Oregon State Board of Nursing Oregon’s Nurse Practice Act: What it means to the Licensee . April 8th, 2016 Ruby R. Jason, MSN, RN, NEA-BC Executive Director OSBN

Following today’s presentation the licensee will be able to: Navigate within the nurse Practice Act to find standards of practice. Identify the role of self-regulation in determining individual scope of practice. State what it means to practice at the “top of your scope” Utilize the Scope Decision Making tool to identify if a task/assignment/role is within the individual licensee’s scope of practice The following content is based upon application of Chapter 678 Oregon Revised Statutes (ORS), Chapter 851 Oregon Administrative Rules (OAR), and OSBN practice documents. The content provided is intended for general knowledge only and does not replace or supersede the laws and rules codified in Oregon’s Nurse Practice Act.

Professional Regulation Oregon’s NPA Context of Care Self Regulation RN

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

These are the responsibility of: The OSBN does not: Serve as a membership organization for nurses, Regulate settings, organizations, or work conditions, Regulate conditions of employment, Intervene in human resource matters, or Set staffing ratios or acuity metrics. These are the responsibility of: Professional nursing and other organizations Labor unions and collective bargaining organizations Employers Other regulatory agencies and credentialing bodies

Oregon Nurse Practice Act Oregon Revised Statute 678.150 (5) The Board shall determine qualifications of applicants for a license to practice nursing in this state… (6) The Board shall exercise general supervision over the practice of nursing in this state… (7) The Board shall determine scope of practice as delineated by the knowledge acquired through approved courses of education…

Practice of Nursing ORS 678.010 (8), the “Practice of nursing” means: diagnosing and treating human responses to actual or potential health problems through such services as identification thereof, health teaching, health counseling and providing care supportive to or restorative of life and well-being and including the performance of such additional services requiring education and training which are recognized by the nursing profession as proper to be performed by nurses licensed under ORS 678.010 to 678.410 and which are recognized by rules of the board… Oregon Revised Statutes (ORS) – 2011 Edition Chapter 678 – Nurses; Nursing Home Administrators

Oregon’s Nurse Practice Act Oregon Administrative Rules (OARs) Chapter 851 OARs: Interpret ORS 678 Help define & promote safe & competent nursing practice. Have the effect of law

Division 45: RN Standards & Scope of Practice The Board recognizes that the scope of practice for the RN encompasses a variety of roles including: Provision of client care Supervision of others in the provision of care Development and implementation of health care policy Consultation in the practice of nursing Nursing administration Nursing education Case management Nursing Research Teaching Specialization in advanced practice Nursing informatics Scope of Practice: The actions & processes that are permitted for the licensed individual Page 6

Division 45: Standards & Scope of Practice Client Advocacy Ethics, Professional Accountability, Competence Environment of Care Nursing Technology Assign and Supervise Care Accept and Implement Orders Nursing Practice Implementation Collaboration w/Interdisciplinary Team Leadership Quality of Care Health Promotion Cultural Sensitivity Delegate and Supervise the Practice of Nursing Standards of Practice: The behaviors/actions that demonstrate a competent level of nursing for each scope of practice authority.

Division 45: Standards & Scope of Practice Standards related to the licensed nurse’s responsibilities for ethics, including professional accountability and competence. The licensed nurse: (a) Has knowledge of the statutes and regulations governing nursing, and practices within the legal boundaries of licensed nursing practice; (b) Accepts responsibility for individual nursing actions and maintains competence in one's area of practice. 851 – 045 – 0040 (3) (a) & (b) Chapter Division Rule Section Subsections Number Page 3

Division 45: Standards & Scope of Practice Standards related to the licensed nurse’s responsibilities for ethics, including professional accountability and competence. The licensed nurse: (d) Accepts only nursing assignments for which one is educationally prepared and has the current knowledge, skills and ability to safely perform. (f) Maintains documentation of the method by which competency was gained, and evidence that it has been maintained. 851 – 045 – 0040 (3) (d) & (f) Chapter Division Rule Section Subsections Number Page 3

851-045-0040(6) Standards related to the licensed nurse’s responsibilities to accept and implement orders for client care and treatment. The licensed nurse: May accept and implement orders for client care from…. Prior to implementation of the order... Has the responsibility to question any order….

Division 45: Standards & Scope of Practice 0040 (5) Standards related to the licensed nurse’s responsibility to assign and supervise care. “Assign” means directing and distributing, within a given work period, the work that each staff member is already authorized to perform. The RN may: Assign to the RN, nursing interventions that fall within RN scope of practice and that the licensee receiving the assignment has the competencies to perform safely. Assign to the LPN, nursing interventions that fall within LPN scope of practice and that the licensee receiving the assignment has the competencies to perform safely. Assign to the CNA and CMA authorized duties identified within Chapter 851 Division 63 and that the certificate holder has the competencies to perform safely.

Division 45: Standards & Scope of Practice “Assign” means directing and distributing, within a given work period, the work that each staff member is already authorized to perform. The RN may: Assign to the UAP work the UAP is authorized to perform within the setting and that the UAP has the competencies to perform safely; Ensure the assignment matches the client’s service needs with qualified personnel and available resources. Provide clinical supervision of the RN, LPN, CNA, CMA, and UAP to whom an assignment has been made. Ensures documentation of the activity. Revise the assignment as indicated.

What does it mean to practice at the top of your license? What does “top of your license” mean to you? The Basics: What is applicable to every nurse regardless of knowledge, skills, and abilities. Defining your own scope Oregon State Board of Nursing: December 16, 2015

Individual Scope of Practice

The RN who self-regulates: Can I do “X” Answer: It depends… Professional Regulation Oregon’s NPA Context of Care Self Regulation

Reporting questionable practice, even when done appropriately, may present substantial risk to the nurse; however, such risk does not eliminate the obligation to address threats to patient safety. Provision 3.5 Code of Ethics for Nurses (ANA, 2015)

Questions & Discussion www.oregon.gov/OSBN

OSBN On-line Resources www.oregon.gov/OSBN Nurse Practice Act Licensing Information Interpretive Statements Ask a Scope-of-Practice Question link

American Nurses Association (2015) American Nurses Association (2015). Code of ethics for nurses with interpretive statements. Silver Spring, Maryland: Author. American Nurses Association (2015). Scope and standards of practice (3rd. ed.). Silver Spring, Maryland: Author. American Nurses Association (2015). Guide to nursing’s social policy statement: Understanding the profession from social contract to social covenant. Silver Spring, Maryland: Author. American Nurses Association (2010). Nursing’s social policy statement: The essence of the profession. Silver Spring, Maryland: Author. American Nurses Association and National Council of State Boards on Nursing. (2008). Joint statement of delegation. Foote, J. (1917). State Board questions and answers for nurses. Lippincott: Philadelphia, PA. LaCharity, L. A. Kumagai, C. K. , & Bartz, B. (2011). Prioritization, delegation, and assignment Practice exercises for the NCLEX® examination (2nd ed.). Mosby: St. Louis.

Motacki, K., & Burke, K. (2011). Nursing delegation and management of patient care. Mosby: St. Louis. Oregon Secretary of State (2013). Oregon Revised Statute 678.036 – Nurses; Nursing Home Administrators. Oregon Secretary of State (2012, August 1). Oregon Administrative Rules Chapter 851 Division 45: Standards and Scope of Practice for the Licensed Practical Nurse and Registered Nurse. Oregon Secretary of State (2004, February 26). Oregon Administrative Rules Chapter 851 Division 47: Standards for Community Based Care Registered Nurse Delegation. Oregon Senior Forums (2013, May). A History of Oregon’s Unique Long-Term-Care System. Author. Retrieved from http://www.oregon.gov/LTCO/docs/Senior%20History%20project%20final%20full%20copy%206-2013.pdf Oregon State Board of Nursing (2006, November 9). Oregon State Board of Nursing Scope of Practice Decision Making Guideline for RN and LPN Practice. Oregon State Board of Nursing.