Or. Admin. R. 851-063-0030

Current through Register Vol. 63, No. 8, August 1, 2024

Section 851-063-0030 - Authorized Duties and Standards for Certified Nursing Assistant 1 (CNA 1)

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

(a) Tasks associated with collaboration with health care team:

(A) Accepting assignments and delegations;

(B) Handing off care to another nursing assistant;

(C) Coaching and mentoring nursing assistant students; and

(D) Orienting other nursing assistants to workflow and environment.

(b) Tasks associated with communication and interpersonal skills:

(A) Answering and placing call signals;

(B) Communicating with clients, family members, and co-workers;

(C) Maintaining confidentiality;

(D) Reporting abuse, mistreatment, and neglect; and

(E) Utilizing de-escalation techniques.

(c) Tasks associated with person-centered care.

(A) Following the individual's plan of care and providing feedback to nurse on care plan;

(B) Organizing daily routines for a group of people according to the individuals' preferences and the individual care plans; and

(C) Protecting and respecting a person's rights.

(d) Tasks associated with infection control and prevention including Standard or Transmission Based Precautions:

(A) Handwashing and hand hygiene;

(B) Utilizing personal protective equipment;

(C) Maintaining client hygiene and grooming;

(D) Caring for the client's environment;

(E) Cleaning shared equipment;

(F) Bedmaking and handling of linen;

(G) Delivering and handling food and drinks;

(H) Implementing precautions associated with communicable and infectious diseases;

(I) Executing neutropenic precautions;

(J) Assisting with coughing and deep breathing;

(K) Handling of contaminated materials;

(L) Handling of disposal of hazardous wastes; and

(M) Applying a simple dressing to a dry, non-infected wound.

(e) Tasks associated with safety and emergency procedures:

(A) Implementing bleeding, cervical, hip, and sternal precautions;

(B) Moving and transferring a person;

(C) Transporting a person in a wheelchair or other specialized chairs;

(D) Turning and positioning a person;

(E) Using lifts and safe client handling devices;

(F) Turning oxygen on and off or transferring oxygen between wall, concentrator, and tank at pre-established flow rate for stable individuals;

(G) Managing hazards in the workplace;

(H) Preventing burns;

(I) Preventing falls; and

(J) Performing cardiopulmonary resuscitation.

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

(A) Assisting with nutrition and hydration:

(i) Measuring and recording height and weight;

(ii) Measuring and recording intake and output;

(iii) Positioning a person for nutritional and fluid intake;

(iv) Preventing choking and aspiration;

(v) Preventing dehydration;

(vi) Thickening liquids; and

(vii) Utilizing techniques for assisting with eating.

(B) Assisting with elimination:

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

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

(iii) Assisting with toileting;

(iv) Providing perineal and incontinence care;

(v) Applying external catheters;

(vi) Connecting external catheters to suction;

(vii) Providing catheter care;

(viii) Changing catheter bag;

(ix) Removing external urinary catheter;

(x) Providing ostomy care for established, healthy ostomy including cleaning the ostomy site and emptying the ostomy bag or changing the dressing or ostomy appliance or bag; and

(xi) Collecting specimens (sputum, nasal swab, rectal swab, stool, and urine including clean catch).

(C) Assisting with personal care:

(i) Bathing;

(ii) Providing comfort care;

(iii) Dressing and undressing;

(iv) Grooming to include:

(I) Application and care of eye glasses; and

(II) Application and care of hearing aids.

(v) Nail care for fingernails and toenails on person with no visually compromised skin or compromised circulation:

(I) Soaking and washing;

(II) Trimming with standard clippers;

(III) Applying lotion; and

(IV) Recognizing risk factors.

(vi) Oral hygiene:

(I) Brushing and flossing teeth; and may include medication mouthwash and toothpaste;

(II) Inserting, removing, and cleaning dentures;

(III) Caring for implants; and

(IV) Performing mouth care on a comatose person.

(vii) Personal care considerations for persons who have tubes or special equipment;

(viii) Shampooing and caring for hair;

(ix) Shaving;

(I) Electric razor;

(II) Cartridge or disposable razor; and

(III) Recognizing safety risks.

(x) Skin Care to include:

(I) Pediculicides that can be obtained without a prescription;

(II) Applying topical barrier creams, ointments, and wipes for skin care;

(III) Applying anti-fungal ointments and powders;

(IV) Maintaining skin integrity;

(V) Preventing pressure, friction, and shearing; and

(VI) Using pressure relieving devices;

(xi) Sleep to include:

(I) Applying and removing delivery device and turn continuous positive airway pressure (CPAP) or bi-level positive airway (BiPAP) devices on and off; and

(II) Promoting sleep.

(D) Assisting with positioning devices and restraints;

(E) Assisting with restorative care:

(i) Ambulating;

(ii) Applying, turn on and off, sequential compression devices;

(iii) Assisting with and encouraging the use of self-help devices for ambulation, dressing, eating, grooming, positioning and transferring;

(iv) Assisting with bowel and bladder training;

(v) Assisting with ADL programs;

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

(vii) Assisting with warm and cold therapies;

(viii) Caring for, applying, and removing antiembolus stockings, braces, orthotic devices, and prosthetic devices;

(ix) Elevating extremities;

(x) Maintaining alignment;

(xi) Performing range of motion exercises;

(xii) Reinforcing task sequence by breaking down tasks into small, obtainable steps;

(xiii) Reinforcing the use of an incentive spirometer;

(xiv) Using footboards; and

(xv) Utilizing devices for transferring, ambulation, and alignment.

(g) Tasks associated with mental health and social service needs:

(A) Recognizing and reporting relevant observations of domestic violence, mental illness or substance abuse;

(B) Protecting client, self, and other individuals when in a situation where an individual's behavior is escalating out of control;

(C) Providing trauma-informed care;

(D) Appropriately executing tools for behavior management; and

(E) Utilizing appropriate harmless release techniques.

(h) Tasks associated with technical skills:

(A) Changing a suction canister;

(B) Measuring, recording, and emptying output from drainage devices and closed drainage systems;

(C) Performing fingerstick capillary blood test; and

(D) Removing mask after nebulizer treatment.

(i) Tasks associated with observation and reporting:

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

(B) Measuring and recording:

(i) Temperature, apical and radial pulse, respiration and blood pressure (manual and electronic- forearm, upper arm 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.

(C) Relieving pain:

(i) Assisting with complementary therapies such as aromatherapy and using pre-recorded audio/visuals for guided imagery; deep relaxation;

(ii) Planning activities in relation to pain;

(iii) Providing comfort measures;

(iv) Reporting to the nurse;

(v) Repositioning; and

(vi) Using touch to massage non-diseased tissue.

(j) Tasks associated with documentation.

(A) Recording care provided; and

(B) Documenting incidents.

(k) Tasks associated with end of life care.

(A) Providing comfort care for the dying individual and their family; and

(B) Caring for the deceased individual including removing non-surgically inserted tubes:

(i) Feeding tube;

(ii) Rectal bag;

(iii) Foley Catheter;

(iv) Nasogastric tube; and

(v) Saline lock.

(l) Tasks associated with caregiver self-care.

(2) The CNA may, as an unlicensed person, provide care as delegated or assigned by a nurse in a community-based care setting.

(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 under licensed nurse monitoring 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.

(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 50;

(b) When working in Residential Care Facilities, as permitted under OAR Chapter 411, division 54.

(6) A CNA may add phlebotomy to the authorized duties when the individual CNA has:

(a) Obtained and holds current phlebotomy certification from one of the following: American Society for Clinical Pathology (ASCP) Board of Certification, National Phlebotomy Association (NPA), Association of Phlebotomy Technicians (ASPT), American Association of Bioanalysts (ABOR), American Certification Agency for Healthcare Professionals (ACA), American Medical Technologists (AMT), or successful completion of phlebotomy specific military education program; and

(b) Maintained competency in performing phlebotomy; and

(c) Been assigned the task by an Oregon licensed nurse according to the employer's policy.

(7) A CNA may add child safety seat check to the authorized duties when the individual CNA has:

(a) Successfully completed a national child passenger safety certification program;

(b) Maintained competency in child passenger seat safety; and

(c) Been assigned the task by an Oregon licensed nurse according to the employer's policy.

(8) A CNA may add telemetry monitoring to the authorized duties when the individual CNA has:

(a) Successfully completed a dysrhythmia recognition course;

(b) Maintained competency in rhythm interpretation; and

(c) Been assigned the task by an Oregon licensed nurse according to the employer's policy.

(9) A CNA may add to the authorized duties when the following elements occur:

(a) An RN at the CNA employment site who has the knowledge and skills necessary to teach the performance of the task:

(A) Develops an evidence-based teaching plan;

(B) Implements the teaching plan;

(C) Evaluates CNA learner outcomes related to the performance of the task; and

(D) Validates the CNA's initial and ongoing competency to perform the task.

(b) The CNA has:

(A) Successfully completed training on the task;

(B) Maintained competency in the task; and

(C) Been assigned the task by an Oregon licensed nurse according to the employer's policy.

(c) Additional authorized duties:

(A) Discontinuing a saline lock;

(B) Discontinuing a urethrally inserted catheter;

(C) Clipping hair in preparation for surgical procedure;

(D) Giving Chlorhexidine bath;

(E) Assisting a person in and out of continuous passive motion (CPM) machine;

(F) Administering enemas;

(G) Measuring and recording: blood pressure (lower leg, thigh);

(H) Scanning a bladder;

(I) Scanning glucometer sensor; and

(J) Changing a wound vacuum canister.

(10) 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 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.

Or. Admin. R. 851-063-0030

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; BN 4-2011, f. & cert. ef. 10-6-11; BN 7-2014, f. 12-3-14, cert. ef. 1/1/2015; BN 16-2021, amend filed 07/21/2021, effective 8/1/2021; BN 1-2024, amend filed 02/23/2024, effective 3/1/2024

Statutory/Other Authority: ORS 678.440, ORS 678.442 & ORS 678.444

Statutes/Other Implemented: ORS 678.440, ORS 678.442 & ORS 678.444