851-047-0000
Statement of Purpose

These rules establish standards for delegation to other than licensed nursing personnel in a community-based setting, of procedures including patient care tasks and tasks related to the administration of medication, ordered by a nurse practitioner (NP), clinical nurse specialist (CNS), or by a physician licensed under ORS Chapter 677.

Statutory/Other Authority: ORS 678.150
Statutes/Other Implemented: ORS 678.150
History:
BN 9-2024, amend filed 08/27/2024, effective 09/01/2024
BN 3-2023, amend filed 07/06/2023, effective 08/01/2023
BN 5-2004, f. & cert. ef. 2-26-04
BN 2-1999, f. & cert. ef. 3-16-99
BN 3-1998, f. & cert. ef. 3-13-98
NB 8-1992, f. & cert. ef. 7-27-92, Renumbered from 851-045-0011
NB 2-1990, f. & cert. ef. 4-2-90
NB 7-1989(Temp), f. & cert. ef. 10-4-89
NB 2-1988, f. & cert. ef. 6-24-88

851-047-0030
General Provisions

(1) In accordance with these rules:

(a)  The registered nurse (RN) may delegate, to other than licensed nursing personnel, tasks relating to the administration of medication and patient care tasks that are ordered or prescribed by a physician licensed under ORS chapter 677, a CNS or NP;

(b) The delegation must occur under the procedural guidance, initial direction and periodic inspection and evaluation of the physician, CNS, NP or RN;

(c) The provision of nursing care may be delegated only by a registered nurse; and

(d) Delegation under these rules may only occur in a community-based setting.

(2) For the purposes of these rules:

(a) The term “nursing procedure” includes the tasks referenced in section (1) of this rule; and

(b) The term “unregulated assistive person (UAP) means a person other than licensed nursing personnel.

(3) An RN may not delegate the nursing process components of assessment, identification of reasoned conclusions, outcome identification, planning, or evaluation to a UAP.

(4) Prior to delegating, an RN must ensure that practice setting policies:

(a) Support RN engagement in delegation process; and

(b) Are consistent with these rules.

(5) Pursuant to ORS 678.036(3), a nurse who delegates the provision of nursing care to another person pursuant to ORS 678.150 shall not be subject to an action for civil damages for the performance of a person to whom nursing care is delegated unless the person is acting pursuant to specific instructions from the nurse or the nurse fails to leave instructions when the nurse should have done so

(6) Nothing in these rules waives or otherwise alters an RN’s obligation to comply with OAR Chapter 851 Division 45.  

(7) The decision to delegate or not delegate remains solely with the RN.

Statutory/Other Authority: ORS 678.150
Statutes/Other Implemented: ORS 678.150
History:
BN 9-2024, amend filed 08/27/2024, effective 09/01/2024
BN 3-2023, amend filed 07/06/2023, effective 08/01/2023
BN 5-2004, f. & cert. ef. 2-26-04
BN 3-1998, f. & cert. ef. 3-13-98
NB 8-1992, f. & cert. ef. 7-27-92, Renumbered from 851-045-0011
NB 2-1990, f. & cert. ef. 4-2-90
NB 7-1989(Temp), f. & cert. ef. 10-4-89
NB 2-1988, f. & cert. ef. 6-24-88

851-047-0045
Process for RN Initial Delegation

(1)  The RN may proceed with delegation process only when they determine delegation is a safe care delivery option for their client. Delegation is a safe care delivery option for the client only when all the following are met:

(a) The client’s condition for which the nursing procedure is ordered is stable and predictable;

(b) The client does not require assessment during performance of the nursing procedure;

(c) The performance of the nursing procedure does not require interpretation or independent decision-making;

(d) The results of performing the nursing procedure are reasonably predictable;

(e) The selected client and circumstances of the delegation are such that the consequences of performing the nursing procedure are not life- threatening and delegation of the nursing procedure’s performance to the UAP poses minimal risk to the client;

(f) The client’s environment of care supports the safe performance of the nursing procedure for the client by the UAP;

(g) The nursing procedure will be performed by the UAP at a frequency that allows for the UAP’s continued safe performance;

(h) The UAP possesses the skills necessary for learning and safely performing the nursing procedure;

(i) The UAP communicates they are willing and able to perform the nursing procedure for the client; and

(j) The RN has the appropriate resources necessary to fulfill nursing practice and delegation process responsibilities with the client and the UAP including:

(A) Availability to provide ongoing assessment of the client at the frequency deemed necessary by the RN to determine the ongoing stability and predictability of the client’s condition; and

(B) Availability to provide ongoing competency validation of the authorized UAP’s performance of the nursing procedure for the client.

(2) The RN must provide procedural guidance and initial direction to the UAP by:

(a) Educating the UAP through providing information about the nursing procedure and why it is necessary in the management or treatment of the client’s condition; and

(b) Providing documented step-by-step evidence-based instructions for the performance of the nursing procedure for the client. The documented instructions must:

(A) Be respectful of the client’s needs, choices and dignity;

(B) Be documented in a manner that is understood by the UAP, and

(C) Identify:

(i)  How to perform the nursing procedure for the client;

(ii) Infection control practices to follow when performing the nursing procedure;

(iii) Client risks associated with the nursing procedure’s performance;

(iv) Observation of the client including desired effects, side effects, potential adverse reactions and emergencies related to performance of the nursing procedure on the client;

(v) Actions to take in response to observations; and

(vi) Documentation requirements when performing the nursing procedure.

(3) After providing procedural guidance and initial direction as required in section (2) of this rule, the RN must:

(a) Evaluate the UAP’s performance of the nursing procedure;

(b) Address questions the UAP and client may have; and

(c) Amend the documented instructions as deemed appropriate by the RN.

(4) The RN who validates the UAP’s accurate performance of the nursing procedure as outlined in section (3) of this rule may authorize the UAP to perform the nursing procedure for the client for a period not to exceed 90 days. The authorization period must be determined through clinical judgment and based on the RN’s evaluation of data that include but are not limited to:

(a) The nursing procedure delegated;

(b) Whether the RN has previously authorized the same UAP to perform the same nursing procedure;

(c) The length of time the RN has worked with the UAP as a health care team member;

(d) The frequency of client assessment deemed necessary to determine the ongoing stability and predictability of the client’s condition related to their assessed baseline; and

(e) The client’s responses to other actual or potential health problems that may impact the client’s condition for which the nursing procedure is ordered.

(5) The RN must:

(a) Document the length of the UAP’s initial authorization period;

(b) Provide documented instructions for the UAP to reference;

(c) Instruct the UAP to adhere to the instructions when performing the nursing procedure for the client;

(d) Instruct the UAP that the authorization to perform the nursing procedure is client specific, time limited, and not transferable;

(e) Update the plan of care to identify that performance of the client’s nursing procedure has been delegated to a UAP;

(f) Provide periodic inspection and evaluation of the delegation per OAR 851-047-0050; and

(g) Continue to engage in nursing practice with the client.

Statutory/Other Authority: ORS 678.150
Statutes/Other Implemented: ORS 678.150
History:
BN 9-2024, amend filed 08/27/2024, effective 09/01/2024
BN 3-2023, adopt filed 07/06/2023, effective 08/01/2023

851-047-0050
Process for Periodic Inspection and Evaluation

(1) The RN must provide periodic inspection and evaluation to reach a clinical judgment on whether the delegation remains a safe care delivery option for the client. At a minimum, the periodic inspection and evaluation must occur at least once prior to the expiration of the initial authorized period and at least once prior to the expiration of any subsequent reauthorization period.

(2) The RN’s periodic inspection and evaluation must include:

(a) Verification that the requirements of 851-047-0045(1)(a) through (j) continue to be met;

(b) Assessment of the client in their environment of care; and

(c) Validation of the UAP’s adherence to the documented instructions, by:

(A) Verifying the UAP’s documentation of the nursing procedure;

(B) Addressing questions or concerns the UAP and client may have; and

(C) Directly observing the UAP perform the nursing procedure.

(3) If the RN concludes the delegation is not a safe care delivery option for the client, the RN may not re-authorize the UAP’s performance of the nursing procedure for the client. Nothing in these rules prevents the RN from:

(a) Addressing an identified issue rendering the delegation unsafe;

(b) Verifying resolution of the issue; and

(c) Proceeding to section (4) of this rule.

(4) If the RN concludes the delegation remains a safe care delivery option for the client, the RN may re-authorize the UAP’s performance of the nursing procedure for another period not to exceed 180 days from the date of the periodic inspection and evaluation. When reauthorizing the UAP’s performance of the nursing procedure, the RN must:

(a) Document the length of the reauthorization period;

(b) Ensure a copy of the documented instructions are accessible to the UAP;

(c) Instruct the UAP to adhere to the instructions when performing the nursing procedure for the client;

(d) Instruct the UAP that their reauthorization to perform the nursing procedure is client specific, time limited, and not transferable;

(e) Continue to provide periodic inspection and evaluation of the delegation per this rule; and

(f) Continue to engage in nursing practice with the client.

Statutory/Other Authority: ORS 678.150
Statutes/Other Implemented: ORS 678.150
History:
BN 9-2024, amend filed 08/27/2024, effective 09/01/2024
BN 3-2023, adopt filed 07/06/2023, effective 08/01/2023

851-047-0055
Limitations on the Delegation of a Nursing Procedure related to the Administration of Medication by the Intravenous Route

(1) Only the RN who is an employee of a licensed home health agency or a licensed hospice agency may delegate a nursing procedure related to the administration of a medication by the intravenous (IV) route.

(2) The delegation of a nursing procedure related to the administration of IV medication is limited to: 

(a) The administration of pre-measured IV flushing solution;

(b) Changing a pre-measured bag of IV fluid;

(c) Connecting a pre-measured IV medication to an existing IV line; and

(d) The administration of a bolus of IV medication by using a preprogrammed delivery device.

(3) The RN may not delegate venipuncture or the discontinuation of an IV access device.

(4) Prior to delegating, the RN must verify all pre-measured flushing solutions, bags of fluid and doses of medication are pharmacy dispensed.

Statutory/Other Authority: ORS 678.150
Statutes/Other Implemented: ORS 678.150
History:
BN 9-2024, amend filed 08/27/2024, effective 09/01/2024
BN 3-2023, adopt filed 07/06/2023, effective 08/01/2023

851-047-0060
Ending a UAP’s Authorization to Perform a Nursing Procedure

(1) The RN must end a UAP’s authorization or reauthorization to perform a nursing procedure when:

(a) The medical order for the nursing procedure is discontinued;

(b) The UAP no longer works with the client;

(c) The RN cannot provide ongoing periodic inspection and evaluation;

(d) Delegation is no longer a safe care delivery option for the client; or

(e) The RN ends their professional relationship with the client.     

(2) When the RN ends a UAP’s authorization or reauthorization to perform a nursing procedure, the RN must:

(a) Document the action taken, reason, date, time; and

(b) Inform care team members who need to know.

Statutory/Other Authority: ORS 678.150
Statutes/Other Implemented: ORS 678.150
History:
BN 9-2024, amend filed 08/27/2024, effective 09/01/2024
BN 3-2023, adopt filed 07/06/2023, effective 08/01/2023