OAR 851-045-0050: Standards Related to LPN Scope in the Practice of Nursing

(1) The LPN’s practice of practical nursing must occur at the clinical direction of a plan of care developed by an RN, or at the clinical direction of a treatment plan developed by a health care provider. (2) The LPN’s clinically directed practice of practical nursing may occur in a variety of roles that can include: (a) Provision of direct care; (b) Participation in the development and implementation of health care policy; (c) Participation in nursing research; and (d) Participation in teaching health care professionals and prospective health care professionals. (3) The LPN’s engagement in the practice of practical nursing must occur through the following actions: (a) Perform a focused assessment of the client that recognizes the client’s priority condition at the time of the interaction; (b) Develop a focused plan of care that identifies prioritized interventions from the plan providing clinical direction of the LPN's practice; (c) Implement prioritized focused plan of care interventions; (d) Evaluate client’s: (A) Response(s) to focused plan of care interventions; and (B) Progress toward expected outcomes as identified in the plan providing clinical direction of the LPN's practice; (e) Communicate with the RN or health care provider whose plan is providing clinical direction: (A) The client’s response to focused interventions and progress toward expected outcomes; and (B) Data pertinent to the client which falls outside of the plan of care or treatment plan. (4) Limitations on scope in the practice of nursing for the LPN. (a) The LPN cannot conduct a focused assessment or generate a focused plan of care outside of the plan providing clinical direction. (b) For a situation presenting outside of the parameters of plan providing clinical direction, the LPN is responsible to collect client data, communicate data to, and seek direction from, the RN or health care provider whose plan is providing clinical direction. (5) The LPN may assign focused plan of care interventions to a practice team member per the context of care. (a) The LPN may assign: (A) To an LPN, work the LPN is authorized by license and organizational position description to perform in the setting. (B) To a UAP, work the UAP is authorized by organizational position description to perform in the setting. (C) To a CNA: (i) OAR 851-063-0030 authorized duties the CNA is authorized by organizational position description to perform in the setting. (ii) An OAR 851-063-0035 additional authorized duty when the CNA has been validated by an RN representing the employment site as competent in the performance of the additional duty. (D) To a CMA, OAR 851-063-0070 authorized duties the CMA is authorized by organizational position description to perform in the setting. (b) Prior to assigning interventions, the LPN must know the duties, activities or interventions the recipient is authorized to perform in the setting. (c) The LPN who assigns must: (A) Assign based on their focused plan of care; (B) Provide supervision of the assigned work in a manner consistent with the context of care; and (C) Revise the distribution of focused plan of care interventions as indicated by: (i) Client safety; and (ii) Discussion with the RN or health care provider whose plan is providing clinical direction.