OAR 851-045-0065: Standards of Practice for the LPN and the RN

(1) Standards related to the licensee’s responsibility for self-regulation in the practice of nursing. The licensee must: (a) Practice: (A) Within the laws and rules governing the practice of nursing applicable to one’s license type; (B) In adherence with accepted and prevailing professional nursing practice standards; (C) Consistent with current and evolving nursing science, other sciences, the humanities; and (D) Within one’s context of care. (b) Establish, communicate, and maintain professional boundaries; (c) Demonstrate honesty, integrity and professionalism in the practice of nursing; (d) Accept accountability for one’s decisions and actions; (e) Maintain documented evidence of current competence relevant to: (A) One’s nursing practice role; and, (B) Activities and interventions performed in one’s practice role. (f) Integrate ethics in all aspects of the practice of nursing; (g) Promote and advocate for a practice setting that is conducive to health and safety; (h) Identify safety and environmental concerns, take action to address concerns identified; and report as needed; (i) Accept responsibility for notifying one’s employer of an ethical objection to the provision of a specific nursing activity, intervention, or role; (j) Remove oneself from practice when unable to practice with professional skill and safety; (k) Ensure unsafe nursing practice is addressed immediately; (l) Report one’s knowledge of a licensee whose practice of nursing is believed to not meet the standards set in these rules to the person in the practice setting who has authority to undertake corrective action; and (m) Ensure unsafe nursing practice and practice conditions are reported to the appropriate regulatory agency. (2) Standards related to individual scope of practice. The licensee: (a) Must only accept an assignment that the licensee knows is within their individual scope of practice; and (b) May not perform an activity, intervention or role until the licensee has determined that the activity, intervention or role is within their individual scope of practice. An activity, intervention or role is within the licensee’s individual scope of practice only if all the following criteria are met: (A) The activity, intervention or role is not prohibited by Oregon’s Nurse Practice Act (NPA) or any other applicable law, rule, regulation or accreditation standard; (B) Performing the activity, intervention or role, is consistent with professional nursing standards, evidence-based nursing, and other health care literature; (C) The practice setting has policies and procedures in place to support the licensee’s performance of the activity, intervention or role; (D) The licensee has completed the education necessary to safely perform the activity, intervention or role; (E) The licensee has documented evidence of their current competence to safely perform the activity, intervention or role; (F) The licensee has the appropriate resources to perform the activity, intervention or role in the practice setting; (G) A reasonable and prudent nurse would perform the activity, intervention or role in this setting; and (H) The licensee is prepared to accept accountability for the activity, intervention, or role, and any related outcomes. (3) Standards related to the licensee’s responsibility for disclosure of nursing license type and practice role. The licensee shall disclose their license type and practice role to the client unless the disclosure creates a safety or health risk for either the nurse or the client. (4) Standards related to the licensee’s responsibility regarding the use of informatics and technologies in the practice of nursing. The licensee must: (a) Establish and maintain the competency necessary to properly use informatics and technologies of the practice setting; (b) Advocate for the use of informatics and technologies that are compatible with the safety, dignity, and rights of the client; and, (c) Adhere to accepted and prevailing standards and guidelines on the use of telecommunications technologies in the practice of nursing. (5) Standards related to the licensee’s responsibility for documentation of the practice of nursing. The licensee must document their practice of nursing: (a) In a timely, accurate, thorough, and clear manner; (b) Consistent with the context of care; and (c) Using one’s name of record. (6) Standards related to the licensee’s responsibility for client advocacy. The licensee must: (a) Recognize and respect the cultural values, beliefs, and social practices of the client. (b) Advocate for the client’s right to receive nursing services and other services that are respectful of the client’s needs, choices and dignity. This includes: (A) Communicating client choices, concerns and needs to other members of the practice team; and (B) Promoting safe client hand offs and care transitions. (c) Intervene on behalf of the client to identify changes in health status, to protect, promote and optimize health. (d) Advocate for the client’s right to receive appropriate and accurate information. (e) Protect the client’s right to make informed decisions. This includes the client’s right: (A) To decline or to consent to an intervention, medication or treatment; and, (B) To decline or to consent to participation in research. (f) Respect client decisions without bias. (g) Protect confidential client information. This includes the protection of client information that is: (A) Communicated by any method; (B) Transmitted through use of telecommunications technology; and (C) Stored in an electronic or hard copy format. (7) Standards related to the licensee’s responsibility for collaboration with the practice team. The licensee must: (a) Function as a member of the practice team. (b) Demonstrate a knowledge of practice team members’ roles. (c) Communicate with practice team members regarding the plan of care. (d) Demonstrate cultural responsiveness in the practice of nursing. (e) As appropriate to the context of care, collaborate in the development, implementation and evaluation of combined plans of care. (8) Standards related to the licensee’s responsibility for leadership and quality of practice. The licensee must: (a) Demonstrate respect in interactions with practice team members. (b) Interpret and evaluate policies, protocols, and guidelines that are pertinent to the practice of nursing, nursing services, and to health services delivery: (A) Ensure policies, procedures, and guidelines pertinent to the practice of nursing are consistent with the laws and rules of Oregon’s NPA. (B) Take action to address any policy, protocol, or guideline that is not consistent with the laws and rules of Oregon’s NPA; and, (C) Take action to address any policy, protocol or guideline that jeopardizes client health and safety. (c) Participate in quality improvement initiatives and activities within the practice setting. (d) Participate in the mentoring and precepting of nursing and nursing assistant students, new licensees, nursing colleagues, and other members of the practice team. (9) Standards related to the licensee’s responsibility in the acceptance and execution of medical orders. (a) Per ORS 678.010(9), the practice of nursing includes the authority to execute medical orders. (b) The licensee may accept and implement orders from any of the health care providers licensed and authorized by Oregon statute to independently diagnose and treat: (A) Clinical nurse specialist (CNS) licensed under ORS Chapter 678; (B) Certified registered nurse anesthetist (CRNA) licensed under ORS Chapter 678; (C) Nurse practitioner (NP) licensed under ORS Chapter 678; (D) Medical doctor (MD) licensed under ORS Chapter 677; (E) Doctor of osteopathic medicine (DO) licensed under ORS Chapter 677; (F) Doctor of podiatric medicine licensed under ORS Chapter 677; (G) Dentist licensed under Chapter ORS 679; (H) Naturopathic physician licensed under ORS Chapter 685; (I) Optometrist licensed under ORS Chapter 683; (J) Doctor of chiropractic licensed under ORS Chapter 684; (K) MD volunteer emeritus license licensed under ORS Chapter 677; (L) DO volunteer emeritus license licensed under ORS Chapter 677; and (M) Physician associate licensed under ORS Chapter 677. (c) Prior to the execution of a medical order, the licensee must determine that the medical order is: (A) Within the prescriber’s scope of practice; (B) Clear and complete; (C) Safe for the client; and (D) Consistent with the prescriber’s plan for the client’s care. (d) The licensee who determines that subsection (c)(A) through (D) is not met, must: (A) Decline to execute the medical order; and (B) Contact the prescriber or the prescriber’s designee to discuss the situation and arrive at a mutual decision on how to move forward. (10) Standards related to the licensee’s responsibility in the acceptance and implementation of recommendations for client care from a health care professional authorized to practice in Oregon: (a) The licensee may accept and implement recommendations for care from the following health care professionals licensed in Oregon: (A) Acupuncturist licensed under ORS Chapter 677; (B) Dietitian licensed under ORS Chapter 691; (C) Occupational therapist licensed under ORS Chapter 675; (D) Physical therapist licensed under ORS Chapter 688; (E) Pharmacist licensed under ORS Chapter 689; (F) Psychologist licensed under ORS Chapter 675; (G) Registered nurse licensed under ORS Chapter 678; (H) Respiratory therapist licensed under ORS Chapter 688; (I) Social worker licensed under ORS Chapter 675; and (J) Speech therapist licensed under ORS Chapter 681. (b) Prior to implementation of a recommendation, the licensee must: (A) Have knowledge that the recommendation is within the health care professional’s scope of practice; (B) Determine the recommendation to be: (i) Clear and complete; (ii) Safe for the client; and (iii) Consistent with the plan of care for the client; (c) The licensee who determines that subsection (b)(A) or (B) are not met, must decline implementation of the recommendation and, as appropriate to the context of care, discuss with practice team members.