216-RICR-40-05-22
216-RICR-40-05-22. Nursing Assistants, Medication Aides, and the Approval of Nursing Assistant and Medication Aide Training Programs (version Amendment, 10/18/2007 to 03/25/2008)
RULES AND REGULATIONS PERTAINING TO
RHODE ISLAND CERTIFICATES OF
REGISTRATION FOR NURSING ASSISTANTS
AND THE APPROVAL OF
NURSING ASSISTANT TRAINING PROGRAMS
[R23-17.9-NA]
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
DEPARTMENT OF HEALTH
August 1990 (E)
AS AMENDED:
October 1990
January 2004
August 1991 (E)
August 2004
November 1991 (E)
August 2005
February 1992
September 2006
April 1992 (E)
August 1992 (E)
October 1992
September 1996
February 2000
January 2007 (re-filing
in accordance with the
provisions of section
42-35-4.1 of the Rhode
Island General Laws,
as amended)
November 2001
September 2007
January 2002 (re-filing in
accordance with the
provisions of section 42-
35-4.1 of the Rhode
Island General Laws, as
amended)
i
INTRODUCTION
These amended Rules and Regulations Pertaining to Rhode Island Certificates of Registration
for Nursing Assistants and the Approval of Nursing Assistant Training Programs [R23-17.9-NA] are
promulgated pursuant to the authority conferred under Chapter 23-17.9 of the General Laws of
Rhode Island, as amended, and 42 Code of Federal Regulations, Part 431 et seq. and are established
for the purpose of defining the minimum standards for: (1) the training, competency evaluation and
registration of nursing assistants; and (2) and to adopt unified standards for nursing assistants in this
state to ensure safe and adequate care to individuals receiving nursing assistants' health care services
in this state.
Pursuant to the provisions of section 42-35-3(c) of the General Laws of Rhode Island, as
amended, the following issues have been given consideration in arriving at the regulations: (a)
alternative approaches to the regulations; and (b) duplication or overlap with other state regulations.
Based on the available information, no known alternative approach, duplication or overlap was
identified.
These amended regulations shall supersede all previous Rules and Regulations Pertaining to
Rhode Island Certificates of Registration for Nursing Assistants and the Approval of Nursing
Assistant Training Programs promulgated by the Department of Health and filed with the Secretary
of State.
ii
TABLE OF CONTENTS
Page
PART I
Definitions
1
1.0
Definitions
1
PART II
Requirement For Registration
2.0
General Requirements
4
3.0
Qualifications
4
4.0
Licensure by Examination
6
5.0
Issuance and Renewal of Registration and Fee
7
6.0
Denial, Suspension, Revocation, of Registration and Disciplinary Proceedings
8
PART III
Requirements Pertaining To Nursing Assistant Training Programs
7.0
Application for and Approval of Nursing Assistant Training Programs
10
8.0
Denial, Suspension or Revocation of Approval and Termination of Program
13
9.0
Advisory Board
13
PART IV
Confidentiality/Violations And Sanctions/ Practices And Procedures/Severability
10.0
Violations and Penalties
14
11.0
Rules Governing Practices and Procedures
14
12.0
Severability
14
Appendix I
15
Appendix II
18
References
20
1
PART I
Section 1.0
Definitions
Wherever used in these rules and regulations the following terms shall be construed as follows:
1.1
"Abuse" means any assault as defined in Chapter 11-5, including, but not limited to
hitting, kicking, pinching, slapping or the pulling of hair, provided however, unless such is
required as an element of offense, it shall not be necessary to prove that the patient or
resident was injured thereby, or any assault as defined in Chapter 11-37, or any offense
under Chapter 11-10 of the General Laws; or
1.1.1
any conduct which harms or is likely to physically harm the resident/patient
except where the conduct is a part of the care and treatment, and in furtherance of
the health and safety of the resident; or
1.1.2
intentionally engaging in a pattern of harassing conduct which causes or is likely
to cause emotional or psychological harm to the resident/patient, including but not
limited to, ridiculing or demeaning a patient/resident, making derogatory remarks
to a patient/ resident or cursing directed towards a patient/resident, or threatening
to inflict physical or emotional harm on a patient/resident.
1.2
"Act" refers to Chapter 23-17.9 of the General Laws of Rhode Island, as amended, entitled,
"Registration of Nursing Assistants."
1.3
“Adult day services program” means a community-based group program, licensed by the
Rhode Island Department of Elderly Affairs in accordance with the provisions of Chapter
42-66 of the Rhode Island General Laws, as amended, designed to meet the
biopsychosocial needs of adults with impairments through individual plans of care.
These structured, comprehensive, nonresidential programs provide a variety of health,
social, and related support services in a protective setting. By supporting families and
other caregivers, adult day services enable participants to live in the community. Adult
day programs employ an interdisciplinary team to assess the biopsychosocial needs of
each participant and to design and deliver integrated programs and services to meet those
needs. Participants attend on a planned basis.
1.4
"Approval" means the process whereby the Director or his/her designee evaluates and
grants official recognition to a nursing assistant training program based on the requirements
herein.
1.5
"Assisted living residence" means a publicly or privately operated residence, licensed
under the provisions of Chapter 23-17.4 of the Rhode Island General Laws, as amended,
that provides directly or indirectly by means of contracts or arrangements personal
assistance to meet the resident's changing needs and preferences, lodging, and meals to
two (2) or more adults who are unrelated to the licensee or administrator, excluding
however, any privately operated establishment or facility licensed pursuant to Chapter
2
23-17 of the General Laws of Rhode Island, as amended, and those facilities licensed by
or under the jurisdiction of the Department of Mental Health, Retardation and Hospitals,
the Department of Children, Youth, and Families, or any other state agency. Assisted
living residences include sheltered care homes, and board and care residences, or any
other entity by any other name providing the above services which meet the definition of
assisted living residence.
1.6
“Certificate of Registration”, as used herein, has the same meaning as “license.”
1.7
“Complicated feeding”, as used herein, means the feeding of residents with complex
medical needs such as those with recurrent lung aspirations, difficulty swallowing, or those
residents on feeding tubes or parenteral/IV feedings.
1.8
“Department” means the Rhode Island Department of Health.
1.9
"Director" means the Director of the Rhode Island Department of Health or his/her
designee.
1.10
"Health care facility" means any institutional health service provider, facility or
institution, place, building, agency, or portion thereof, whether a partnership or
corporation, whether public or private, whether organized for profit or not, used,
operated, or engaged in providing health care services, including but not limited to
hospitals; nursing facilities; home nursing care provider (which shall include skilled
nursing services and may also include activities allowed as a home care provider or as a
nursing service agency); home care provider (which may include services such as
personal care or homemaker services); kidney disease treatment centers; health
maintenance organizations; free-standing emergency care facilities, and facilities
providing surgical treatment to patients not requiring hospitalization (surgi-centers);
hospice care, and physician ambulatory surgery centers and podiatry ambulatory surgery
centers providing surgical treatment. The term "health care facility" also includes
organized ambulatory care facilities which are not part of a hospital but which are
organized and operated to provide health care services to outpatients such as central
services facilities serving more than one health care facility or health care provider,
treatment centers, diagnostic centers, rehabilitation centers, outpatient clinics,
infirmaries and health centers, school based health centers and neighborhood health
centers. The term "health care facility" shall not apply to organized ambulatory care
facilities owned and operated by professional service corporations as defined in chapter
5.1 of title 7, as amended (the "Professional Service Corporation Law"), or to a private
practitioner's (physician, dentist, or other health care provider) office or group of the
practitioners' offices (whether owned and/or operated by an individual practitioner,
alone or as a member of a partnership, professional service corporation, organization, or
association).
1.11
“Long term care services” means a set of health care, personal care and social services
required by persons who have lost, or never acquired, some degree of functional capacity
(e.g., chronically ill, aged, disabled) in an institution or at home on a long-term basis. The
3
term may refer to long-term institutional care such as that provided in nursing homes, or to
ambulatory services such as home health care, which may also be provided on a long-term
basis.
1.12
"Neglect" means the intentional failure to provide treatment, care, goods and services
necessary to maintain the health and safety of the patient or resident, or the intentional
failure to carry out a plan of treatment or care prescribed by the physician of the
patient/resident, or the intentional failure to report patient/resident health problems or
changes in health conditions to an immediate supervisor or nurse, or the intentional lack
of attention to the physical needs of a patient/resident including, but not limited to
toileting, bathing, meals and safety. Provided, however, no person shall be considered to
be neglected for the sole reason that he or she relies or is being furnished treatment in
accordance with the tenets and teachings of a well recognized church or denomination
by a duly-accredited practitioner thereof.
1.13
"Nursing assistant" means a nurse's aide, orderly, or home health aide who is a
paraprofessional, and who holds a Rhode Island certificate of registration pursuant to the
provisions of the Act and the rules and regulations herein, and who is trained to give
personal care and related health care and assistance based on his or her level of preparation
to individuals who are sick, disabled, dependent, or infirm, and who are residents of or who
are receiving services from health care facilities.
1.14 "Nursing assistant examination" means an examination approved by the Director that
includes a written and practical component that tests the ability of a person to perform the
skills and exercise the judgment that is necessary to carry out the duties of a nursing assistant
as defined in these regulations.
1.15
"Nursing assistant training program" means an organized course of classroom instruction
and practical training, approved by the Director, and which has as a major goal the
preparation of individuals to function as nursing assistants and to discharge those duties
commensurate with basic preparation.
1.16
"Nursing service agency" means any person, firm, partnership or corporation doing
business within the state of Rhode Island that supplies, on a temporary basis, registered
nurses, licensed practical nurses, or nursing assistants, to a hospital, nursing home, or
other health care facility requiring the services of such persons, with the exception of
hospitals, home nursing care providers, home care providers, and hospices licensed in
this state.
For all purposes, a nursing service agency shall be considered an employer and those
persons that it supplies on a temporary basis shall be considered employees and not
independent contractors. Nursing services agencies shall be subject to all state and
federal laws which govern employer-employee relations.
1.17
"Patient", as used herein, is synonymous with client and resident.
4
1.18
"Person" shall mean any individual, trust or estate, partnership, corporation (including
associations, joint stock companies), limited liability companies, state, or political
subdivision or instrumentality of a state.
1.19
“Registry” means the Department's licensure database that provides a mechanism to verify
currency of a nursing assistant’s registration.
1.20
"Supervision" means the provision or exercise of control and direction over the services of
the nursing assistant under the direction of a registered nurse or physician licensed in this
state or other appropriate health professionals duly licensed, registered and/or certified as
may be required by the laws of this state.
1.20.1
"Direct supervision" means supervision provided by a supervisor who is and remains on
the premises, in the building, while the nursing assistant duties are being performed and
evaluates the performance of the nursing assistant.
1.20.2 "Indirect supervision" means supervision provided by a supervisor who does not need to
be on the premises while the nursing assistant duties are being performed, but who is
responsible for the assignment of duties and evaluation of the performance of the nursing
assistant.
Section 2.0
General Requirements
2.1
No person shall be employed in this state as a nursing assistant unless he/she holds a
certificate of registration as a nursing assistant in accordance with the provisions of the Act
and the rules and regulations herein.
2.2
No person shall assume the title of “nursing assistant” or such similar title or use any
abbreviations or any other words, letters, signs, figures or devices to indicate that the
individual using same is a nursing assistant as set forth in these regulations, unless he/she
holds a certificate of registration as a nursing assistant in this state. The only abbreviation
that a nursing assistant may use in this state is limited to "N.A."
2.3
All health care providers licensed by this state to provide health care services and all
health care facilities licensed under Chapter 23-17 of the Rhode Island General Laws, as
amended, shall assess patient pain in accordance with the requirements of the Rules and
Regulations Related to Pain Assessment (R5-37.6-PAIN) of reference 7 herein.
Supervision
5
2.4
Nursing assistants shall be supervised by professional (registered nurses) and other
appropriate professional members of a health care facility or physician. The type of
supervision, either direct or indirect, shall be determined by the health care facility based on
the qualifications and demonstrated competencies of the individual nursing assistant.
Provided, however, those duties listed in Appendix I-C shall be discharged only under direct
supervision of the registered nurse.
Exemptions
2.5
Notwithstanding any provision of section 23-17.9-2 of the Rhode Island General Laws, as
amended, the definition of “nursing assistant” shall not apply to those persons designated
solely as personal care attendants, or programs established and administered for the purpose
of providing personal care attendant service, established by Chapter 40-8.1 entitled,
"Personal Care Attendant Program."
2.6
Furthermore, no provision of the Act shall apply to those persons who are actively
matriculating in a bachelor of science in nursing, associate degree program in nursing, an
accredited licensed practical nursing program or registered nurse course of study in a
National League for Nursing Accrediting Commission, Inc., or a Commission on Collegiate
Nursing Education (CCNE) accredited nursing program provided those persons have
completed a minimum of two (2) clinical courses and provided those individuals are
supervised by a registered nurse.
Section 3.0
Qualifications for Registration for a State Certificate of Registration
3.1
An applicant seeking a certificate of registration as a nursing assistant shall:
a)
be of good moral character; and
b)
have successfully completed a Department-approved nursing assistant training
program; or be actively matriculating in a nursing program and have completed a
minimum of two (2) clinical courses; and
c)
have successfully completed the required nursing assistant examination.
OR
d)
possess a current registered nurse (RN) or licensed practical nurse (LPN) license.
OR
e)
possess a current registration as a nursing assistant in good standing in an
alternate jurisdiction that includes successful completion of a state-approved
training program and successful completion of a nursing assistant examination
and shall possess the equivalent of three (3) months of full-time work experience
as a nursing assistant.
6
OR
f)
have successfully completed a one hundred (100 ) hour state-approved training
program in another state/jurisdiction that includes a minimum of twenty (20) hours
of practical clinical training under supervision and successful completion of a
nursing assistant examination.
Application For Registration
3.2
Application for a Rhode Island certificate of registration as a nursing assistant shall be made
on forms provided by the Department. Said forms shall be completed and notarized.
3.3
Such application shall be accompanied by the following:
a)
one (1) unmounted passport-type photograph of the applicant (head and shoulder
view) approximately 2x3 inches in size;
b)
documented evidence of completion of a Department-approved nursing assistant
training program;
c)
documented evidence of successful completion of the required nursing assistant
examination;
d)
the non-refundable processing fee of forty dollars ($40.00) made payable by certified
check or money order to the General Treasurer, state of Rhode Island; personal
checks shall not be accepted.
If the nursing assistant is currently employed by a health care facility at the time
of application and has been continuously employed by the same facility for six (6)
months after the application, then the processing fee shall be directly refunded to
the applicant by the facility or agency.
e)
submission of examination fees, as follows:
Applicant administration fee ………….$40.00
Written component of examination …… $20.00
Clinical component of examination …… $35.00
The examination fee(s) shall be paid by the individual applicant only in the
following circumstances: If the applicant is unemployed as a nursing assistant; is
an individual with training equivalent to nursing assistant training; or is otherwise
qualified to test as determined by the Department.
If the nursing assistant is currently employed by a health care facility at the time
of application and has been continuously employed by the same facility for six (6)
7
months after the application, then the testing fee paid by the individual applicant
shall be directly refunded on a pro rata basis between months six (6) and twelve
(12) to the applicant by the facility or agency, provided that a Department
application receipt is presented to the facility/agency by the applicant within one
(1) year of the date on the receipt.
f)
Full Bureau of Criminal Investigation (BCI) check from the Rhode Island Attorney
General’s Office only;
g)
If seeking registration under the provisions of section 3.1 (e) {above}, the applicant
shall submit a current registration in good standing from the alternate jurisdiction,
written documentation from an employer attesting to no less than the equivalent of
three (3) months of full-time work experience as a nursing assistant, as well as the
items required in section 3.3, subsections (a)(b)(c) and (d).
h)
If seeking registration under the provisions of section 3.1 (f) {above}, the
applicant shall submit written documentation of successful completion of a one
hundred (100) hour state-approved training program (including the minimum of
twenty (20) hours of practical clinical training under supervision) completed in
another state/jurisdiction as well as the items required in section 3.3, subsections
(a)(c) and (d).
Section 4.0
Licensure by Examination
4.1
The nursing assistant written and practical examinations shall be selected and approved by
the Director or his/her designee.
4.2
All applicants shall be required to successfully complete the nursing assistant examinations
within a period of one (1) year from the date that the applicant began the nursing assistant
training program. Otherwise, the nursing assistant applicant shall be required to complete the
nursing assistant training program again.
4.3
Nursing assistant applicants shall be given three (3) opportunities to successfully complete
both the written and practical components of the nursing assistant examinations. After three
(3) unsuccessful attempts to complete the nursing assistant examinations, the nursing
assistant shall be required to repeat the nursing assistant training program.
4.4
Individuals hired to work as nursing assistants shall complete the basic nursing assistant
training program, and any required nursing assistant examinations, no later than one hundred
twenty (120) days from the employee's effective date of employment, and shall be duly
registered with the Department. Individuals who change employment prior to completion of
the training program within one hundred twenty (120) days from the date of employment,
will not be allowed additional time for completion of the training program without prior
approval of the Director.
If the applicant is actively matriculating in a nursing program and has completed a minimum
8
of two (2) clinical courses, upon application and payment of fees to test, he/she may work
with a temporary permit for one hundred twenty (120) days from the date on the temporary
permit.
Section 5.0
Issuance and Renewal of Registration and Fee
5.1
The Department shall issue to applicants who have satisfactorily met the registration
requirements herein a registration as a nursing assistant in this state. Said registration, unless
sooner suspended or revoked, shall expire biennially (every two (2) years) on the thirtieth
(30th) day of June of every other year following the date of issuance of the original
registration.
5.2
On or before the first day of May of every year, the Department shall mail an application for
renewal of registration to every individual who is to renew that year. Every nursing assistant
so registered who is to renew his or her registration shall file with the Department such
renewal application together with the renewal fee of forty dollars ($40.00) made payable by
certified check or money order to the General Treasurer, State of Rhode Island, before the
fifteenth (15th) day of June.
5.3
Upon receipt of such renewal application and payment of said fee, the Department shall
grant a renewal registration effective the first (1st) day of July, and expiring on the thirtieth
(30th) day of June two (2) years later unless the registration is sooner suspended or revoked.
5.4
Any nursing assistant who allows his/her registration to lapse for less than two (2) years by
failing to renew it, may be reinstated by the Department upon submission of an application
and payment of the renewal fee of forty dollars ($40.00) unless the registration has been
suspended or revoked.
5.4.1 An applicant seeking renewal shall have been employed as a nursing assistant for
at least eight (8) hours within the prior twenty-four (24) months; or have
completed a nursing assistant training and testing program within the past twenty-
four (24) months.
5.4.2
An applicant seeking renewal shall have been employed as a nursing assistant in a
Rhode Island-licensed health care facility licensed under the provisions of
Chapter 23-17 of the Rhode Island General Laws, as amended; an assisted living
residence licensed under the provisions of Chapter 23-17.4 of the Rhode Island
General Laws, as amended; an adult day services program licensed under the
provisions of Chapter 42-66 of the Rhode Island General Laws, as amended; or
employed by a nursing service agency licensed under the provisions of Chapter
23-17.7.1 of the Rhode Island General Laws, as amended. Private duty
employment shall not meet this obligation for renewal of a certificate of
registration as a nursing assistant.
5.4.3
Any nursing assistant who allows his/her registration to lapse for a period of two (2)
years or longer shall be required to successfully complete the nursing assistant
9
training program, and all required examinations, prior to being reinstated as a nursing
assistant.
5.5
An applicant seeking renewal shall have his/her employment verified by the employer on the
renewal form provided by the Department.
Removal of Name from Nurse Aide Registry
5.6
In the case of a finding of neglect, as defined herein, a nursing assistant may petition the
Department in writing to have his/her offense removed from the registry upon a
determination by the Department that the employment and personal history of the nursing
assistant does not reflect a pattern of abusive behavior or neglect; and the neglect involved in
the original finding was a singular occurrence.
5.7
A nursing assistant shall submit a written petition to:
Rhode Island Department of Health
Nursing Assistant Advisory Board
3 Capitol Hill, Room 105
Providence, RI 02908
Such petition shall request that the nursing assistant’s offense be removed from the registry
in accordance with the criteria stated in section 5.6 (above).
5.8
The nursing assistant’s name and offense shall remain on the registry for a period of one (1)
year from the date on which the name was placed on the registry after which time the name
may be removed if the petitioner’s request is granted by the Department.
Reinstatement of License
5.9
A nursing assistant who has been registered in Rhode Island in good standing, has let his/her
registration lapse, and has been working as a nursing assistant in an alternate jurisdiction
within the two (2) years immediately preceding application for reinstatement, may apply for
reinstatement of registration upon submission of the following:
• Recent passport-type photograph;
• Full Bureau of Criminal Investigation (BCI) check from the Rhode Island Attorney
General’s Office only, within two (2) months of registration;
• Photocopy of active license/registration from the state where employed as a nursing
assistant;
• Reinstatement processing fee of forty dollars ($40.00);
• Proof of employment for at least one 8-hour shift within the past two (2) years (license
must be current at the time of employment) in a nursing home, hospital, home care
agency, assisted living residence, adult day services program, or employed by a nursing
service agency; OR
possesses a current registered nurse (RN) or licensed practical nurse (LPN) license.
•
Verification from current state of licensure that the applicant for reinstatement is and has
been in good standing in that jurisdiction.
10
Section 6.0
Denial, Revocation or Suspension of Registration/Disciplinary Proceedings
6.1
Pursuant to the statutory provisions of sections 23-17.9-8 and 23-17.9-9 of the Rhode Island
General Laws, as amended, the Department may deny, suspend or revoke any registration
issued hereunder or may reprimand, censure or otherwise discipline an individual who has
been found guilty of violations of the Act or the rules and regulations herein, in accordance
with section 23-17.9-8 of the Rhode Island General Laws, as amended, and upon decision
and after hearing as provided pursuant to section 11.0 herein in any of the following cases:
a)
upon proof that such nursing assistant is unfit or incompetent by reason of
negligence, habits or other causes;
b)
upon proof that such nursing assistant has violated any of the provisions of the Act or
the rules and regulations herein; or acted in a manner inconsistent with the health and
safety of the patients of the agency/home in which he or she is providing nursing
assistant services;
c)
upon proof that such nursing assistant has been convicted in a court of competent
jurisdiction, either within or without this state, of a felony;
d)
upon proof that the nursing assistant has otherwise violated the provisions of the Act;
e)
has engaged in conduct detrimental to the health, welfare, and safety of
patients/residents in his/her care;
f)
has engaged in unprofessional conduct including, but not limited to, departure from,
or failure to conform to, the standards of acceptable and prevailing practice.
6.2
All hearings and reviews as may be required herein shall be conducted in accordance
with the provisions of the Administrative Procedures Act and the Rules and Regulations
of the Rhode Island Department of Health Regarding Practices and Procedures Before
the Department of Health and Access to Public Records of the Department of Health
(R42-35-PP) of reference 4 herein.
11
PART II
Section 7.0 Application for and Approval of Training for Nursing Assistant Training Programs
7.1
Approval of a nursing assistant training program shall be granted for two (2) years, if the
program is found to meet the requirements herein, and such approval may be renewed
biennially unless approval has been sooner revoked or suspended.
7.2
Any person desiring to conduct a nursing assistant training program for the preparation of
individuals to provide nursing assistant services shall apply to the Department for approval
by submitting a completed application on forms provided by the Department accompanied
by documentation pertaining to no less than the following:
a)
evidence of support and fiscal administration accountability;
b)
sources and locations of potential students, faculty, classrooms, conference rooms,
clinical laboratory for practical experience and other resources;
c)
names and qualifications of instructors;
d)
copy of the curriculum including provisions for the practical experience;
e)
written statements of purpose, philosophy and objectives;
f)
organization with clearly defined authorities and responsibilities and a chart showing
the relationships and channels of communication of the program to other agencies,
programs, etc.;
g)
practical experiences related to areas of instruction of the didactic segment of the
program; and
h)
written policies and procedures pertaining to the nursing assistant training
program.
7.3
The application fee for a nursing assistant training program certification shall be two
hundred fifty dollars ($250.00). Any nursing assistant training program within a facility
administered and operated by the state of Rhode Island shall be exempt from this fee.
Standards for Training Program Approval
7.4
The nursing assistant training program shall consist of no less than one hundred (100 ) clock
hours including no less than twenty (20) hours of practical training integrated with the
classroom topics and under supervision in accordance with the provisions of section 1.20
herein.
7.5
A nursing assistant training program conducted in a health care facility shall be completed
within ninety (90) days.
12
7.6
The course of instruction shall be designed to prepare students to perform all the nursing
assistant duties listed in Appendix I herein. At least sixteen (16) hours of classroom
instruction shall be required prior to a trainee's direct involvement with patients. Such
instruction shall be consistent with the curriculum outline of Appendix II herein.
Personnel
Program Coordinator
7.7
Each nursing assistant training program shall have a coordinator who shall be responsible for
the management of the instructional and practical portions of the program. The program
coordinator must be a registered nurse with a minimum of two (2) years of nursing
experience, one (1) of which must be in the provision of long term care services; and must
have documented evidence of teaching and/or appropriate supervisory experience. Directors
of nursing in nursing facilities are prohibited from performing actual training, but may
supervise clinical training.
Instructors
7.8
Competent resource personnel from various areas of the health field may participate as
program instructors at the discretion of the program coordinator. Such personnel may
include: licensed registered nurses (RNs)/practical nurses (LPNs) with one (1) year of
nursing experience, dietitians; pharmacists; or physical therapists. Instructors shall have
completed a course in teaching adults or have experience in teaching adults, or supervising
nursing assistants, and shall have at least one (1) year of experience in their respective fields.
Policies and Procedures
7.9
Each nursing assistant training program shall have available for students written policies
pertaining to no less than the following:
a)
admission, re-admission, retention, dismissal and course completion requirements;
b)
the identification of the resource facilities for the practical experience in a long-term
care or appropriate acute care facility;
c)
the supervision requirement of nursing assistants in all settings in accordance with
section 1.20 herein; and
d)
such other provisions as may be deemed appropriate.
Resources and Facilities
7.10
Each nursing assistant training program shall have adequate resources/facilities consistent
with the philosophy, purposes, objectives and policies of the nursing assistant program.
Such resources/facilities shall include no less than:
13
a)
classroom, offices, and conference rooms accessible to and adequate for the number
of students;
b)
sufficient instructional materials to meet the needs of students and instructor,
including clinical supplies;
c)
furnishings of appropriate size and numbers as may be required for the instructional
program and for the number of students;
d)
an adequate number of service resources to provide the kinds of practical learning
experiences as required to meet the curriculum objectives;
e)
adequate financial support to implement and operate the nursing assistant program;
f)
compliance with all applicable licensing laws and regulatory requirements.
Curriculum
7.11
The objectives of the nursing assistant training program shall be consistent with the
curriculum outline of Appendix II herein and shall promote the provision of quality health
care services by nursing assistants who are able to perform competently the duties listed in
Appendix I herein.
Evaluation of Curriculum
7.12
A systematic plan for on-going evaluation of the curriculum shall be established and
include evaluation provisions pertaining to no less than:
a)
the implementation of the curriculum design;
b)
the relationship of the curriculum to current needs of patients in health care facilities
and current standards of practice;
c)
revisions and/or modifications of curriculum as may be necessary based on
evaluation data and/or other federal and state requirements.
Examinations
7.13
A written examination shall be administered that tests the knowledge and competency of a
person to carry out the duties of a nursing assistant as defined in these regulations.
7.14
The nursing assistant program shall determine a person’s skill, knowledge levels, and
competency through a manual skills (practical) examination. Such examination shall test no
less than the following:
14
a)
communication and interpersonal skills;
b)
infection control;
c)
safety emergency procedures;
d)
promotion of patients' independence;
e)
respecting patients' rights;
f)
basic nursing skills;
g)
mental health/social service needs;
h)
care of cognitively impaired patients;
i)
basic restorative services.
7.15
In addition, the nursing assistant program shall test specific manual skills as set forth in
Appendix I. Where appropriate, skills demonstration shall be performed on a real patient, or
"pseudo-patient", but shall not be performed on a mannequin.
Section 8.0
Denial or Revocation of Approval/Termination of Program
8.1
If the Department determines that an approved nursing assistant training program does not
meet the requirements herein, the Department shall notify, in writing, the institution and/or
agency or such other training program of a proposed pending action to deny or revoke the
approval of the program and the institution and/or agency shall be given an opportunity for a
prompt and fair hearing in accordance with the provisions of section 11.0 herein.
8.2
Any nursing assistant training program that terminates, for whatever reason, shall make
provisions for the appropriate storage of its students' records to ensure future accessibility to
the training program data for a minimum of five (5) years after the date of termination.
8.2.1
Provisions shall be made for the completion of the nursing assistant training program
for any individual who has begun a program, if, for whatever reason, the training
program terminates.
Section 9.0
Advisory Board
9.1
Within the Department there shall be established an Advisory Board which shall meet at
least once a year and shall consist of eleven (11) members, four (4) of whom shall be
registered nurses, three (3) of whom shall be nursing assistants, two (2) of whom shall be
administrators of health care facilities, one (1) of whom shall be a public member, and one
(1) of whom shall be a licensed practical nurse. All Board members shall be currently
licensed in Rhode Island, where required, and shall be actively working in his/her profession.
15
9.2
Members of the Advisory Board shall be appointed by the Director: three (3) to serve for
one (1) year; four (4) to serve for two (2) years; and four (4) to serve for three (3) years. No
member shall be appointed for more than two (2) consecutive full terms. A member
appointed for less than a full term (originally, or to fill a vacancy) may serve two (2) full
terms in addition to that part of a full term, and a former member shall again be eligible for
appointment after a period of one (1) or more years passes.
9.3
Successors to members of the Advisory Board whose terms expire shall be appointed in such
year by the Director to hold office for three (3) years or until their respective successors are
appointed.
9.4
The Director may remove any member of the Advisory Board for neglect of duty or
incompetency and may fill vacancies that occur for any purpose for the remainder of the
unexpired term.
Functions of the Advisory Board
9.5
The Advisory Board shall serve in an advisory capacity to the Director in matters pertaining
to the registration of nursing assistants and the practice of nursing assistants. The Advisory
Board shall advise the Director on such matters as policies affecting examination,
qualifications, issuance and renewal, denial or revocation of licenses, and the development of
rules and regulations.
Section 10.0
Violations and Penalties
10.1
Any person who violates the statutory or regulatory provisions herein shall be subject to the
disciplinary provisions herein. Section 23-17.9-9 of the Act provides that it shall be a
misdemeanor punishable by a fine of not more than five hundred dollars ($500.00) and/or
imprisonment for not more than one (1) year for any person who:
a)
obtains his or her certification or registration by means of fraud, misrepresentation,
or concealment of material facts;
b)
practices as a nursing assistant under cover of any certification or registration
illegally or fraudulently obtained or unlawfully issued; or
c)
practices as a nursing assistant without registration and/or practices during the time
his or her certification or registration issued under the provisions of the Act and the
regulations herein is suspended or revoked; or
d)
otherwise violates any of the provisions of the Act.
Section 11.0
Rules Governing Practices and Procedures
11.1
All hearings and reviews required under the provisions of Chapters 23-17.9 and 42-35 of the
16
General Laws of Rhode Island, as amended, shall be held in accordance with the provisions
of the rules and regulations of reference 4.
Section 12.0
Severability
12.1
If any provisions of these rules and regulations or the application to any individual or
institution or agency or circumstances shall be held invalid, such invalidity shall not affect
the provisions or the application of the regulations which can be given effect, and to this end
the provisions of the regulations are declared to be severable.
17
APPENDIX I
A)
DUTIES OF NURSING ASSISTANTS
A nursing assistant duly registered in this state may discharge the following duties under
supervision as described herein.
Personal Care Skills
Assist with complicated feeding, hydration
Bed bath, tub bath, shower
Care of skin and back
Foot care, foot soak, applying foot lotion
Nail care
Oral hygiene
Shampoo hair (sink, tub, bed) comb/brush
Shave
Basic Nursing Skills
Application of dry heat and cold packs to intact skin
Sitz bath to intact skin for comfort measures and pain relief only
Application of topical over-the-counter (OTC) drugs to intact skin
Apply lamb's wool
Apply elastic stockings
Care of patients on precautions
Make an occupied, unoccupied bed
Measure intake and output
Reinforce simple non-sterile dressings
Remind patient to take medication
Care for a patient when death is imminent
Post-mortem care
Specimen collection
Apply condom catheter
Empty catheter bag, commode, urinal
Assist with ostomy appliance
Assist with commode, toilet, bedpans and urinals
Change urinary drainage bag, excluding any sterile procedures
Assist with bowel/bladder retraining
Report and record weight and height
Take and record vital signs (temperature, pulse, and respiration (TPR) and blood pressure)
Rehabilitation Skills
Ambulate
Encourage self-help
Positioning
Normal range of motion
18
Restraining and use of appropriate alternatives
Transfer from bed, wheel chair, chair, commode
Transfer using mechanical lift
Use of assistive devices in ambulation, eating and dressing
Environment
Care of patient environment
Handling of blood/body fluid spills
Clean patient care area
Do basic domestic chores (e.g., laundry, ironing, dishes, food
preparation, where appropriate)
Recognition of and Reporting Signs and Symptoms
Infection
redness
swelling
fever
chills
drainage
Respiratory Problems
shortness of breath
rapid respirations
Cheyne-Stokes respirations
cough
Cardiac Problems
chest pains
cyanosis lips/nails
rapid pulse
GI/GU problems
abdominal pain
nausea
vomiting
blood: urine/stool
difficulty urinating
diarrhea
Endocrine problems
drowsiness
thirst
sweating
B)
EXCLUDED FROM THE DUTIES OF A NURSING ASSISTANT:
A nursing assistant shall not perform functions that otherwise require a professional
license, certification or registration by state law and shall not perform the following duties
19
that include but are not limited to:
Sterile dressing application
Gastric lavage or gavage, including
any tube feeding
Injections
Cutting toenails or fingernails for
diabetic
Vaginal Irrigations
Cutting toenails
Giving advice on medical/nursing matters
Any treatment to non-intact skin
Changing a Foley catheter
Tracheostomy tube care
Medications: may only remind patient to take medication, unless he or she has completed a
state approved training course in drug administration, but then shall not administer drugs or
biologicals under any circumstances in an acute care setting, and shall not administer any
Schedule II controlled substances.
C)
DUTIES WHICH A NURSING ASSISTANT MAY PERFORM UNDER DIRECT
SUPERVISION:
Enema
Colostomy irrigation
Application of hot packs using moist heat device or heat lamp
In addition, nursing assistants may be assigned nursing duties beyond those listed in Parts A
and C above (but in no case may they may be assigned any of the duties excluded in Part B),
so long as those duties are clearly delineated in facility policies. Documented evidence of
training and competency evaluation for each additional duty permitted to be discharged shall
be filed in the individual's personnel file.
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APPENDIX II
CURRICULUM OUTLINE BASIC NURSING ASSISTANT TRAINING PROGRAM
(80 classroom hours)
(20 hours of practical experience)
PART I
BEING A NURSING ASSISTANT - INTRODUCTION
Function of the nursing assistant
„
in health care institutions
„
in the home
Working with the health care team
Ethical responsibilities
„
accountability
„
confidentiality
Policies and procedures
State rules and regulations related to the registration of nursing assistants
Communication and interpersonal skills
Infection control
Safety/emergency procedures
Promoting patients' independence
Respecting patients' rights
PART II
BASIC HUMAN NEEDS
Patients as human beings
„
Physical, emotional, spiritual and mental health needs of patients throughout
the life cycle
„
Modifying the nursing assistant's behavior in response to patient's behavior
„
Identifying developmental tasks associated with the life cycle
„
Behavior management (reinforcement, reduction, elimination of behaviors)
„
Allowing maximum independence in relation to patient's ability
Working with the patient's family
PART III
CARING FOR PATIENTS
Admission and discharge procedures
Personal care skills
„
To include instruction relative to all those personal care duties outlined in
Appendix I, which a nursing assistant may discharge under supervision.
Basic nursing skills
„
Taking and recording vital signs
„
Measuring and recording vital signs
„
Caring for patient's environment
„
Observing, reporting and documenting abnormal signs and symptoms of
common diseases
„
Caring for patients when death is imminent
„
Specimen collection (urine, stool, sputum)
„
Heimlich maneuver
21
Basic Nutrition
„
Food and nutrition
„
Fluid balance
intake and output
maintaining proper hydration
PART IV
BASIC RESTORATIVE SERVICES
Rehabilitation
„
Basic body mechanics
„
Anatomy/physiology
Training the patient in self-care, according to ability
Use of assistive devices in transferring, ambulation, eating and dressing
Maintenance of range of motion
Proper turning and positioning in bed and chair
Bowel and bladder training
Care and use of prosthetic and orthotic devices
PART V
CARE OF PATIENTS WITH SPECIFIC PROBLEMS
The patient with cognitive impairment
„
Techniques for addressing the unique needs and behaviors of individuals with
dementia (Alzheimer's disease and others)
„
Communicating with patients
„
Understanding behavior
„
Appropriate responses to behavior
„
Methods for reducing the effects of cognitive impairment
Care of patients with diseases of other body systems
„
Circulatory problems
„
Respiratory problems
„
Digestive system problems
„
Bowel and bladder problems
„
Musculoskeletal problems
„
Neurological problems
„
Endocrine problems
„
Skin problems
PART VI
PATIENT'S RIGHTS
Privacy/confidentiality
The right to personal choices
Giving assistance in resolving grievances and disputes
Maximizing participation in resident and family groups
Maintaining care and security of personal possessions/property
Providing care which maintains the patient free from abuse
Reporting abuse, mistreatment and neglect
The use of restraints; avoiding the use of restraints
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PART VII
PRACTICAL TRAINING
Each student must satisfactorily complete twenty (20) hours of practical training under supervision
and such practical experience shall be provided in a clinical setting for the practical application of
nursing assistant duties as outlined in Appendix I.
The practical training must be integrated with the didactic portion of the curriculum for a meaningful
learning experience.
REFERENCES
1.
"Registration of Nursing Assistants", Chapter 23-17.9 of the General Laws of Rhode Island,
as amended.
2.
"Licensing of Health Care Facilities", Chapter 23-17 of the General Laws of Rhode Island,
as amended.
3.
"Confidentiality of Health Care Information Act," Chapter 5-37.3 of the General Laws of
Rhode Island, as amended.
4.
Rules and Regulations of the Rhode Island Department of Health Regarding Practices and
Procedures Before the Department of Health and Access to Public Records of the
Department of Health (R42-35-PP), Rhode Island Department of Health, April 2004 and
subsequent amendments thereto.
5.
Omnibus Budget Reconciliation Act (OBRA) 1987, Federal Register, Public Law 100-203,
enacted 1987, and updates in 1989, 1990, 1991.
6.
Chapter 16-40 of the General Laws, entitled "Proprietary Schools."
7.
Rules and Regulations Related to Pain Assessment (R5-37.6-PAIN), Rhode Island
Department of Health, May 2003 and subsequent amendments thereto.
28 August 2007
NursingAssts_Final_Sept2007.doc