivalent to the Department of Human Services (DHS) rules.

(14) “Direct supervision” means that the registered nurse, clinical nurse specialist, or nurse practitioner is physically present and accessible in the immediate client care area and is available to intervene if necessary.

(15) “Facility-Based Program” means an approved nursing assistant or medication aide training program in a licensed nursing facility.

(16) “Full-time” means at least 32 hours of regularly scheduled work each week.

(17) “Independent Training Program” means an approved nursing assistant or medication aide training program that is not a facility-based program.

(18) “Instructor-directed” means an on-line training that is managed, directed, and facilitated through interaction between learners and identified instructor(s). Learning activities may occur through either synchronous or asynchronous interaction between instructor and students and among students.

(19) “Level 1 training” is the minimum training required to prepare a graduate to take the state certification examination for CNA 1.

(20) “Level 2 training” is training available to a CNA 1 to prepare them for a role in one or more of the Board approved category areas.

(21) “Licensed Nursing Facility” means a licensed nursing home or a Medicare or Medicaid certified long term care facility.

(22) “Nursing Assistant” means a person who assists licensed nursing personnel in the provision of nursing care. ORS 678.440(4)

(23) “On-line program” means an interactive computer based training program that provides at least the equivalent of the Board required classroom, laboratory, and clinical hours under the supervision of a Board approved instructor/preceptor.

(24) “On-line program provider” means a provider that has a proven track record of successfully providing professional development, training and educational programs in both classroom and on-line environments in Oregon, either directly or in partnership, in the previous 24 months of application, and meets all Board requirements.

(25) “Program” means a training program that prepares graduates for certification as a nursing assistant level 1, level 2, or medication aide. The terms “nursing assistant program, or “medication aide program” as used in these rules, are synonymous with “Program.”

(26) “Representative of the Board” means the Nursing Assistant Program Consultant or Board designee qualified to perform the necessary responsibilities.

(27) “Residential Care Facility” means a facility that is licensed by the State of Oregon and as defined by the Oregon Department of Human Services.

(28) “Self-directed” means an on-line program in which course materials, learning activities, communications, and assessment activities are delivered and completed electronically. Learners engage in and complete activities at their own pace.

(29) “Self-Evaluation” means a review of a basic nursing assistant or medication aide training program conducted by the program director using forms provided by the Board and submitted to the Board.

(30) “Site Visit” means that representative(s) of the Board go to the location of a program for specified purpose(s) which may include a survey for approval.

(31) “Standards for Approval” means authoritative statements which set expectations for a program to achieve and maintain approval status. (OAR 851-061-0080 through 0130).

(32) “Survey Visit” means that representative(s) of the Board go to the location of a program to review the program for compliance with Standards for Approval, and to prepare a report and recommendation regarding approval status.

(33) “Waiver of Prohibition” authorizes a program to be taught in but not by a facility that has had its approval denied or withdrawn pursuant to OAR 851-061-0050(2).

Stat. Auth.: ORS 678.440, 678.442 & 678.444

Stats. Implemented: ORS 678.440, 678.442 & 678.444

Hist.: BN 6-1999, f. & cert. ef. 7-8-99; BN 1-2004, f. 1-29-04, cert. ef. 2-12-04; BN 11-2004, f. & cert. ef. 7-13-04; BN 2-2008, f. & cert. ef. 2-25-08; BN 2-2011, f. & cert. ef. 7-11-11; BN 13-2013, f. 12-3-13, cert. ef. 1-1-14

851-061-0030

Process for Program Approval

(1) Any person, partnership, association, corporation, or limited liability company desiring to offer training other than just nursing assistant or medication aide training to non-employed students will need to be licensed through the Oregon Department of Education in addition to meeting the Board’s standards as described in these rules.

(2) All nursing assistant or medication aide training programs shall be Board-approved prior to being offered. Retroactive approval shall not be granted.

(3) Application for Initial Approval of level 1, level 2, and medication aide training programs. A facility, agency, on-line program provider, or individual wishing to establish a new nursing assistant or medication aide training program shall make application to the Board at least 45 days in advance of expected start date. The application for initial approval of a training program shall include:

(a) A completed form provided by the Board;

(b) Appropriate fees;

(c) Faculty names and qualifications;

(d) Names of classroom and clinical facilities;

(e) Name of person authorized to accept service of notices issued by the Board;

(f) Program rationale, philosophy and purpose;

(g) Program outline:

(A) Objectives;

(B) Curriculum content divided into number and sequence of didactic and clinical hours; and

(C) Teaching methodology.

(h) Evaluation method:

(A) Laboratory and clinical skills checklist approved by the Board;

(B) Final exam; and

(C) In addition, for level 2 training programs, a Board approved competency evaluation.

(i) Enrollment agreement and disclosure statement that includes:

(A) Beginning and ending dates of the training;

(B) An outline of the instructional program as required by these rules for which the student is enrolled;

(C) Fees, tuition, and other program costs (books, clothing, etc.) itemized separately;

(D) A published cancellation and refund policy, procedure, and schedule that is fully explained during orientation, prior to the beginning of instruction, and requires no less than:

(i) If the training program discontinues after the fees and tuition have been paid, the program provider must refund the tuition and fees in full if the closure happens before the course is completed;

(ii) If the student cancels enrollment in writing three days before the commencement of the first day of classes or three days before they receive access to the online didactic training, all tuition and fees paid to the program specific to the enrollment agreement, will be refunded, less a cancellation fee that cannot exceed 10 percent of the tuition and fees paid; and

(iii) Clearly stated reasons for which a refund will not be granted; and

(E) Information about how the student can file a complaint about the program with the Board.

(j) Tentative time schedule for initiating the program; and

(k) Plan for what job placement assistance will consist of from the training program.

(4) A site visit may be conducted by a representative(s) of the Board;

(5) The program director will be notified of approval or non-approval. Following receipt of notification from the Board of approval or non-approval:

(a) A program that is approved may begin classes according to the schedule submitted;

(b) A program that is not approved will be notified of the deficiencies and will be re-evaluated after appropriate modifications are made;

(c) A program denied approval may petition the Board for reconsideration.

(6) An approved nursing assistant level 1 or medication aide training program:

(a) Shall be required to demonstrate ongoing compliance with the standards of approval at least every two years for continued approval.

(b) Shall be surveyed for consideration of continued approval and may have a survey visit or interim self-evaluation report required by the Board at any time.

(c) May be subject to scheduled or non-scheduled site visits for continued approval or any other purpose at any time.

(d) Shall submit an interim self evaluation during the intervening year or as requested by the Board on forms provided by the Board.

(e) Shall have records available for review.

(f) Shall have adequate financial support for the stability and continuation of the program.

(7) An on-line provider shall have a proven track record of successfully providing professional development, training and educational programs in both classroom and on-line environments in Oregon, either directly or in partnership, in the previous 24 months, and meet all Board requirements prior to being approved.

(8) Following initial approval, level 2 training programs remain approved unless specifically withdrawn by the Board.

(9) Program changes requiring Board approval:

(a) Change of program ownership:

(A) If the change only causes minor changes, there is no need to seek new approval of the program.

(B) If the change causes a substantial difference as determined by the Board through the impact on the students, faculty, or program resources, an application and approval for the program shall be required.

(b) Changes in course content, lab/clinical skill checklist, final exam, certificate of completion, program director, primary instructor, clinical instructor, clinical preceptor, policies and procedures related to attendance, course requirements, cancellation and refunds, or classroom or clinical training sites shall be submitted to the Board for approval.

Stat. Auth.: ORS 678.440 & 678.444

Stats. Implemented: ORS 678.444

Hist.: BN 6-1999, f. & cert. ef. 7-8-99; BN 5-2002, f. & cert. ef. 3-5-02; BN 1-2004, f. 1-29-04, cert. ef. 2-12-04; BN 7-2006, f. & cert. ef. 5-8-06; BN 2-2008, f. & cert. ef. 2-25-08; BN 2-2011, f. & cert. ef. 7-11-11; BN 13-2013, f. 12-3-13, cert. ef. 1-1-14

851-061-0080

Standards for Program Approval: Faculty Qualifications and Responsibilities

(1) The training of nursing assistants level 1 shall be by or under the supervision of a program director or primary instructor who has at least one year of nursing experience in a licensed nursing facility.

(2) The program director shall hold a current, unencumbered license to practice as a registered nurse in Oregon. A registered nurse who has an encumbered license may be considered on an individual basis; and

(a) For a nursing assistant level 1 and level 2 training program, have at least three years of nursing experience, including at least one year of working in direct patient care; and one of the following:

(A) One year of experience on a nursing faculty;

(B) One year of experience in staff development;

(C) Evidence of academic preparation for teaching adults; or

(D) Evidence of equivalent experience.

(b) For a medication aide training program, have at least three years of experience as a Registered Nurse, including at least one year as a nurse educator or nurse administrator.

(3) The program director shall:

(a) Act as liaison with the Board related to the program’s continuing compliance with the required elements of these rules;

(b) Implement and maintain a program that complies with all Board standards;

(c) Assume the ultimate responsibility for the implementation of the Board-approved curriculum;

(d) Have sufficient time provided for carrying out administrative responsibilities. Number of faculty, students, classes in progress, and locations utilized for classroom and clinical training are to be considered in determining appropriate time allocated;

(e) Recruit, supervise, and evaluate qualified primary instructors and clinical instructors or preceptors;

(f) Develop and implement written policies necessary for the operation of the program, including those maintained under OAR 851-061-0110(1)(c)(G);

(g) Ensure that all students have initiated a criminal history check prior to entering the program and that all students are eligible pursuant to laws governing the clinical site facility to participate in the program’s clinical experiences.

(h) Coordinate classroom and clinical sites and activities;

(i) Ensure that the classroom, lab, and clinical environment is conducive to teaching and learning;

(j) Assure that the clinical setting provides an opportunity for the students to perform the skills taught in the curriculum;

(k) Ensure that a Board-approved primary instructor, clinical instructor, or clinical preceptor is on the premises at all times during scheduled clinical hours;

(l) Supervise or coordinate supervision of students in the clinical setting or assign this responsibility to the primary instructor.

(m) Provide or arrange for the orientation of the primary and clinical instructors or clinical preceptors to their role and responsibilities.

(n) Assess students’ reactions to course content, instructional effectiveness, and other aspects of the learning experience;

(o) Submit program data upon request of the Board on forms provided by the Board;

(p) Submit required reports;

(q) Verify that the training facility in which the training program is offered or utilized for the clinical experience is licensed under the appropriate licensing agency and is in substantial compliance with all standards for licensure;

(r) Verify that a facility utilized for out-of-state clinical experience:

(A) Has not been found within the preceding two years, by the state survey and certification agency, using the currently applicable Center for Medicare and Medicaid Services regulations, to be categorized as providing substandard quality of care;

(B) Is no more than 50 miles from an Oregon border; and

(C) Has given permission for site visit(s) by Board staff.

(s) For medication aide training programs, determine student eligibility by verifying that the applicant:

(A) Holds a current certificate to practice as a CNA 1 on the CNA Registry prior to starting and throughout the medication aide training;

(B) Has graduated from an approved basic nurse aide training program at least six months prior to enrollment in the medication aide training program; and

(C) Meets the employment requirement of at least six months of full time experience as a nursing assistant or the equivalent in part time experience since graduation from a basic nursing assistant training program unless the applicant is exempt under OAR 851-062-0090.

(t) For level 2 training programs, determine student eligibility by verifying that the applicant holds a current certificate to practice as a CNA 1 on the CNA Registry prior to starting and throughout the level 2 training.

(4) The primary instructor shall hold a current, unencumbered license to practice as a registered nurse in Oregon. A registered nurse who has an encumbered license may be considered on an individual basis; and

(a) For a nursing assistant level 1 and level 2 training program, have two years experience as a registered nurse and teaching experience or educational preparation for teaching adults.

(b) For a medication aide training program, have at least three years of nursing experience, to include:

(A) One year as a nurse educator, a primary instructor in a nursing assistant training program or as a nurse administrator, and

(B) One year working with the particular type of clientele or providing clinical instruction in a setting with the particular type of clientele with whom students will have their clinical experience.

(c) May be the director of nursing service in a long term care facility only if there is evidence of formal arrangements for the director of nursing position to be filled by another qualified nurse during the period of instruction.

(5) The primary instructor shall:

(a) Implement the required Board-approved curriculum;

(b) Provide effective teaching strategies in an environment that encourages student and instructor interaction;

(c) Supervise and be present in the classroom at least 75% of the time that classes are being taught, or for on-line programs, be available for consultation and additional clarification at least every 72 hours;

(d) Evaluate competency of students; and

(e) In addition, for medication aide training programs, the primary instructor shall:

(A) Obtain approval from a facility prior to using a facility employee as a clinical preceptor. The facility has the right to refuse such approval;

(B) Ensure that each student’s clinical experience includes administration of medications by all approved routes of administration and includes administration of a variety of medications; and

(C) Supervise the clinical experience for all medication aide students. Clinical preceptors may be used as appropriate.

(6) Other personnel from the healthcare professions may supplement the instructor in their area of expertise:

(a) For a nursing assistant level 1 and level 2 training program, the program director or primary instructor may:

(A) Involve as trainers for a specific portion of the nursing assistant training, other licensed nursing personnel or other licensed health care professionals who have at least one year of experience in their field.

(B) Use an approved clinical instructor who shall:

(i) Hold a current, unencumbered license to practice as a registered nurse in Oregon. A registered nurse who has an encumbered license may be considered on an individual basis; and

(ii) Have the equivalent of one year full time experience as a registered nurse.

(C) Use an approved clinical preceptor who shall:

(i) Hold a current, unencumbered license to practice nursing in Oregon. A licensed nurse who has an encumbered license may be considered on an individual basis; and

(ii) Have the equivalent of at least one year of experience as a licensed nurse.

(b) For a medication aide training program, the clinical preceptor shall:

(A) Hold a current, unencumbered license to practice nursing in Oregon. A licensed nurse who has an encumbered license may be considered on an individual basis;

(B) Have the equivalent of one year full time experience as a licensed nurse and shall have three months’ nursing experience in a facility licensed the same as the setting in which the medication aide student will be passing medications;

(C) Provide direct supervision; and

(D) Have only the responsibility for clinical precepting during the scheduled clinical experience.

(c) Certified medication aides, resident care managers, and directors of nursing are prohibited from acting as clinical preceptors for medication aide students.

Stat. Auth.: ORS 678.440 & 678.444

Stats. Implemented: ORS 678.440 & 678.444

Hist.: BN 6-1999, f. & cert. ef. 7-8-99; BN 18-2002, f. & cert. ef. 10-18-02; BN 1-2004, f. 1-29-04, cert. ef. 2-12-04; BN 11-2004, f. & cert. ef. 7-13-04; BN 7-2006, f. & cert. ef. 5-8-06; BN 2-2008, f. & cert. ef. 2-25-08; BN 2-2011, f. & cert. ef. 7-11-11; BN 13-2013, f. 12-3-13, cert. ef. 1-1-14

851-061-0090

Standards for Program Approval: Curriculum

(1) Board-approved curriculum shall be used in approved nursing assistant level 1 and medication aide training programs.

(2) A nursing assistant level 1 training program shall consist of:

(a) At least 150 hours of instruction divided into 75 hours of classroom instruction and 75 hours of supervised clinical experience;

(b) At least 24 hours of supervised classroom/laboratory instruction with return student demonstrations of learned skills to determine comprehension and competency, in addition to facility orientation, preceding the students’ care of clients; and

(c) At least 75 hours of supervised clinical experience in a hospital, licensed nursing, residential care, or assisted living facility that has a registered nurse on duty during all scheduled student clinical hours, is in substantial compliance with all standards of licensure, and provides an opportunity for the student to perform the skills taught in the Board’s approved curriculum.

(3) An on-line nursing assistant level 1 training program shall consist of:

(a) At least the equivalent of 51 hours according to the nationally recognized standard of content to credit ratio;

(b) At least 24 hours of supervised laboratory instruction provided no later than two weeks after the successful completion of the on-line portion of the curriculum. The laboratory portion of the program shall include return student demonstration of learned skills to determine comprehension and competency, in addition to facility orientation, preceding the students’ care of clients;

(c) At least 75 hours of supervised clinical experience in a hospital, licensed nursing, residential care, or assisted living facility that has a registered nurse on duty during all scheduled student clinical hours, is in substantial compliance with all standards of licensure, and provides an opportunity for the student to perform the skills taught in the Board’s approved curriculum;

(d) Ongoing technical support service(s) to sustain the electronically offered program including provisions for staffing, reliability, privacy, and security; and

(e) Ongoing technical support service(s) for students on each required educational technology hardware, software, and delivery system.

(4) A nursing assistant level 2 training program will have Board approved:

(a) Standardized category curriculum that may vary in training hours from other Board approved standardized category curricula; and

(b) Competency evaluation.

(5) Medication aide training program classroom and clinical instruction hours:

(a) A medication aide training program shall consist of at least 84 hours of instruction divided into at least 60 hours of classroom/lab instruction and at least 24 hours of 1:1 supervised clinical experience.

(b) All clinical hours shall be completed at one site (licensed nursing facility, hospital, assisted living facility, or residential care facility).

(c) All required clinical hours shall be in medication administration related activities.

(6) Admission requirements for medication aide training programs shall be:

(a) Current, CNA 1 status on the Oregon CNA Registry maintained by the Board;

(b) Documentation of graduation from an approved basic nursing assistant level 1 training program at least six months prior to enrollment in the medication aide training program; and

(c) Documentation of at least six months full time experience as a nursing assistant level 1 or the equivalent in part time experience since graduation from a basic nursing assistant training program.

(7) An on-line nursing assistant level 2 or medication aide training program shall consist of:

(a) At least the nationally recognized standard of content to credit ratio to meet the Board’s curriculum policy for the specific training program;

(b) Supervised laboratory instruction that meets the Board’s approved curriculum provided no later than two weeks after the successful completion of the on-line portion of the curriculum. The laboratory portion of the program shall include return student demonstration of learned skills to determine comprehension and competency, in addition to facility orientation, preceding the students’ care of clients;

(c) Supervised clinical experience in a hospital, licensed nursing, residential care, or assisted living facility that has a registered nurse on duty during all scheduled student clinical hours, is in substantial compliance with all standards of licensure, and provides an opportunity for the student to perform the skills taught in the Board’s approved curriculum;

(d) Ongoing technical support service(s) to sustain the electronically offered program including provisions for staffing, reliability, privacy, and security; and

(e) Ongoing technical support service(s) for students on each required educational technology hardware, software, and delivery system.

(8) Classroom and clinical faculty/student ratios for nursing assistant level 1, level 2, and medication aide training programs:

(a) Classroom:

(A) The ratio of students per instructor in the classroom shall be such that each trainee is provided with registered nurse assistance and supervision and be no more than 30 students per instructor for nursing assistant level 1 training programs, 20 students per instructor for medication aide training programs, and 32 students per instructor for CNA level 2 training programs.

(B) The amount of students assigned per instructor with self-directed, on-line instruction shall be such that each trainee is provided with consultation and additional clarification by a Board approved instructor within 72 hours of a trainee’s inquiry.

(C) The ratio of students per instructor with instructor-directed, on-line instruction shall be such that each trainee is provided with consultation and additional clarification by a Board approved instructor within 72 hours of a trainee’s inquiry, and the class size shall be no more than 20 students per instructor per on-line classroom.

(b) Lab: The ratio of students per instructor in nursing assistant level 1, level 2, and medication aide training programs shall be no more than 10 students per instructor at all times during the lab experience.

(c) Clinical:

(A) The ratio of students per instructor in a nursing assistant level 1 training program shall be no more than 10 students per instructor at all times during the clinical experience.

(B) The ratio of students per instructor in a nursing assistant level 2 training program shall be no more than 8 students per instructor at all times during the clinical experience.

(C) The ratio of students per instructor in a medication aide training program shall begin with a ratio of one clinical preceptor to one medication aide student during the first 24 hours of the clinical experience. Less intensive supervision (either more students per preceptor or less direct supervision by preceptor) may occur after the first 24 hours, with satisfactory evaluation and approval of the clinical preceptor and primary instructor.

(9) Clinical experience and demonstration of competency for nursing assistant level 1 and medication aide training programs:

(a) A clinical schedule shall be prepared for all students prior to the beginning of the clinical experience, and provided to the clinical facility director of nursing, the clinical instructor/preceptor, and the student.

(b) Student practice and demonstration of competency for nursing assistant level 1 and medication aide training programs:

(A) Students may provide direct client care within their authorized duties under the supervision of an approved instructor.

(B) Students shall be identified as students at all times while in the clinical area.

(C) Students must not be counted as staff or utilized as staff during the hours that are scheduled for clinical experience.

(D) Students may be on a unit, floor or wing of a facility only under direct supervision of a qualified instructor.

(E) Students shall not be on a unit, floor, or wing without a CNA or licensed nurse.

(F) Students shall provide care only to the level they have been taught and determined competent by the approved clinical instructor.

(c) In addition, for medication aide training programs, the clinical experience shall be progressive with the Board approved clinical preceptor observing the medication administration and gradually increasing the number of clients to whom the student is administering medications;

(10) Program completion:

(a) Completion of a nursing assistant level 1 or medication aide training means that:

(A) The student has successfully completed 100% of the required classroom and clinical hours and content in the curriculum;

(B) The student has successfully demonstrated the required skills on the laboratory and clinical skills checklist;

(C) The student has achieved a score of 75% or higher on the program’s final examination;

(D) The student has successfully completed the clinical portion of the program no later than four months following the last date of classroom instruction or within four months after the successful completion of the on-line portion of the program; and

(E) In addition, for nursing assistant level 1 training programs, the student has successfully completed current, adult CPR certification in accordance with Board-approved curriculum.

(b) Completion of a nursing assistant level 2 training means that:

(A) The student has successfully completed 100% of the required classroom and clinical hours and content in the curriculum; and

(B) The student has successfully completed the competency evaluation.

Stat. Auth.: ORS 678.440 & 678.444

Stats. Implemented: ORS 678.444

Hist.: BN 6-1999, f. & cert. ef. 7-8-99; BN 15-2002, f. & cert. ef. 7-17-02; BN 1-2004, f. 1-29-04, cert. ef. 2-12-04; BN 11-2004, f. & cert. ef. 7-13-04; BN 12-2005, f. & cert. ef. 12-21-05; BN 7-2006, f. & cert. ef. 5-8-06; BN 2-2008, f. & cert. ef. 2-25-08; BN 1-2009, f. & cert. ef. 5-15-09; BN 10-2009, f. & cert. ef. 12-17-09; BN 2-2011, f. & cert. ef. 7-11-11; BN 13-2013, f. 12-3-13, cert. ef. 1-1-14


Rule Caption: Expanding Board options related to nursing assistant and medication aide applicants and updating references

Adm. Order No.: BN 14-2013

Filed with Sec. of State: 12-4-2013

Certified to be Effective: 1-1-14

Notice Publication Date: 11-1-2013

Rules Amended: 851-062-0010, 851-062-0050, 851-062-0080, 851-062-0130

Subject: Language is proposed to be added that gives the Board its full range of options related to approving applicants for a certified nursing assistant 1 (CNA 1) , certified nursing assistant 2 (CNA 2), and certified medication aide (CMA). This proposed revision also removes the outdated reference to Senior and People with Disabilities and replaces it with the broader organizational name.

Rules Coordinator: Peggy A. Lightfoot—(971) 673-0638

851-062-0010

Definitions

(1) “Application” means a request for certification including all information identified on a form supplied by the Board and payment of required fee.

(2) “Approved Nursing Program” means a pre-licensure educational program approved by the Board for registered or practical nurse scope of practice, or an educational program in another state or jurisdiction approved by the licensing board for nurses or other appropriate accrediting agency for that state.

(3) “Certificate of Completion” means a document meeting the standards set in OAR 851-061-0100(3)(a)–(i) and awarded upon successfully meeting all requirements of a nursing assistant or medication aide training program.

(4) “Certified Medication Aide (CMA)” means a Certified Nursing Assistant who has had additional training in administration of noninjectable medication and holds a current Oregon CMA Certificate.

(5) “Certified Nursing Assistant (CNA)” means a person who holds a current Oregon CNA certificate by meeting the requirements specified in these rules; whose name is listed on the CNA Registry; and who assists licensed nursing personnel in the provision of nursing care. The phrase Certified Nursing Assistant and the acronym CNA are generic and may refer to CNA 1, CNA 2 or all CNAs.

(6) “Certified Nursing Assistant 1 (CNA1)” means a person who holds a current Oregon CNA 1 certificate and who assists licensed nursing personnel in the provision of nursing care.

(7) “Certified Nursing Assistant 2 (CNA 2)” means a person who holds a current, CNA 1 certificate and has met requirements specified in these rules for one or more of the CNA 2 categories.

(8) “Client” means the individual who is provided care by the CNA or CMA including a person who may be referred to as “patient” or “resident” in some settings.

(9) “CNA Registry” means the listing of Oregon Certified Nursing Assistants maintained by the Board.

(10) “Competency evaluation” means the Board-approved process for determining competency.

(11) “Completed Application” means a signed application, paid application fee and submission of all supporting documents related to certification requirements.

(12) “Completed Application Process” means a completed application, a Law Enforcement Data System (LEDS) check including any subsequent investigation; successful competency examination, if required; and final review for issue or denial.

(13) “Endorsement” means the process of certification for an applicant who is trained and certified as a CNA in another state or jurisdiction.

(14) “Enrolled” means making progress toward completion of a RN or LPN nursing program, whether or not registered in the current quarter or semester, as verified by the director or dean of the program.

(15) Examinations:

(a) “Competency Examination” means the Board-approved examination administered to determine minimum competency for CNA 1 authorized duties. The competency examination consists of a written examination and a manual skills examination. The examination is administered in English.

(b) “Medication Aide Examination” means the Board-approved examination administered to determine minimum competency for CMA authorized duties. The examination is administered in English.

(16) “Full-time” means at least 32 hours of regularly scheduled work each week.

(17) “Licensed Nursing Facility” means a licensed nursing home or a Medicare or Medicaid certified long term care facility.

(18) “Monitoring” means that a Registered Nurse assesses and plans for care of the client, assigns duties to the nursing assistant according to the nursing care plan, and evaluates client outcomes as an indicator of CNA/CMA competency.

(19) “Nurse Aide Registry” means the listing of Certified Nursing Assistants maintained by the appropriate state agency in another state or jurisdiction of the United States.

(20) “OBRA” means the Omnibus Budget Reconciliation Act of 1987, successor legislation and written directives from the Center for Medicare and Medicaid Services (CMS).

(21) “Qualifying Disability” means a diagnosed physical or mental impairment which substantially limits one or more major life activities, and is subject to the protection of the Americans with Disabilities Act (ADA).

(22) “Reactivation” is the process of renewing certification after the certificate is expired.

(23) “Reinstatement” is the process of activating a certificate after it has been subject to disciplinary sanction by the Board.

(24) “Supervision” means that the licensed nurse is physically present and accessible in the immediate client care area, is available to intervene if necessary, and periodically observes and evaluates the skills and abilities of the CNA/CMA to perform authorized duties.

(25) “Unlicensed Persons” means individuals who are not necessarily licensed or certified by this Board or another Oregon health regulatory agency but who are engaged in the care of clients.

Stat. Auth.: ORS 678.442

Stats. Implemented: ORS 678.442

Hist.: BN 6-1999, f. & cert. ef. 7-8-99; BN 2-2004, f. 1-29-04, cert. ef. 2-12-04; BN 4-2004, f. & cert. ef. 2-20-04; BN 13-2005, f. & cert. ef. 12-21-05; BN 10-2010, f. & cert. ef. 6-25-10; BN 14-2013, f. 12-4-13, cert. ef. 1-1-14

851-062-0050

CNA Certification

(1) An applicant for CNA 1 certification must submit a completed application using forms and instructions provided by the Board and pay fees established by the Board. CNA 1 certification may be obtained in one of the following ways:

(a) Training and Competency Examination:

(A) Complete an approved nursing assistant level 1 training program.

(B) Pass the competency examination within two years of the date of completion of the training program and within three attempts.

(b) Military corpsman or medic training and experience and competency examination:

(A) Complete a training course equal in content to OBRA curriculum for nursing assistants; and

(B) Document evidence of at least 400 hours of paid employment in a nursing related capacity within the last two years; and

(C) Pass the competency examination within two years of application and within three attempts.

(c) RN or LPN licensure:

(A) Hold a current unencumbered RN or LPN license in any U.S. state or jurisdiction.

(B) Provide verification of current unencumbered licensure.

(C) A nurse in any U.S. state or jurisdiction who has an encumbered license may be considered on an individual basis.

(d) Enrollment in an approved nursing education program in the United States:

(A) Provide verification of enrollment in an approved nursing program; and

(B) Complete required course work equivalent to a Board-approved nursing assistant level 1 training program documented by:

(i) An official transcript from the nursing program; or

(ii) Written verification of completion of equivalent coursework from the nursing program director or dean.

(e) Graduation from an approved nursing program in the United States:

(A) Within one year after graduation, submit an official transcript documenting graduation from an approved nursing program.

(B) Between one and three years after graduation:

(i) Submit an official transcript documenting graduation from an approved nursing program; and

(ii) Pass the competency examination within two years and three attempts.

(C) Three or more years after graduation. The individual shall meet requirements for initial CNA 1 certification by training and competency examination.

(f) Graduation from a nursing program outside of the United States and competency examination:

(A) Submit a transcript or other documentation, in English, of nursing education which includes nursing knowledge and skills necessary to perform the CNA 1 authorized duties; and

(B) Pass the competency examination; or

(C) Complete the training and competency examination as provided in OAR 851-062-0050(1).

(g) Nursing assistant training outside of the United States. Complete training and competency examination as provided in OAR 851-062-0050(1).

(h) Endorsement:

(A) Provide documentation of successful completion of a nursing assistant training program that met OBRA standards.

(i) Certificate of completion meeting the standards set in OAR 851-061-0100(3)(a-i); or

(ii) Letter from facility where training was completed, on letterhead, indicating the date that program was completed and the number of classroom and clinical hours; or

(iii) Information from the appropriate state agency attesting to program completion.

(B) Supply evidence of at least 400 hours of paid employment within CNA 1 authorized duties under the supervision of a nurse in another state where the individual held current certification in the two years immediately preceding application for endorsement. A CNA who has graduated from a nursing assistant training program within the previous two years has satisfied this requirement.

(C) Submit verification of current certification by the state agency in which CNA certification is held.

(D) An individual who cannot satisfy these requirements may be eligible for CNA 1 certification by training and competency examination as provided in OAR 851-062-0050(1).

(2) CNA Testing Eligibility:

(a) An applicant who has completed a nursing assistant training program in Oregon or another of the United States, that met OBRA standards shall be eligible for examination for two years from the date of completion of the nursing assistant training program.

(b) An applicant who is eligible for the competency examination as provided in OAR 851-062-0050(1)(b)(e)(f) shall be eligible for examination for two years from the date of application.

(c) A completed application shall be valid for the period of eligibility to test.

(d) An incomplete application becomes void in one year.

(e) An applicant who fails to pass the competency examination within two years of eligibility and within three attempts shall not be eligible to reapply for the examination except that the applicant may regain eligibility enrolling in and successfully completing a Board-approved nursing assistant program.

(3) CNA 2 certification may be obtained in one of the following ways:

(a) Training and Competency Examination:

(A) Obtain CNA 1 certification;

(B) Complete an approved CNA 2 training program; and

(C) Pass the corresponding competency evaluation.

(b) RN or LPN licensure:

(A) Hold a current unencumbered RN or LPN license in any U.S. state or jurisdiction.

(B) Provide verification of current unencumbered licensure.

(C) A nurse in any U.S. state or jurisdiction who has an encumbered license may be considered on an individual basis.

(c) Enrollment in an approved nursing education program in the United States:

(A) Provide verification of enrollment in an approved nursing program; and

(B) Complete required course work equivalent to a Board-approved CNA 2 training program documented by:

(i) An official transcript from the nursing program; and

(ii) Written verification of completion of equivalent coursework from the nursing program director or dean.

Stat. Auth.: ORS 678.440 & 678.442

Stats. Implemented: ORS 678.442

Hist.: BN 6-1999, f. & cert. ef. 7-8-99; BN 2-2004, f. 1-29-04, cert. ef. 2-12-04; BN 10-2010, f. & cert. ef. 6-25-10; BN 14-2013, f. 12-4-13, cert. ef. 1-1-14

851-062-0080

Certification of Medication Aides Required

A CMA must have a current Oregon CMA certificate and be listed on the Oregon CNA Registry prior to performing medication aide duties.

Stat. Auth.: ORS 678.442

Stats. Implemented: ORS 678.442

Hist.: BN 6-1999, f. & cert. ef. 7-8-99; BN 2-2004, f. 1-29-04, cert. ef. 2-12-04; BN 14-2013, f. 12-4-13, cert. ef. 1-1-14

851-062-0130

CNA Registry

In accordance with 42 CFR ¦ 483.156 the Board maintains a CNA Registry. The Registry contains:

(1) Identifying demographic information on each CNA;

(2) Date of initial and most recent certification;

(3) Board sanctions against a CNA certificate; and

(4) Findings of resident abuse, neglect or misappropriation of resident property, made by the Department of Human Services against a CNA.

Stat. Auth.: ORS 678.442

Stats. Implemented: ORS 678.442

Hist.: BN 6-1999, f. & cert. ef. 7-8-99; BN 2-2004, f. 1-29-04, cert. ef. 2-12-04; BN 14-2013, f. 12-4-13, cert. ef. 1-1-14

Notes
1.) This online version of the OREGON BULLETIN is provided for convenience of reference and enhanced access. The official, record copy of this publication is contained in the original Administrative Orders and Rulemaking Notices filed with the Secretary of State, Archives Division. Discrepancies, if any, are satisfied in favor of the original versions. Use the OAR Revision Cumulative Index found in the Oregon Bulletin to access a numerical list of rulemaking actions after November 15, 2013.

2.) Copyright Oregon Secretary of State: Terms and Conditions of Use

Oregon Secretary of State • 136 State Capitol • Salem, OR 97310-0722
Phone: (503) 986-1523 • Fax: (503) 986-1616 • oregon.sos@state.or.us

© 2013 State of Oregon All Rights Reserved​