Standards And Authorized Duties For The Certified Nursing Assistant And Certified Medication Aide

Link to law: http://arcweb.sos.state.or.us/pages/rules/oars_800/oar_851/851_063.html
Published: 2015

The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

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OREGON STATE BOARD OF NURSING

 

DIVISION 63
STANDARDS AND AUTHORIZED DUTIES FOR THE CERTIFIED NURSING ASSISTANT

AND CERTIFIED MEDICATION AIDE

851-063-0010
Purpose of Authorized Duties and Standards
(1) To identify the range of authorized
duties which may be performed by the certified nursing assistant (CNA) and certified
medication aide (CMA) in the process of assisting a licensed nurse;
(2) To serve as a guide to the
Board to evaluate safe and effective assistance in nursing care; and
(3) To establish standards and
conduct unbecoming for CNAs and CMAs.
Stat. Auth.: ORS 678.440, 678.442 &
678.444
Stats. Implemented: ORS 678.440,
678.442 & 678.444
Hist.: BN 6-1999, f. &
cert. ef. 7-8-99; BN 3-2004, f. 1-29-04, cert. ef. 2-12-04; BN 7-2014, f. 12-3-14,
cert. ef. 1-1-15
851-063-0020
Definitions
(1) “Activities of Daily Living”
means self-care activities which a person performs independently, when able, to
sustain personal needs or to participate in society.
(2) "Assessment" means the systematic
collection of data about a person for the purpose of judging that person's health/illness
status and actual or potential health care needs.
(3) “Certified Medication
Aide (CMA)” means a certified nursing assistant who has successfully completed
additional training in administration of non-injectable medications, holds current
Oregon CMA certification, and performs CMA authorized duties under the supervision
of a licensed nurse.
(4) “Certified Nursing
Assistant (CNA)” means an individual who holds current Oregon CNA certification;
whose name is listed on the CNA Registry; and through their position as a CNA assists
a licensed nurse in the provision of nursing care. The phrase certified nursing
assistant and the acronym CNA are generic and may refer to a CNA 1, a CNA 2 or all
CNAs.
(5) "Certified Nursing Assistant
1 (CNA 1)" means an individual who holds current Oregon CNA certification and who
assists a licensed nurse in the provision of nursing care.
(6) "Certified Nursing Assistant
2 (CNA 2)" means a CNA 1 who has successfully completed additional training and
competency validation in accordance with these rules.
(7) “Client” means
the individual who is provided care by the CNA or CMA including a person who may
be referred to as “patient” or “resident” in some settings.
(8) "CNA Registry" means the
listing of Oregon certified nursing assistants maintained by the Board.
(9) “Community-Based Care
(CBC) Setting” means a setting that does not exist for the purpose of providing
medical and nursing service but where nursing service can be provided incidental
to the setting. This is a setting where federal or state regulations do not require
the presence of nursing personnel 24-hours a day. These settings include those
identified in ORS 678.150(8).
(10) “Context of Care”
means the cumulative factors which affect the manner in which nursing service is
rendered. Factors include, but are not limited to, nursing role, job description,
practice setting, organizational policy, regulations governing the setting, demographics
of the population served, the surrounding environment, current community and industry
standards, and the ability of the person to direct and to engage in their own care.
(11) "Hand Hygiene" means those
measures recommended by the Centers for Disease Control (CDC) and used by the CNA
or CMA to protect themselves and others from infection. Hand hygiene includes handwashing
with soap and water, use of alcohol-based hand rubs and proper use of disposable
gloves.
(12) “Health Care Team”
means the team of people working with the client to achieve the client’s
identified outcomes. The composition of the health care team is appropriate to
the context of care and the practice setting.
(13) “Licensed Independent
Practitioner (LIP)” means a licensed health care professional who is authorized
by Oregon statute to independently diagnose and treat.
(14) “Licensed Nurse”
means the licensed practical nurse (LPN) and registered nurse (RN) licensed under
ORS 678.
(15) "Monitoring" means that
a registered nurse assesses and plans for the care of the client, assigns or delegates
duties to the nursing assistant according to the nursing care plan, and evaluates
client outcomes as an indicator of CNA or CMA competency.
(16) “Nursing Assistant”
means a person who assists licensed nursing personnel in the provision of nursing
care per ORS 678.440(5).
(17) "Periodic Assessment and
Evaluation" means that the RN, at regular intervals, assesses and evaluates the
condition of the client and reviews, and modifies if necessary, the procedures and
directions established for the provision of care. The interval shall be determined
by the RN based on the condition of the client and the nature of the nursing care
tasks being performed.
(18) “Person-centered
Care” means to collaborate with the client regarding their health in a manner
that is considerate and respectful of the client’s expressed wishes, choices,
and health goals.
(19) “Plan of Care”
means the licensed nurse-generated document that identifies desired outcomes and
the nursing activities selected to attain the desired outcomes.
(20) “Professional Boundaries”
means the relationship limitations that promote professional and therapeutic interactions.
Professional boundaries allow for safe and therapeutic interactions between the
nursing assistant and the person, the nursing assistant and colleagues, the nursing
assistant and society.
(21) "PRN" means as necessary.
(22) “Site” means
the specific geographic location of the facility or institution.
(23) "Stable/Predictable Condition"
means a situation where the client’s health and behavioral state is known,
is not characterized by rapid changes, and does not require frequent reassessment
and evaluation. This includes the client whose deteriorating condition is predictable
such as the client receiving hospice services.
(24) “Supervision”
means that the licensed nurse regularly observes, provides guidance, direction,
oversight, and evaluation of the skills and abilities of the CNA or CMA to perform
authorized duties.
Stat. Auth.: ORS 678.440, 678.442 &
678.444
Stats. Implemented: ORS 678.440,
678.442 & 678.444
Hist.: BN 6-1999, f. &
cert. ef. 7-8-99; BN 3-2004, f. 1-29-04, cert. ef. 2-12-04; BN 11-2010, f. &
cert. ef. 6-25-10; BN 7-2014, f. 12-3-14, cert. ef. 1-1-15
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 communication
and interpersonal skills:
(A) Answering and placing call
signals;
(B) Coaching and mentoring other
nursing assistants;
(C) Communicating with clients
and co-workers;
(D) Maintaining confidentiality;
(E) Reporting abuse, mistreatment,
and neglect; and
(F) Utilizing de-escalation
techniques.
(b) Tasks associated with person-centered
care.
(c) Tasks associated with infection
control and Standard or Transmission Based Precautions:
(A) Assisting with coughing
and deep breathing;
(B) Bedmaking and handling of
linen;
(C) Caring for the client’s
environment;
(D) Handling and disposal of
hazardous wastes;
(E) Handling of contaminated
materials;
(F) Handwashing and hand hygiene;
(G) Implementing precautions
associated with communicable and infectious diseases;
(H) Implementing neutropenic
precautions;
(I) Maintaining client cleanliness
and grooming; and
(J) Utilizing personal protective
equipment.
(d) Tasks associated with safety
and emergency procedures:
(A) Implementing bleeding, cervical,
hip, and sternal precautions;
(B) Moving and transferring
clients;
(C) Transporting clients in
wheelchairs and specialized chairs;
(D) Turning and positioning
clients;
(E) Using lifts and safe client
handling devices;
(F) Turning oxygen on and off
or transferring oxygen between wall and tank at pre-established flow rate for stable
clients;
(G) Managing hazards in the
workplace;
(H) Preventing burns;
(I) Preventing falls; and
(J) Performing cardiopulmonary
resuscitation.
(e) 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 clients for
nutritional and fluid intake;
(iv) Preventing choking and
aspiration;
(v) Preventing dehydration;
and
(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) Administering enemas;
(iii) Assisting with the use
of bedpan and urinal;
(iv) Assisting with toileting;
(v) Collecting specimens; sputum,
stool, and urine including clean catch urine specimens;
(vi) Providing catheter care
including the application of and removal of external urinary catheters;
(vii) 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
(viii) Providing perineal and
incontinence care.
(C) Assisting with personal
care:
(i) Bathing;
(ii) Providing comfort care;
(iii) Dressing and undressing;
(iv) Grooming to include: application
and care of dentures, eye glasses, and hearing aids.
(v) Nail care for fingernails
and toenails of persons with uncompromised circulation;
(vi) Oral hygiene;
(vii) Personal care considerations
for persons who have tubes or special equipment;
(viii) Shampooing and caring
for hair;
(ix) Shaving; and
(x) Skin Care to include: application
of non-prescription pediculicides; application of topical barrier creams and ointments
for skin care; maintenance of skin integrity; prevention of pressure, friction,
and shearing; and use of anti-pressure devices;
(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 eating, grooming and other personal care tasks;
(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.
(f) Tasks associated with collaboration
with health care team.
(g) 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, lower
leg, thigh, 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.
(h) Tasks associated with documentation.
(i) Tasks associated with end
of life care.
(2) The CNA may, as an unlicensed
person, provide care as delegated or assigned by a nurse in a CBC 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 CBC 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; and
(c) When working in Assisted
Living Facilities, as permitted under OAR Chapter 411, division 54.
(6) 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.
Stat. Auth: ORS 678.440, ORS 678.442,
678.444
Stats. Implemented: ORS 678.440,
ORS 678.442, 678.444
Hist.: 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. 1-1-15
851-063-0035
Authorized Duties and Standards for
Certified Nursing Assistant 2 (CNA 2)
(1) Under the supervision and at the direction
of a licensed nurse, a CNA 2 may provide care and assist clients with the following:
(a) Tasks associated with communication
and interpersonal skills including:
(A) Coaching and mentoring peers;
and
(B) Crisis intervention.
(b) Tasks associated with observation
and reporting:
(A) Observing and collecting
pain responses; and
(B) Relieving pain:
(i) Assisting with complementary
therapies such as 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.
(C) Understanding the concept
of Situation, Background, Assessment (Observation), Recommendation, and Read-back/Review
(SBARR).
(c) Tasks associated with person-centered
care:
(A) Embracing the friendship
philosophy of care;
(B) Positively impacting the
environment for person with dementia; and
(C) Cultural responsiveness.
(d) Tasks associated with technical
skills:
(A) Adjusting oxygen rate of
flow;
(B) Applying and removing delivery
device and turning continuous positive airway pressure (CPAP) or bilevel positive
airway (BiPAP) devices on and off;
(C) Bladder scanning;
(D) Clipping hair in preparation
for surgical procedure;
(E) Discontinuing saline lock;
(F) Fingerstick capillary blood
testing;
(G) Interrupting and re-establishing
nasogastric (NG) suction;
(H) Obtaining nasal or rectal
swab;
(I) Placing electrodes/leads
and run electrocardiogram (EKG);
(J) Placing electrodes/leads
for telemetry;
(K) Removing casts in non-emergent
situations;
(L) Screening newborn hearing;
(M) Setting up traction equipment;
(N) Suctioning nose or oral
pharynx;
(O) Testing stool for occult
blood; and
(P) Urine dip stick testing.
(e) Tasks associated with infection
prevention and control:
(A) Establishing and maintaining
a sterile field;
(B) Obtaining urine specimen
from port of catheter;
(C) Discontinuing Foley catheters;
(D) Measuring, recording and
emptying output from drainage devices and closed drainage systems; and
(E) Changing wound vac canisters.
(f) Tasks associated with safety:
(A) Implementing preventive/protective
strategies; and
(B) Minimizing safety risks.
(g) Tasks associated with promoting
nutrition and hydration.
(A) Adding fluid to established
post pyloric, jejunostomy and gastrostomy tube feedings;
(B) Changing established tube
feeding bags; and
(C) Pausing and resuming established
post pyloric, jejunostomy and gastrostomy tube feedings to provide personal care;
(h) Tasks associated with promoting
functional abilities:
(A) Assisting persons in and
out of continuous passive motion (CPM) machines;
(B) Performing range of motion
on persons with complex medical problems: fragile skin, at risk for pathological
fractures, spascity, and contractures;
(C) Therapeutic positioning
in a variety of situations and considering a person’s condition including
but not limited to bridging and proning; and
(D) Use of adaptive, assistive
and therapeutic equipment:
(i) Ankle and foot orthotics;
(ii) Braces;
(iii) Established traction equipment:
remove and re-apply;
(iv) Foot lifter; and
(v) Splints.
(i) Tasks associated with end-of-life
care:
(A) Comfort care; and
(B) Removal of non-surgically
inserted tubes and devices from post-mortem persons.
(j) Tasks associated with documentation.
(2) Standards of Care for CNA
2. In the process of client care the CNA 2 shall consistently apply standards set
for CNA 1s and:
(a) Establish competency as
a CNA 2;
(b) Maintain competency as a
CNA 2;
(c) Perform only authorized
duties for which the CNA 2 has established competency.
Stat. Auth.: ORS 678.440 & 678.442
Stats. Implemented: ORS 678.440
& 678.442
Hist.: BN10-2007, f. &
cert. ef. 10-1-07; BN 2-2009, f. & cert. ef. 5-15-09; BN 11-2009, f. & cert.
ef. 12-17-09; BN 11-2010, f. & cert. ef. 6-25-10; BN 7-2014, f. 12-3-14, cert.
ef. 1-1-15
851-063-0070
Authorized Duties and Standards for
Certified Medication Aide (CMA)
(1) Under supervision by a licensed nurse,
a CMA may administer:
(a) Oral, sublingual and buccal
medications;
(b) Eye medications with the
exception of eye medications to new post-operative eye clients;
(c) Ear medications;
(d) Nasal medications;
(e) Rectal medications;
(f) Vaginal medications;
(g) Skin ointments, topical
medications including patches and transdermal medications;
(h) Medications by gastrostomy
and jejunostomy tubes;
(i) Premeasured medication delivered
by Aerosol/Nebulizer; and
(j) Medications delivered by
metered hand-held inhalers.
(2) Administration of PRN Medications.
A CMA may administer PRN medications (including controlled substances) to stable
clients according to physician's or nurse practitioner's orders in the following
circumstances:
(a) In response to specific
client requests:
(A) Client request must be reported
to licensed nurse; and
(B) Client response must be
reported to licensed nurse.
(b) At the direction of the
licensed nurse, when:
(A) A licensed nurse assesses
the patient prior to administration of the PRN medications; and
(B) A licensed nurse assesses
the patient following the administration of the PRN medication.
(3) A CMA may:
(a) Administer regularly scheduled
controlled substances;
(b) Jointly witness wasted controlled
substances with a licensed nurse;
(c) Count controlled substances
with a licensed nurse or another CMA;
(d) Perform capillary blood
glucose (CBG);
(e) Turn oxygen on and off at
predetermined, established flow rate;
(f) Add fluid to established
jejunostomy or gastrostomy tube feedings and change established tube feeding bags;
and
(g) Accept verbal or telephone
orders for medication from a licensed health care professional who is authorized
to independently diagnose and treat. Such acceptance can occur only when the CMA
is working in the following settings under the specified administrative rules:
(A) Adult Foster Homes, as permitted
under OAR Chapter 411, division 050;
(B) Residential Care Facilities,
as permitted under OAR Chapter 411, division 054; and
(C) Assisted Living Facilities,
as permitted under OAR Chapter 411, division 054.
(4) A CMA may not administer
medications by the following routes:
(a) Central lines;
(b) Colostomy;
(c) Intramuscular;
(d) Intrathecal;
(e) Intravenous;
(f) Nasogastric;
(g) Nonmetered inhaler;
(h) Subcutaneous;
(i) Intradermal;
(j) Urethral;
(k) Epidural; or
(l) Endotracheal.
(5) A CMA may not administer
the following kinds of medications:
(a) Barium and other diagnostic
contrast media; or
(b) Chemotherapeutic agents
except oral maintenance chemotherapy.
(6) A CMA may not administer
medication by, nor assume responsibility for, medication pumps, including client
controlled analgesia.
(7) A CMA may not act as a clinical
teaching associate to a student in a medication aide training program.
(8) In a community-based care
setting, a CMA may, as an unlicensed person, provide care as delegated or assigned
by a licensed nurse.
(9) Standards of Care for a
certified medication assistant. In the process of client care a CMA shall consistently
apply standards set for CNAs and:
(a) Establish competency as
a CMA;
(b) Maintain competency as a
CMA;
(c) Perform within Authorized
Duties;
(d) Follow written instructions
of a LIP authorized to independently diagnose and treat as transcribed in the medication
administration record (MAR); and
(e) Accurately record on the
MAR medications administered, medications withheld or refused and the reason why
a medication was withheld or refused.
Stat. Auth.: ORS 678.440, 678.442, 678.444
& 678.445
Stats. Implemented: ORS 678.440,
678.442 & 678.444
Hist.: BN 6-1999, f. &
cert. ef. 7-8-99; BN 3-2004, f. 1-29-04, cert. ef. 2-12-04; BN 7-2014, f. 12-3-14,
cert. ef. 1-1-15
851-063-0080
Causes for Denial, Reprimand, Suspension, Probation or Revocation of CNA Certificate
Under the contested case procedure in ORS
183.310 to 183.550 the Board may impose a range of disciplinary sanctions including,
but not limited to deny, reprimand, suspend, place on probation or revoke the certificate
to perform duties as a CNA for the following causes:
(1) Conviction of the nursing
assistant of a crime where such crime bears demonstrable relationship to the duties
of a nursing assistant;
(2) Any willful fraud or misrepresentation
in applying for or procuring a certificate or renewal thereof;
(3) Use of any controlled substance
or intoxicating liquor to an extent or in a manner injurious to the certificate
holder or others or to an extent that such use impairs the ability to conduct safely
the duties of a nursing assistant;
(4) Violation of any provision
of ORS 678.010 to 678.445 or rules adopted thereunder;
(5) Physical or mental condition
that makes the certificate holder unable to perform the duties of a nursing assistant;
or
(6) Conduct unbecoming a nursing
assistant.
Stat. Auth.: ORS 678.442
Stats. Implemented: ORS 678.442
Hist.: BN 6-1999, f. &
cert. ef. 7-8-99; BN 3-2004, f. 1-29-04, cert. ef. 2-12-04; BN 7-2014, f. 12-3-14,
cert. ef. 1-1-15
851-063-0090
Conduct Unbecoming a Nursing Assistant
A CNA, regardless of job location, responsibilities,
or use of the title “CNA," whose behavior fails to conform to the legal standard
and accepted standards of the nursing assistant profession, or who may adversely
affect the health, safety or welfare of the public, may be found guilty of conduct
unbecoming a nursing assistant. Such conduct includes but is not limited to:
(1) Conduct, regardless of setting,
related to general fitness to perform nursing assistant authorized duties:
(a) Demonstrated incidents of
violent, abusive, neglectful or reckless behavior; or
(b) Demonstrated incidents of
dishonesty, misrepresentation, or fraud.
(2) Conduct related to achieving
and maintaining clinical competency:
(a) Failing to conform to the
essential standards of acceptable and prevailing nursing assistant performance of
duties. Actual injury need not be established;
(b) Performing acts beyond the
authorized duties except for as allowed for in these rules;
(c) Assuming duties and responsibilities
for a person’s care without documented preparation for the duties and responsibilities
and when competency has not been established and maintained; or
(d) Performing new nursing assistant
techniques or procedures without documented education specific to the technique
or procedure and supervised clinical experience to establish competency.
(3) Conduct related to client
safety and integrity:
(a) Failing to take action to
preserve or promote a person’s safety based on nursing assistant knowledge,
skills, and abilities;
(b) Failing to implement the
plan of care developed by the registered nurse;
(c) Failing to report changes
in a person’s status from the last assessment made by the registered nurse;
(d) Jeopardizing the safety
of a person under the CNA’s care;
(e) Leaving or failing to complete
a nursing assistant assignment without properly notifying appropriate supervisory
personnel;
(f) Failing to report through
proper channels information or facts known regarding the incompetent, unethical,
unsafe, or illegal practice of any health care provider;
(g) Failing to respect the dignity
and rights of the person receiving nursing services, regardless of social or economic
status, age, race, religion, sex, sexual orientation, national origin, nature of
health needs, other physical attributes, or disability;
(h) Failing to report actual
or suspected incidents of abuse, neglect, or mistreatment;
(i) Engaging in or attempting
to engage in sexual misconduct with a client in any setting;
(j) Engaging in sexual misconduct
in the workplace; or
(k) Failing to maintain professional
boundaries.
(4) Conduct related to communication:
(a) Failing to accurately document
nursing assistant activities and tasks;
(b) Failing to document nursing
assistant activities and task implementation in a timely manner. This includes failing
to document a late entry within a reasonable time period;
(c) Entering inaccurate, incomplete,
falsified or altered documentation into a health record or into agency records.
This includes but is not limited to:
(A) Documenting the provision
of services that were not provided;
(B) Failing to document information
pertinent to the person’s care;
(C) Filling in someone else’s
charting omissions, or signing someone else’s name;
(D) Falsifying data;
(E) Altering or changing words
or characters within an existing document to mislead the reader; or
(F) Adding documentation to
a health record or agency record without recording the date and time of the event
being recorded. This includes late entry documentation that does not demonstrate
the date and time of the initial event being documented, the date and time the late
entry is being placed into the record, and the signature of the nursing assistant
placing the documentation into the record.
(d) Destroying an agency record,
a person’s health record, or any document prior to the destruction date indicated
for the type of recorded data or document;
(e) Directing another individual
to falsify, alter or destroy an agency record, a person’s health record, or
any document prior to the destruction date indicated for type of recorded data or
type of document;
(f) Failing to communicate information
regarding a person’s status to the supervising nurse or other appropriate
member of the healthcare team in an on-going and timely manner and as appropriate
to the context of care; or
(g) Failing to communicate information
regarding the person’s status to individuals who are authorized to receive
the information and need to know.
(5) Conduct related to interactions
with the client’s family:
(a) Failing to respect the person’s
family and the person’s relationship with their family;
(b) Using one’s title/position
as a nursing assistant to exploit a person’s family for personal gain or
for any other reason;
(c) Stealing money, property,
services or supplies from the family;
(d) Soliciting or borrowing
money, materials or property from the family; or
(e) Engaging in unacceptable
behavior towards or in the presence of the client’s family. Such behavior
includes but is not limited to using derogatory names, derogatory or threatening
gestures, or profane language.
(6) Conduct related to relationships
with co-workers and health care team members:
(a) Engaging in violent, abusive
or threatening behavior towards a co-worker; or
(b) Engaging in violent, abusive
or threatening behavior that relates to the performance of safe care to a person.
(7) Conduct related to safe
performance of authorized duties:
(a) Performing authorized duties
when unable/unfit to perform nursing assistant activities or tasks due to:
(A) Physical impairment as evidenced
by documented deterioration of functioning in the work setting or by the assessment
of a LIP qualified to diagnose physical condition/status; or
(B) Psychological or mental
impairment as evidenced by documented deterioration of functioning in the work setting
or by the assessment of a LIP qualified to diagnose mental condition/status.
(b) Performing authorized duties
when physical or mental ability to perform is impaired by use of a prescription
or non-prescription drug, alcohol, or a mind-altering substance; or
(c) Using a prescription or
non-prescription drug, alcohol, or a mind-altering substance to an extent or in
a manner dangerous or injurious to the nursing assistant or others, or to an extent
that such use impairs the ability to perform the authorized duties safely.
(8) Conduct related to other
federal or state statutes/rule violations:
(a) Aiding, abetting or assisting
an individual to violate or circumvent any law, rule or regulation intended to guide
the conduct of the nursing assistant or other healthcare provider;
(b) Violating the rights of
privacy, confidentiality of information, or knowledge concerning the person, unless
required by law to disclose such information;
(c) Discriminating against a
person on the basis of age, race, religion, gender, sexual preference, national
origin or disability;
(d) Abusing a person;
(e) Neglecting a person;
(f) Failing to report actual
or suspected incidents of abuse through the proper channels in the workplace and
to the appropriate state agencies;
(g) Failing to report actual
or suspected incidents of abuse to the appropriate state agency;
(h) Engaging in other unacceptable
behavior towards or in the presence of the client. Such behavior includes but is
not limited to using derogatory names, derogatory or threatening gestures, or profane
language;
(i) Possessing, obtaining, attempting
to obtain, furnishing or administering prescription or controlled drugs to any person,
including self, except as directed by a LIP authorized by law to prescribe drugs;
(j) Unauthorized removal or
attempted removal of any drugs, supplies, property, or money from any person or
setting;
(k) Unauthorized removal of
records, client information, or facility property from the workplace;
(l) Using one’s role or
title as a nursing assistant to solicit or borrow money, materials, property or
possessions from a client or the client’s family for personal gain or sale;
(m) Violating a person’s
rights of privacy and confidentiality of information by accessing information without
proper authorization to do so or without a demonstrated need to know;
(n) Failure to report to the
Board the CNA’s arrest for a felony crime within ten days of the arrest; or
(o) Failure to report to the
Board the CNA’s conviction of a misdemeanor or a felony crime within ten days
of the conviction.
(9) Conduct related to certification
violations:
(a) Resorting to fraud, misrepresentation,
or deceit during the application process for licensure or certification, while taking
the examination for licensure or certification, while obtaining initial licensure
or certification or renewal of licensure or certification;
(b) Functioning as a certified
nursing assistant without current certification as a nursing assistant;
(c) Functioning as a certified
medication assistant without current certification as a medication assistant;
(d) Representing oneself as
a CNA without current, valid CNA certification;
(e) Allowing another person
to use one's nursing assistant certificate for any purpose;
(f) Using another licensee’s
nursing license or nursing assistant certificate for any purpose;
(g) Impersonating any applicant
or acting as a proxy for the applicant in any nursing assistant examination;
(h) Disclosing contents of the
competency examination or soliciting, accepting or compiling information regarding
the contents of the examination before, during or after its administration; or
(i) Altering a certificate of
completion of training or nursing assistant certification issued by the Board.
(10) Conduct related to the
certification holder’s relationship with the Board:
(a) Failing to fully cooperate
with the Board during the course of an investigation, including but not limited
to waiver of confidentiality, except attorney-client privilege.
(b) Failing to answer truthfully
and completely any question asked by the Board on an application for certification,
renewal of certification, during the course of an investigation, or any other question
asked by the Board;
(c) Failing to provide the Board
with any documents requested by the Board; or
(d) Violating the terms and
conditions of a Board order.
Stat. Auth.: ORS 678.442
Stats. Implemented: ORS 678.442
Hist.: BN 6-1999, f. &
cert. ef. 7-8-99; BN 9-2002(Temp), f. & cert. ef. 3-5-02 thru 8-1-02; BN 16-2002,
f. & cert. ef. 7-17-02; BN 12-2009, f. & cert. ef. 12-17-09; BN 4-2010(Temp),
f. & cert. ef. 4-19-10 thru 10-15-10; BN 15-2010, f. & cert. ef. 9-30-10;
BN 7-2014, f. 12-3-14, cert. ef. 1-1-15
851-063-0100
Conduct Unbecoming a Certified Medication Aide
A certified medication aide is subject
to discipline as a CNA as described in these rules. In addition, a CMA is subject
to discipline for conduct unbecoming a medication aide. Such conduct includes but
is not limited to:
(1) Failing to administer medications
as ordered by a LIP;
(2) Failing to document medications
as administered, medications withheld or refused and the reason a medication was
withheld or refused.
(3) Altering or falsifying medication
administration record;
(4) Altering or falsifying CNA
or CMA certificate;
(5) Diverting drugs for use
by self or others;
(6) Accepting a verbal order
or telephone order for medication from a LIP, except as allowed in authorized duties;
(7) Performing acts beyond the
authorized duties for which the individual is certified;
(8) Working as a CMA without
CMA Certification;
(9) Performing client care tasks
other than authorized in these rules;
(10) Representing oneself as
a CMA without current CMA certification; or
(11) Failing to conform to the
standards and authorized duties in these rules.
Stat. Auth.: ORS 678.442
Stats. Implemented: ORS 678.442
Hist.: BN 6-1999, f. &
cert. ef. 7-8-99; BN 3-2004, f. 1-29-04, cert. ef. 2-12-04; BN 7-2014, f. 12-3-14,
cert. ef. 1-1-15
851-063-0110
Criminal Conviction History/Falsification
of Application — Denial of Certification — Grounds for Discipline
(1) The Board has determined that the following
crimes bear a demonstrable relationship to the role of a CNA and will issue a Notice
to Deny Certification to an applicant for certification, renewal of certification
or for reactivation of certification as a nursing assistant, following the provisions
of the Administrative Procedure Act in contested case hearings, to persons who have
been convicted as an adult, or found responsible except for mental illness, or adjudicated
as a juvenile for the following crimes as set forth in Oregon law or comparable
law in other jurisdictions:
(a) Aggravated Murder, as in
ORS 163.095 and 115;
(b) First Degree Manslaughter,
as in ORS 163.118;
(c) Second Degree Manslaughter,
as in ORS 163.125;
(d) First Degree Assault, as
in ORS 163.185;
(e) Second Degree Assault, as
in ORS 163.175;
(f) First Degree Criminal Mistreatment,
as in ORS 163.205;
(g) Second Degree Criminal Mistreatment,
as in ORS 163.200;
(h) First Degree Kidnapping,
as in ORS 163.235;
(i) First Degree Rape, as in
ORS 163.375;
(j) Second Degree Rape, as in
ORS 163.365;
(k) Third Degree Rape, as in
ORS 163.355;
(l) First Degree Sodomy, as
in ORS 163.405;
(m) Second Degree Sodomy, as
in ORS 163.395;
(n) Third Degree Sodomy, as
in ORS 163.385;
(o) First Degree Unlawful Sexual
Penetration, as in ORS 163.411;
(p) Second Degree Unlawful Sexual
Penetration, as in ORS 163.408;
(q) First Degree Sexual Abuse,
as in ORS 163.427;
(r) Second Degree Sexual Abuse,
as in ORS 163.425;
(s) Contributing to the Sexual
Delinquency of a Minor, as in ORS 163.435;
(t) Sexual Misconduct, as in
ORS 163.445;
(u) Child Abandonment, as in
ORS 163.535.
(2) Any individual who applies
for certification or renewal of certification as a nursing assistant or holds current
certification, who has a history of arrests and convictions over an extended period
of time, will be issued a Notice to Deny Certification following the provisions
of the Administrative Procedure Act in contested case hearings.
(3) All other applicants or
individuals with current nursing assistant certification, with conviction histories,
other than those listed above, including crimes which are drug and alcohol related,
will be considered on an individual basis.
(4) Any individual who applies
for certification as a nursing assistant or holds current certification, and supplies
false or incomplete information to the Board on an application for certification
regarding the individual's criminal conviction record, may be issued a Notice to
Deny Certification under the provisions of the Oregon Administrative Procedure Act
in contested case hearings.
Stat. Auth.: ORS 678.442
Stats. Implemented: ORS 678.442
Hist.: BN 6-1999, f. &
cert. ef. 7-8-99; BN 7-2014, f. 12-3-14, cert. ef. 1-1-15

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