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Oregon Bulletin

July 1, 2011

 

Board of Nursing
Chapter 851

Rule Caption: Correction to errors in wording (2) in Rules for Authorized Duties and Standards for Certified Nursing Assistants.

Adm. Order No.: BN 1-2011(Temp)

Filed with Sec. of State: 6-6-2011

Certified to be Effective: 6-23-11 thru 12-20-11

Notice Publication Date:

Rules Amended: 851-063-0030

Subject: Under OAR 851-063-0030 Authorized Duties and Standards for Certified Nursing Assistants, (1)(c)(A)(vi) Preventing hydration should read: Preventing dehydration. In addition, OAR 851-063-0030(1)(a)(B)(vi) Providing catheter care including the application of an removal of external urinary catheters should read: Providing catheter care including the application of and removal of external urinary catheters.

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

851-063-0030

Authorized Duties and Standards for Certified Nursing Assistants

(1) Under the supervision of a licensed nurse, the CNA may provide care and assist clients with the following tasks:

(a) Tasks associated with infection control and Standard or Transmission Based Precautions:

(A) Bedmaking and handling of linen;

(B) Caring for the client’s environment;

(C) Handling and disposal of hazardous wastes;

(D) Handling of contaminated materials;

(E) Handwashing and hand hygiene;

(F) Maintaining client cleanliness and grooming; and

(G) Utilizing personal protective equipment.

(b) Tasks associated with safety and emergency procedures:

(A) Moving and transferring clients;

(B) Transporting clients in wheelchairs and specialized chairs;

(C) Turning and positioning clients;

(D) Using lifts and safe client handling devices;

(E) Turning oxygen on and off or transferring oxygen between wall and tank at pre-established flow rate for stable clients;

(F) Managing hazards in the workplace;

(G) Preventing burns;

(H) Preventing falls; and

(I) Performing cardiopulmonary resuscitation.

(c) Tasks associated with activities of daily living (ADL):

(A) Assisting with nutrition and hydration:

(i) Assisting with feeding;

(ii) Measuring and recording height and weight;

(iii) Measuring and recording intake and output;

(iv) Positioning clients for nutritional and fluid intake;

(v) Preventing choking and aspiration; and

(vi) Preventing dehydration.

(B) Assisting with elimination:

(i) Administering bowel evacuation suppositories that are available without a prescription;

(ii) Administering enemas;

(iii) Assisting with the use of bedpan and urinal;

(iv) Assisting with toileting;

(v) Collecting specimens; sputum, stool, and urine including clean catch urine specimens;

(vi) Providing catheter care including the application of and removal of external urinary catheters;

(vii) Providing ostomy care for established, healthy ostomy including cleaning the ostomy site and emptying the ostomy bag or changing the ostomy bag which does not adhere to the skin; and

(viii) Providing perineal and incontinence care.

(C) Assisting with personal care:

(i) Bathing;

(ii) Providing comfort care;

(iii) Dressing and undressing;

(iv) Grooming to include: application and care of dentures, eye glasses, and hearing aides.

(v) Nail care;

(vi) Oral hygiene;

(vii) Shampooing and caring for hair;

(viii) Shaving; and

(ix) Skin Care to include: application of non-prescription pediculicides; application of topical, non-prescription barrier creams and ointments for prophylactic skin care; maintenance of skin integrity; prevention of pressure, friction, and shearing; and use of anti-pressure devices.

(D) Assisting with positioning devices and restraints;

(E) Assisting with restorative care:

(i) Ambulating;

(ii) Assisting with and encouraging the use of self-help devices for eating, grooming and other personal care tasks;

(iii) Assisting with bowel and bladder training;

(iv) Assisting with feeding and ADL programs;

(v) Assisting with the use of crutches, walkers, or wheelchairs;

(vi) Caring for, applying, and removing antiembolus stockings, braces, orthotic devices, and prosthetic devices.

(vii) Elevating extremities;

(viii) Maintaining alignment;

(ix) Performing range of motion exercises;

(x) Using footboards; and

(xi) Utilizing and assisting clients with devices for transferring, ambulation, and alignment.

(d) Tasks associated with observation and reporting:

(A) Assisting with coughing and deep breathing;

(B) Observing and reporting changes of condition to licensed nurse; and

(C) Measuring and recording:

(i) Temperature, apical and radial pulse, respiration and blood pressure (manual and electronic-upper arm only and orthostatic blood pressure readings);

(ii) Emesis;

(iii) Liquid stool;

(iv) Pain level using a facility approved pain scale;

(v) Pulse oximetry; and

(vi) Urinary output, both voided and from urinary drainage systems.

(e) Tasks associated with documentation.

(f) Tasks associated with end of life care.

(2) The CNA may, as an unlicensed person, provide care as delegated or assigned by a nurse pursuant to the terms and conditions in OAR 851-047-0000 through 851-047-0040.

(3) ORS 678.440(5) defines the term “nursing assistant” as a person who assists licensed nursing personnel in the provision of nursing care. Consistent with that definition, a CNA must either:

(a) Be regularly supervised by a licensed nurse; or

(b) Work in a community-based care setting or other setting where there is no regularly scheduled presence of a licensed nurse provided there is periodic supervision and evaluation of clients under the provisions of OAR 851-047-0000 through 851-047-0040.

(4) Under no circumstance shall a CNA work independently without supervision or monitoring by a licensed nurse who provides assessment of clients as described in OAR 851-063-0030(3)(a)(b).

(5) A CNA may accept verbal or telephone orders for medication from a licensed health care professional who is authorized to independently diagnose and treat only when working in the following settings under the specified administrative rule:

(a) When working in Adult Foster Homes, as permitted under OAR Chapter 411, division 050;

(b) When working in Residential Care Facilities, as permitted under OAR Chapter 411, division 054; and

(c) When working in Assisted Living Facilities, as permitted under OAR Chapter 411, division 054.

(6) Standards of Care for Certified Nursing Assistants. In the process of client care the CNA shall consistently:

(a) Apply standard precautions according to the Centers for Disease Control and Prevention guidelines;

(b) Use hand hygiene between episodes of care;

(c) Use appropriate body mechanics to prevent injury to self and client;

(d) Follow the care plan as directed by the licensed nurse;

(e) Use appropriate communication with client, client’s family and friends, and coworkers;

(f) Use alternatives to physical restraints, or apply physical restraints as directed by the licensed nurse;

(g) Determine absence of pulse and/or respiration, and initiate an emergency response;

(h) Report to the licensed nurse any recognized abnormality in client’s signs and symptoms;

(i) Record observations and measurements, tasks completed, and client statements about condition or care;

(j) Apply safety concepts in the workplace;

(k) Report signs of abuse, neglect, mistreatment, misappropriation or exploitation;

(l) Demonstrate respect for rights and property of clients and coworkers; and

(m) Maintain client confidentiality.

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 3-2004, f. 1-29-04, cert. ef. 2-12-04; BN 11-2009, f. & cert. ef. 12-17-09; BN 11-2010, f. & cert. ef. 6-25-10; BN 1-2011(Temp), f. 6-6-11, cert. ef. 6-23-11 thru 12-20-11

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, 2010.

2.) Copyright 2011 Oregon Secretary of State: Terms and Conditions of Use

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