2.1 Scope of Practice, OSBN Rules & Delegation

2.1 Scope of Practice, OSBN Rules & Delegation

The Regulatory Foundation: OSBN and Division 63

In the state of Oregon, the practice of Certified Nursing Assistants (CNAs) is governed by the Oregon State Board of Nursing (OSBN). The OSBN is the state agency responsible for licensing, certifying, and regulating nursing professionals and assistive personnel to ensure the safety and welfare of the public. The legal rules defining what a CNA can and cannot do are codified in the Oregon Administrative Rules (OAR) Chapter 851, Division 63. These rules establish the standard curriculum, registration requirements, and the specific limits of the CNA's clinical role.

Every candidate preparing for the Oregon CNA exam must thoroughly understand the boundaries established by Division 63. Working within these boundaries is referred to as practicing within your "scope of practice." The scope of practice is the legal framework that outlines the procedures, actions, and processes that a certified healthcare worker is permitted to undertake. Operating outside this scope is not only a violation of facility policy but a violation of state law, which can lead to the immediate revocation of certification, administrative fines, and potential civil or criminal liability.

Permitted Tasks: What an Oregon CNA Can Do

Under the direct supervision of a licensed nurse (either a Registered Nurse or a Licensed Practical Nurse), an Oregon CNA is authorized to perform a variety of basic care and data collection tasks. These tasks are primarily focused on maintaining resident hygiene, comfort, mobility, and basic physical monitoring.

1. Activities of Daily Living (ADLs): CNAs assist residents with essential daily self-care tasks. This includes bathing (complete bed baths, partial baths, showers, and tub baths), grooming (shaving, hair care, nail care for non-diabetic residents), dressing and undressing, and oral hygiene (brushing teeth, denture care).
2. Mobility and Positioning: CNAs assist residents with safe transfers (bed to wheelchair, wheelchair to toilet) using proper body mechanics and assistive devices like mechanical lifts (e.g., Hoyer lifts) under appropriate supervision. They also perform positioning (turning bedbound residents every two hours) and assist with passive or active Range of Motion (ROM) exercises as outlined in the care plan.
3. Data Collection and Vital Signs: CNAs are responsible for measuring and recording critical physiological data. This includes measuring temperature, pulse, respirations, blood pressure, and pain levels. Additionally, they measure and record height, weight, and fluid intake and output (I&O).
4. Nutrition and Hydration: CNAs assist in preparing dining areas, serving meals, feeding residents who require assistance, and encouraging fluid intake to prevent dehydration.
5. Simple Care Procedures: Oregon CNAs may perform non-sterile tasks such as applying dry dressings to intact skin, collecting non-sterile specimens (urine, stool, sputum), and providing perineal and catheter care (cleaning the external portion of an indwelling catheter).

Prohibited Tasks: What an Oregon CNA Cannot Do

It is equally critical to understand what is strictly outside the CNA's scope of practice. Under OSBN rules, CNAs are unlicensed assistive personnel who lack the advanced clinical training required for complex decision-making and invasive interventions.

1. Medication Administration: A standard CNA cannot administer medications of any kind. This includes oral pills, eye drops, ear drops, topical creams, patches, inhalers, or injections. Only a Certified Medication Aide (CMA)—a CNA who has completed additional training and passed a state exam—may administer medications, and even CMAs have strict limitations (e.g., they cannot administer injections or handle intravenous therapy).
2. Invasive and Sterile Procedures: CNAs must never perform sterile dressing changes, insert or remove indwelling urinary catheters (Foley catheters), or perform sterile bladder irrigations. They cannot perform deep tracheal suctioning or insert nasogastric (NG) tubes.
3. Clinical Assessments and Care Planning: While CNAs collect data (such as measuring blood pressure or observing a red spot on a resident’s heel), they cannot analyze or interpret this data. The act of "assessment"—determining what the data means clinically and deciding on a course of action—is the exclusive legal domain of the Registered Nurse. CNAs cannot formulate, write, or modify the nursing care plan.
4. Receiving Medical Orders: CNAs cannot take verbal or telephone orders from physicians, physician assistants, or nurse practitioners. If a physician calls a facility, the CNA must immediately transfer the call to a licensed nurse.

Principles of Delegation in Oregon

Delegation is the process by which a licensed nurse transfers the authority to perform a specific nursing task to a CNA. In Oregon, the delegation process is strictly structured to ensure resident safety:

• Nurse Responsibility: Only a licensed nurse (RN or LPN) can delegate tasks. The nurse remains legally accountable for the outcome of the delegated task and must supervise and evaluate how the task is performed. The RN is responsible for assessing the resident's stability before delegation.
• No Sub-Delegation: Delegation is a direct agreement between the licensed nurse and the individual CNA. A CNA can never sub-delegate a task to another CNA or assistive worker. If a nurse delegates a task to you, you must perform it yourself or discuss it with the nurse; you cannot hand it off to a colleague.
• Refusing a Task: A CNA has a professional and legal duty to refuse a delegated task under specific circumstances. You must refuse a task if:
  1. It is outside the legal CNA scope of practice (e.g., a nurse asks you to give a resident Tylenol).
  2. You have not been trained or evaluated on how to perform the task safely.
  3. The task violates the resident's care plan or poses an immediate physical danger to the resident.
  4. The nurse's instructions are unclear, or you lack the proper equipment.

When refusing a task, you must notify the delegating nurse immediately and explain the specific, objective reason for your refusal (e.g., "I have not yet been trained on how to use this specific mechanical lift model, so I cannot perform this transfer safely alone"). Never ignore the request or walk away without communicating.