covid-19, delegation, Scope of Practice

Delegation of COVID-19 Vaccinations in Oregon: Part I

I recently received the following question regarding the delegation of COVID-19 vaccinations in Oregon:

I am a public health registered nurse [RN]. I represent the Oregon Health Authority COVID-19 Recovery and Response Unit. Under Oregon law, may an RN delegate to medical assistants the administration of COVID-19 vaccinations? I found the following in Oregon nursing law which would seem to indicate that the answer is no:

Authorized Duties and Standards for Certified Medication Aide (CMA)

(4) A CMA may not administer medications by the following routes:

(c) Intramuscular;

[Another division of Oregon nursing law says something similar:]

Division 47

Standards for Community-Based Care Registered Nurse Delegation Process

(11) The Registered Nurse may not delegate the administration of medications by the intramuscular route

Certified medication aides are very different from medical assistants. The RN who contacted me is correct in stating that Division 47 of the Oregon Board of Nursing regulations does not permit RNs to delegate to certified medication aides the administration of intramuscular injections. Whether RNs are permitted by Oregon law to delegate to medical assistants the administration of intramuscular injections, however, is a different legal question.

Furthermore, Division 47 addresses community-based care settings. Note the following language from the Division 47 “Rule Summary, Statement of Purpose and Intent”:

(1) These rules apply only in settings where a Registered Nurse is not regularly scheduled and not available to provide direct supervision [italics added]. These are home and community-based settings as described in OAR 851-047-0010(6) and local corrections, lockups, juvenile detention, youth corrections, detoxification facilities, adult foster care and residential care, training and treatment facilities as described in ORS 678.150(9).

(2) These rules have no application in acute care or long-term care facilities or any setting where the regularly scheduled presence of a registered nurse is required by statute or administrative rule.

Therefore, my legal position is that Division 47 does not answer the question of whether RNs are permitted to delegate to medical assistants the administration of COVID-19 vaccinations in a vaccination clinic when the RNs are on the premises and immediately available.

Stay tuned for part II of this discussion, in which I will examine language in Oregon nursing law that allows RNs to delegate to medical assistants the administration of intramuscular injections.

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