OAR 851-054-0020
Clinical Nurse Specialist Scope of Practice

The Clinical Nurse Specialist (CNS) independently provides evidence-based advanced nursing care to clients, and facilitates attainment of health goals. Within the practice of advanced nursing, the CNS provides innovation in nursing practice, based upon clinical expertise, evidence-based decision making, and leadership skills. The CNS practices within three spheres of influence. These three spheres are: individual clients and populations; nurses and other multidisciplinary team members; and organizations. Practice may target one or more spheres of influence.

(1)

The CNS may practice with individual clients and populations of clients.

(a)

Individual client care includes, but is not limited to:

(A)

Assessing the client using tools, techniques, and methodologies based on theory and research;

(B)

Diagnosing symptoms, functional problems, risk behaviors, and health status of the client;

(C)

Developing a mutually derived therapeutic plan of care with the client;

(D)

Designing, implementing, and evaluating nursing interventions by using data, research, and theoretical knowledge;

(E)

Selecting, recommending, and ordering medical equipment, laboratory and screening or diagnostic tests for the client;

(F)

Selecting, recommending and ordering prescription medications and devices as authorized per division 56 consistent with specialty and scope of practice;

(G)

Establishing standing orders, protocols, algorithms, or electronic order sets related to nursing interventions and specific plans of care;

(H)

Encouraging disease prevention, health promotion and health maintenance;

(I)

Referring the client to other health care services or providers as indicated.

(b)

Population care includes, but is not limited to:

(A)

Planning, implementing and evaluating data collection;

(B)

Selecting, ordering, and recommending screening and diagnostic tests for individuals within the population;

(C)

Interpreting and analyzing population data to formulate diagnoses in the area of needs, functional problems, risks, and health issues;

(D)

Reviewing and revising diagnoses based on subsequent data collection;

(E)

Innovating, implementing, guiding, evaluating, and revising population-focused plans and programs;

(F)

Encouraging disease prevention, health promotion and health maintenance;

(G)

Establishing criteria for referral within a population;

(H)

Establishing algorithms, standing orders, or practice guidelines related to specific populations;

(I)

Informing the population about its health and promoting other community systems that influence health;

(J)

Assessing need for and participating in activities to change health and social policies that affect the health of the community.

(2)

The CNS may practice with nurses and other members of the multidisciplinary care team to advance the practice of nursing and improve client care. This practice includes, but is not limited to:

(a)

Consulting and collaborating to identify and manage health care issues;

(b)

Providing leadership in the utilization of research in practice;

(c)

Coaching nursing staff in clinical practice development;

(d)

Identifying knowledge deficits of target groups providing health care;

(e)

Developing, providing and evaluating educational and other programs that enhance the practice of nursing personnel and/or other members of the health care team.

(3)

The CNS may practice with organizations to provide clinical expertise and guidance. This practice includes, but is not limited to:

(a)

Using system-wide change strategies based on an assessment of the needs and strengths of the organization;

(b)

Initiating collaborative relationships among teams to facilitate interdisciplinary practice;

(c)

Collaboratively developing and evaluating research-based and client-driven systems and processes;

(d)

Creating, advising, and influencing system-level policy that affects programs of care;

(e)

Evaluating and recommending equipment and products being used in patient care for efficacy, efficiency, cost-effectiveness, and client/consumer satisfaction.

(4)

The CNS may provide expertise that includes, but is not limited to:

(a)

Summarizing, interpreting, and applying research results;

(b)

Teaching, coaching, and mentoring health care members in the evaluation and use of research;

(c)

Providing leadership through practice in a CNS Program as a CNS Program Administrator, CNS Educator, or CNS Clinical Preceptor with CNS students;

(d)

Planning, directing, and evaluating multidisciplinary programs of care for clients;

(e)

Evaluating client outcomes and cost effectiveness of care to identify needs for practice improvement;

(f)

Conducting and participating in research and research protocols;

(g)

Designing and establishing standing orders related to nursing interventions.

(5)

The CNS scope of practice may include:

(a)

Prescribing, ordering, administering and dispensing medications per division 56 regulations and requirements.

(b)

Receiving and distributing drug samples.

(c)

Obtaining DEA registration for controlled substances in Schedule II-V.

Source: Rule 851-054-0020 — Clinical Nurse Specialist Scope of Practice, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=851-054-0020.

Last Updated

Jun. 8, 2021

Rule 851-054-0020’s source at or​.us