Or. Admin. Code § 851-063-0030 - [Effective until 6/30/2025] 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 collaboration with health care team:

(A) Accepting assignments and delegations;

(B) Handing off care to another nursing assistant;

(C) Coaching and mentoring nursing assistant students; and

(D) Orienting other nursing assistants to workflow and environment.

(b) Tasks associated with communication and interpersonal skills:

(A) Answering and placing call signals;

(B) Communicating with clients, family members, and co-workers;

(C) Maintaining confidentiality;

(D) Reporting abuse, mistreatment, and neglect; and

(E) Utilizing de-escalation techniques.

(c) Tasks associated with person-centered care.

(A) Following the individual's plan of care and providing feedback to nurse on care plan;

(B) Organizing daily routines for a group of people according to the individuals' preferences and the individual care plans; and

(C) Protecting and respecting a person's rights.

(d) Tasks associated with infection control and prevention including Standard or Transmission Based Precautions:

(A) Handwashing and hand hygiene;

(B) Utilizing personal protective equipment;

(C) Maintaining client hygiene and grooming;

(D) Caring for the client's environment;

(E) Cleaning shared equipment;

(F) Bedmaking and handling of linen;

(G) Delivering and handling food and drinks;

(H) Implementing precautions associated with communicable and infectious diseases;

(I) Executing neutropenic precautions;

(J) Assisting with coughing and deep breathing;

(K) Handling of contaminated materials;

(L) Handling of disposal of hazardous wastes; and

(M) Applying a simple dressing to a dry, non-infected wound.

(e) Tasks associated with safety and emergency procedures:

(A) Implementing bleeding, cervical, hip, and sternal precautions;

(B) Moving and transferring a person;

(C) Transporting a person in a wheelchair or other specialized chairs;

(D) Turning and positioning a person;

(E) Using lifts and safe client handling devices;

(F) Turning oxygen on and off or transferring oxygen between wall, concentrator, and tank at pre-established flow rate for stable individuals;

(G) Managing hazards in the workplace;

(H) Preventing burns;

(I) Preventing falls; and

(J) Performing cardiopulmonary resuscitation.

(f) 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 a person for nutritional and fluid intake;

(iv) Preventing choking and aspiration;

(v) Preventing dehydration;

(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) Assisting with the use of bedpan and urinal;

(iii) Assisting with toileting;

(iv) Providing perineal and incontinence care;

(v) Applying external catheters;

(vi) Connecting external catheters to suction;

(vii) Providing catheter care;

(viii) Changing catheter bag;

(ix) Removing external urinary catheter;

(x) 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

(xi) Collecting specimens (sputum, nasal swab, rectal swab, stool, and urine including clean catch).

(C) Assisting with personal care:

(i) Bathing;

(ii) Providing comfort care;

(iii) Dressing and undressing;

(iv) Grooming to include:

(I) Application and care of eye glasses; and

(II) Application and care of hearing aids.

(v) Nail care for fingernails and toenails on person with no visually compromised skin or compromised circulation:

(I) Soaking and washing;

(II) Trimming with standard clippers;

(III) Applying lotion; and

(IV) Recognizing risk factors.

(vi) Oral hygiene:

(I) Brushing and flossing teeth; and may include medication mouthwash and toothpaste;

(II) Inserting, removing, and cleaning dentures;

(III) Caring for implants; and

(IV) Performing mouth care on a comatose person.

(vii) Personal care considerations for persons who have tubes or special equipment;

(viii) Shampooing and caring for hair;

(ix) Shaving;

(I) Electric razor;

(II) Cartridge or disposable razor; and

(III) Recognizing safety risks.

(x) Skin Care to include:

(I) Pediculicides that can be obtained without a prescription;

(II) Applying topical barrier creams, ointments, and wipes for skin care;

(III) Applying anti-fungal ointments and powders;

(IV) Maintaining skin integrity;

(V) Preventing pressure, friction, and shearing; and

(VI) Using pressure relieving devices;

(xi) Sleep to include:

(I) Applying and removing delivery device and turn continuous positive airway pressure (CPAP) or bi-level positive airway (BiPAP) devices on and off; and

(II) Promoting sleep.

(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 ambulation, dressing, eating, grooming, positioning and transferring;

(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.

(g) Tasks associated with mental health and social service needs:

(A) Recognizing and reporting relevant observations of domestic violence, mental illness or substance abuse;

(B) Protecting client, self, and other individuals when in a situation where an individual's behavior is escalating out of control;

(C) Providing trauma-informed care;

(D) Appropriately executing tools for behavior management; and

(E) Utilizing appropriate harmless release techniques.

(h) Tasks associated with technical skills:

(A) Changing a suction canister;

(B) Measuring, recording, and emptying output from drainage devices and closed drainage systems;

(C) Performing fingerstick capillary blood test; and

(D) Removing mask after nebulizer treatment.

(i) 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, 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.

(C) Relieving pain:

(i) Assisting with complementary therapies such as aromatherapy and 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.

(j) Tasks associated with documentation.

(A) Recording care provided; and

(B) Documenting incidents.

(k) Tasks associated with end of life care.

(A) Providing comfort care for the dying individual and their family; and

(B) Caring for the deceased individual including removing non-surgically inserted tubes:

(i) Feeding tube;

(ii) Rectal bag;

(iii) Foley Catheter;

(iv) Nasogastric tube; and

(v) Saline lock.

(l) Tasks associated with caregiver self-care.

(2) The CNA may, as an unlicensed person, provide care as delegated or assigned by a nurse in a community-based care 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 community-based care 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.

(6) A CNA may add phlebotomy to the authorized duties when the individual CNA has:

(a) Obtained and holds current phlebotomy certification from one of the following: American Society for Clinical Pathology (ASCP) Board of Certification, National Phlebotomy Association (NPA), Association of Phlebotomy Technicians (ASPT), American Association of Bioanalysts (ABOR), American Certification Agency for Healthcare Professionals (ACA), American Medical Technologists (AMT), or successful completion of phlebotomy specific military education program; and

(b) Maintained competency in performing phlebotomy; and

(c) Been assigned the task by an Oregon licensed nurse according to the employer's policy.

(7) A CNA may add child safety seat check to the authorized duties when the individual CNA has:

(a) Successfully completed a national child passenger safety certification program;

(b) Maintained competency in child passenger seat safety; and

(c) Been assigned the task by an Oregon licensed nurse according to the employer's policy.

(8) A CNA may add telemetry monitoring to the authorized duties when the individual CNA has:

(a) Successfully completed a dysrhythmia recognition course;

(b) Maintained competency in rhythm interpretation; and

(c) Been assigned the task by an Oregon licensed nurse according to the employer's policy.

(9) Effective February 21, 2025, through June 30, 2025, a CNA1 may add a duty listed in section (10) of this rule as an individual authorized duty when an RN representing the CNA1 employment site teaches performance of the authorized duty and validates that the CNA1 is competent to perform the duty. Once authorized, the CNA1 may be assigned to perform the additional authorized duty by nurses in the employing organization.

(10) The following duties are eligible to be added as an individual CNA1's authorized duties as permitted in section (9) of this rule:

(a) Duties associated with infection prevention:

(A) Obtaining urine specimen from port of catheter;

(B) Assisting with a chlorhexidine bath;

(C) Clipping hair in preparation for surgical procedure;

(D) Changing a wound VAC canister; and

(E) Performing clean intermittent straight urinary catheterization for chronic condition.

(b) Duties associated with ADL:

(A) Administering enemas;

(B) Assisting with nutrition and hydration of infants and children:

(i) Assisting with breastfeeding by supporting and reinforcing instructions;

(ii) Assisting with human breast milk pumping;

(iii) Handling, storing, and transporting breast milk;

(iv) Preparing infant formula or breast milk for feeding; and

(v) Assisting with and feeding infants by bottle.

(C) Assisting with established post pyloric, jejunostomy, and gastrostomy

(i) Adding fluid to tube feedings;

(ii) Changing feeding bags; and

(iii) Pausing and resuming tube feedings to provide personal care;

(D) Discontinuing a urethrally inserted catheter;

(E) Applying moisture barrier cream or ointment to treat topical skin irritation or non-intact skin due to incontinence or excess moisture;

(F) Established traction equipment: removing and re-applying; and

(G) Applying and removing continuous passive motion (CPM) machine.

(c) Duties associated with technical skills:

(A) Adjusting oxygen rate of flow;

(B) Attaining transcutaneous bilirubin meter reading;

(C) Disconitnuing a saline lock;

(D) Interrupting and re-establising nasogastric (NG) suction;

(E) Irrigating ears;

(F) Measuring arm and leg circumference;

(G) Measuring blood pressure with a Doppler;

(H) Measuring and recording: blood pressure (lower leg, thigh);

(I) Obtaining a throat swab specimen;

(J) Performing fecal occult blood test;

(K) Permorming urine dipstick test;

(L) Performing newborn critical congenital heart disease screening utilizing pulse oximetry;

(M) Placing electrodes or leads and run electrocardiogram (EKG);

(N) Placing electrodes or leads for telemetry;

(O) Removing casts in non-emergent situations;

(P) Scanning bladder;

(Q) Scanning glucometer sensor;

(R) Screening newborn hearing;

(S) Setting up traction equipment; and

(T) Suctioning nose or oral pharynx.

(11) 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.

Notes

Or. Admin. Code § 851-063-0030

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. 1/1/2015; BN 16-2021, amend filed 07/21/2021, effective 8/1/2021; BN 1-2024, amend filed 02/23/2024, effective 3/1/2024; BN 5-2025, temporary amend filed 02/21/2025, effective 3/1/2025 through 6/30/2025

Statutory/Other Authority: ORS 678.440, ORS 678.442 & ORS 678.444

Statutes/Other Implemented: ORS 678.440, ORS 678.442 & ORS 678.444