CareNotes

Revised RN Delegation Process Rules Go into Effect August 1, 2023

On August 1, 2023, Board-approved revisions to Oregon Administrative Rules (OARs) Chapter 851 Division 047 Standards for Registered Nursing Delegation Process will go into effect. The revised Division 047 rules were adopted by the Board on June 22, 2023, through the public hearing process. This document discusses the application of the rules and provides an overview of the revisions.

Summary of the changes:

Applicability of OAR 851-047

RN delegation process rules hold applicability to the RN who practices in a community-based setting. As defined in Division 006 of the Nurse Practice Act (NPA), a community-based setting means a setting that does not exist for the expressed purpose of medical or nursing services delivery but where such services could be provided intermittently. Examples of settings that meet this definition include but are not limited to, private homes, foster homes, assisted living facilities, schools, and 24-hour residential care facilities. This means that if your practice of nursing occurs in a setting that exists for the purpose of providing medical services, providing nursing services, or both, the Division 047 rules do not apply to your RN practice.

About RN Delegation Process

The delegation process presents as an option for an RN in the implementation of their plan of care for a client who is unable to perform their own health-related procedure that has been ordered to treat or manage a chronic health condition.* The rules set forth the process for the RN to: Teach the client’s unregulated assistive person (UAP) care team member how to perform the client’s ordered health-related procedure (i.e. referred to as a nursing procedure when identified in the RN’s plan of care), competency validate the UAP’s performance of the procedure on the client, and then authorize that UAP to perform the procedure for the client for ongoing periods of time.

Where to Find the Rules

On August 1, 2023, the revised OAR 851-047 will be accessible via the Nurse Practice Act link located on the top menu bar of the Oregon State Board of Nursing home page.

Overview of Revisions

Standards Removed From Division 047

• Standards on teaching noninjectable medication administration and on teaching the performance of tasks for an anticipated emergency are no longer contained in Division 047. On August 1, 2022, standards for both registered nursing practice authorities were moved to Division 045 of the NPA and remain enacted.
• A standard that duplicated Oregon Revised Statutes (ORS) Chapter 678.036 that grants civil liability protection for the RN who delegates has been removed from the revised rules. The ORS 678.036 statute remains enacted and applicable to the RN who delegates.
• A standard that provided for an RN to rescind a UAP’s authorization to perform a nursing procedure for a client and then immediately assign the same procedure to the same UAP for the same client, has been removed.
• The prohibition of an RN delegating the performance of their client’s intramuscular injection to a UAP has been removed.

New Rule Numbers

The revised Division 047 rules present the delegation process standards under seven separate rule numbers for ease of reading.

0030 General Provisions: This rule number identifies general obligations or requirements of the RN whose nursing practice includes delegation process.

851-047-0045 RN Authorization of a UAP’s performance of a Nursing Procedure: This rule number identifies the process an RN is responsible to complete when authorizing a UAP’s performance of a nursing procedure for their client. The codified process remains consistent with the process codified in the previous delegation rules.

Within this new rule number, the standards on an RN’s responsibility for educating their UAP care team member on the client’s chronic condition and on the performance of the nursing procedure are expanded. This expansion includes the RN’s responsibility to include their written instructions for the performance of the nursing procedure on the client within their learning content.

Clarified within this new rule number is an RN’s responsibility to provide a one-on-one visit with the UAP and client to address questions the UAP and client may have, amend the written instructions as deemed appropriate, and directly observe and validate the UAP’s accurate performance of the nursing procedure.

Clarified in this new rule number is an RN’s responsibility to complete the above process steps prior to authorizing the UAP’s performance of the procedure for their client. The revised standards also specify data that must be evaluated by an RN whereby a clinical judgment can be made regarding the UAP’s authorization period for their performance of the procedure on the client.

This rule number contains new standards. The new standards identify an RN’s responsibility to:

• Instruct the UAP to utilize the RN’s instructions for the procedure’s performance each time they perform the nursing procedure for the client;
• Document a recommendation that identifies for the client’s health care team how the client might continue to receive their ordered procedure in the event the RN is no longer a member of the team, and the procedure remains ordered for the client;
• Update the plan of care to communicate that the performance of the client’s nursing procedure has been delegated to a UAP; and
• Continue to engage in the practice of nursing with their client pursuant to OAR 851-045.

851-047-0050 Ongoing RN Evaluation of the Safety of the Delegation: This rule number contains standards formerly known as periodic inspection, supervision, and re-evaluation standards. The revised standards identify an RN’s responsibility to provide ongoing evaluation of the safety of a delegation for their client following their authorization of a UAP care team member to perform their client’s nursing procedure.

The revised standards specify data that must be evaluated by an RN whereby a clinical judgment can be made on the safety of the client related to the RN’s decision to delegate and in the determination of the UAP’s authorization period for performance of the procedure on the client.

Under this new rule number are new standards. First is the responsibility of the RN to communicate the UAP’s authorization period for performance of the procedure on the client to other healthcare team members who need to know. The second is the responsibility of the RN to keep current their recommendation to the client’s health care team on how the client might continue to receive the procedure in the event the RN is no longer a member of the team.

0055 Limitations on the RN’s Delegation of the Administration of Medication by the Intravenous Route: This new rule number contains standards that identify the same limitations on the delegation of intravenously administered medication as codified in the previous rules. For example, only the RN who is an employee of a licensed home health agency, a licensed home infusion agency, or a licensed hospice agency may authorize a UAP to perform intravenous medication administration for their client.

0060 Rescinding the UAP’s Authorization to Perform a Nursing Procedure on a Client: Standards codified under this rule number identify an RN’s responsibility to end a UAP’s authorization to perform a nursing procedure for their client for any one of eight situations. Please access the rules directly to identify these situations.

The revised standards clarify the RN’s responsibility to document the date, time, and reason the UAP is no longer authorized to perform the nursing procedure for the client. Clarified through the revised standards is the responsibility of the RN to inform the UAP and other healthcare team members that the UAP is no longer authorized to perform the nursing procedure for the client.

Also clarified are documentation expectations of the RN who rescinds a delegation. For example, the RN who rescinds must document the date, time, and reason the UAP is no longer authorized to perform the nursing procedure for the client.

851-047-0065 Rescinding the delegation for a client and UAP: This rule number contains standards applicable to the RN who is ending their therapeutic relationship with their client.

The standards under this new rule number clarify that for the delegation of a procedure performed for a client by a UAP to no longer be considered under the accountability of the RN’s license, the RN must rescind the delegation. The standards also clarify that the act of transferring a delegation to another RN still requires the rescinding RN to formally end their nursing relationship with the client and the UAP.

For a practice situation where one RN is transferring their delegation to another RN who accepts, the standards require a synchronous handoff (i.e., at the same time, attending together, or meeting together from different locations) to occur between the two RNs. Two exceptions to these standards are codified in the rules which exceed the scope of this summary.

Within this new rule number are new standards that apply in the situation where an RN is rescinding a delegation and formally ending their nursing relationship with the client, and there is no RN to whom a hand-off of the delegation can be made. Please take the time to access the rules and read these standards carefully.

0070 Accepting a Hand-off of Nursing Services Provision and Delegation Process Responsibilities for a Client and a UAP from another RN: This rule number contains standards applicable to the RN who is presented with a hand-off of a client that includes delegation process responsibilities from another RN. The standards identify specific conditions that must be considered by the RN in their decision to accept, or to not accept, the hand-off. These conditions include (but are not limited to):

• Having knowledge that the responsibilities of the hand-off are within the RN’s individual scope of practice.
• Arriving at the clinical judgment that the client’s situation is safe for delegation.
• Having knowledge that the teaching plan content for the UAP on the client’s condition and their performance of the nursing procedure meets the requirements of the Division 047 rules.
• Having knowledge that the written instructions for the UAP’s performance of the nursing procedure on the client meet the requirements of the Division 047 rules.

The revised standards identify the responsibility of the RN to validate and evaluate specific data to determine the UAP’s authorization period for performance of the procedure on the client; a period that cannot exceed 60 days.

A new standard is the responsibility of the RN to communicate the duration of the UAP’s authorization period with other healthcare team members who need to know. Also new is the responsibility of the RN to document a recommendation for the client’s health care team that identifies how the client might continue to receive their ordered procedure in the event the RN is no longer a member of the team, and the procedure remains ordered for the client.

Additionally, standards under this rule number clarify the RN’s responsibility to document the date and time the hand-off is accepted; the date and time the UAP is authorized under their delegated authority to perform the nursing procedure for the client; and the UAP’s authorization period for performance of the procedure on the client.

In closing, the revised Division 047 rules go into effect on August 1, 2023. Please access and read them in their entirety, reflect on your current delegation practices, and engage in professional practice evaluation to ensure that your practice going forward is consistent with the revised rules.

Please be on the lookout for future notices announcing board staff presentations on the revised Division 047 rules beginning in mid-August.

***An RN who is an employee of a licensed home health agency, a licensed home infusion agency, or a licensed hospice agency, may authorize a UAP to administer medication by the intravenous (IV) route that has been ordered to treat or manage a chronic condition or an infection. See OAR 851-047-0030(5).