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, 12/10/2012 to 07/12/2018)
RULES AND REGULATIONS PERTAINING TO
RHODE ISLAND CERTIFICATES OF
REGISTRATION FOR NURSING ASSISTANTS,
MEDICATION AIDES,
AND THE APPROVAL
OF NURSING ASSISTANT AND MEDICATION AIDE TRAINING PROGRAMS
(R23-17.9-NA)
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Department of Health
August 1990 (E)
As Amended:
October 1990
January 2002 (re-filing in accordance
with the provisions of section 42-35-4.1 of
the Rhode Island General Laws, as amended)
August 1991 (E)
January 2004
November 1991 (E)
August 2004
February 1992
August 2005
April 1992 (E)
September 2006
August 1992 (E)
January 2007 (re-filing in accordance
with the provisions of section 42-35-4.1 of
the Rhode Island General Laws, as amended)
October 1992
September 2007
September 1996
March 2008
February 2000
January 2012 (re-filing in accordance
with the provisions of section 42-35-4.1 of
the Rhode Island General Laws, as amended)
November 2001
September 2012
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INTRODUCTION
These amended Rules and Regulations Pertaining to Rhode Island Certificates of Registration for
Nursing Assistants, Medication Aides, and the Approval of Nursing Assistant and Medication Aide
Training Programs 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 medication aides; and (2) and to adopt unified standards for
nursing assistants and medication aides in this state to ensure safe and adequate care to individuals
receiving nursing assistants'/medication aides’ 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.
Upon promulgation, 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. Upon promulgation, these amended regulations shall also supersede any
applicable sections related to the administration of medication by unlicensed persons, however named,
contained in the Rules and Regulations for Licensing Hospice Care (R23-17-HPC), Rules and
Regulations for Licensing of Nursing Facilities (R23-17-NF), Rules and Regulations for Licensing
Rehabilitation Hospital Centers (R23-17-REHAB) and the Rules and Regulations for Licensing
Assisted Living Residences (R23-17.4-ALR) promulgated by the Department of Health and filed with
the Rhode Island Secretary of State.
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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
6
Medication Aides
7
4.0
Licensure by Examination
9
5.0
Issuance and Renewal of Registration and Fee
9
6.0
Denial, Suspension, Revocation, of Registration and Disciplinary Proceedings
12
PART III
Requirements Pertaining To Nursing Assistant Training Programs
14
7.0
Application for and Approval of Nursing Assistant Training Programs
14
8.0
Denial, Suspension or Revocation of Approval and Termination of Program
19
9.0
Advisory Board
19
PART IV
Confidentiality/Violations And Sanctions/ Practices And Procedures/Severability
10.0
Violations and Penalties
20
11.0
Rules Governing Practices and Procedures
20
12.0
Severability
20
Appendix I
21
Appendix II
24
Appendix III
26
Appendix IV
28
References
29
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 Health in accordance with the provisions of section 23-1-52 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 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
2
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 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
“Medication aide” means a nursing assistant who has had additional training in the
administration of medications and is registered with the Department as provided herein.
1.13
"Medication aide training program" means an organized course of classroom instruction and
clinical training, approved by the Director, that has as a major goal the preparation of individuals to
function as assistants to licensed nurses in the administration of medications, as provided herein.
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1.14
"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.
1.15
"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.
1.16 "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.
1.17 "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.
1.18
"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.
1.19
"Patient", as used herein, is synonymous with client and resident.
1.20
"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.
1.21
"PRN" means “as necessary.”
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1.22
“Registry” means the Department's licensure database that provides a mechanism to verify
currency of a nursing assistant’s registration.
1.23
"Supervision" means the provision of guidance for the accomplishment of a nursing assistant
activity by a professional nurse, practical nurse, physician or other appropriate health
professional duly licensed and/or certified as may be required by law.
1.23.1 "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.
1.23.2 "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: Nursing assistants
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
2.4
Nursing assistants shall be supervised by licensed 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.
2.5
A medication aide shall be supervised by a licensed nurse.
2.6
For the first three (3) months of employment, a registered nurse designated by the health care
facility, adult day services program, or assisted living residence, as appropriate, shall conduct
and document monthly evaluations (in accordance with the evaluation checklist of Reference
IV herein) of the medication aide who administers medication. After the first three (3) months,
5
the evaluation shall be conducted no less than quarterly. Copies of said evaluations shall be
placed in the medication aides’ personnel records.
Exemptions
2.7
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."
2.8
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.
General Requirements: Medication Aides
2.9
A person who is performing the duties of a medication aide as of the effective date of these
regulations shall have until July 1, 2008 to become registered with the Department as a
medication aide. Failure to meet this deadline shall require an individual to complete the training
program as provided in section 3.2 herein prior to registration.
2.10 A person who is performing the duties of a medication aide as of the effective date of these
regulations, but who is not registered with the Department as a nursing assistant, shall become
registered as a nursing assistant by July 1, 2010 in order to maintain a valid registration as a
medication aide.
2.11 A person who has never performed the duties of a medication aide and who seeks registration as a
medication aide on and after the effective date of these regulations shall first be registered as a
nursing assistant in accordance with the requirements stated herein.
2.12 Persons registered with the Department as medication aides may administer medications, as
provided herein, in nursing facilities, adult day services programs, and assisted living residences.
2.13 In accordance with section 23-17.9-2(3) of the Rhode Island General Laws, as amended, a
medication aide registration may be issued to any person who meets the requirements established
under the Act and the rules and regulations contained herein.
2.14 No person may serve as a medication aide without holding a valid medication aide registration
from the Department.
2.15 A medication aide applicant shall file with the Department an application for registration (see
below), shall be required to furnish such information as the Department may prescribe, and
simultaneously with the filing of said application, shall pay to the Department the required non-
6
refundable fee as set forth in the Rules and Regulations Pertaining to the Fee Structure for
Licensing, Laboratory and Administrative Services Provided by the Department of Health.
2.16 All registrations issued to medication aides shall be valid for a period of two {2} years.
Provided, however, if a person is registered as both a nursing assistant and a medication aide, one
registration shall be issued for each function that shall expire on the same date.
2.17 A medication aide shall wear a name tag that indicates the aide's name and the appropriate
registration designation.
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.
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.
Qualification for Registration as a Medication Aide
3.2
An applicant for registration as a medication aide shall:
a)
have satisfied the Department that he/she is of good moral and professional character;
b)
be 18 years of age or older;
c)
be a high-school graduate or the equivalent;
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d)
not have been convicted of any felony for violations involving controlled substances (subject
to waiver by the Department upon presentation of satisfactory evidence that such conviction
does not impair the ability of the person to conduct with safety to the public the duties of a
medication aide);
e)
provide proof of demonstrated competency in medication administration from the nursing
facility, adult day services program, or assisted living residence where the person is
performing the duties of a medication aide;
f)
provide proof of successful completion of a Department-approved medication aide training
program defined in sections 3.4—3.9 herein.
Duties and Responsibilities of a Medication Aide
3.3
A medication aide may perform only those tasks and duties for which he/she has been trained
and in which there is documentation of proficiency, as determined by the supervising licensed
nurse, but in no case shall ever exceed what is permitted by regulation, law, scope of practice,
or as set forth in Appendix III herein.
Application For Registration
Nursing Assistants
3.4
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.
3.5
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 as set forth in the Rules and Regulations Pertaining
to the Fee Structure for Licensing, Laboratory and Administrative Services Provided by
the Department of Health; 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 set forth in the Rules and Regulations Pertaining to
the Fee Structure for Licensing, Laboratory and Administrative Services Provided by
8
the Department of Health;
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) 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 3.5, 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 3.5, subsections (a)(c) and (d).
Medication Aides
3.6
Application for a Rhode Island certificate of registration as a medication aide shall be made on
forms provided by the Department. Said forms shall be completed and notarized.
3.7
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 medication aide training
program (shall include signature of registered nurse who evaluates the medication aide at
the health care facility);
c)
the non-refundable application fee as set forth in the Rules and Regulations Pertaining to
the Fee Structure for Licensing, Laboratory and Administrative Services Provided by the
Department of Health; personal checks shall not be accepted.
9
d)
Full Bureau of Criminal Investigation (BCI) check from the Rhode Island Attorney
General’s Office only.
Section 4.0
Licensure by Examination: Nursing Assistants
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 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 and/or medication aide 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 and/or
medication aide so registered who is to renew his or her registration shall file with the Department
such renewal application together with the renewal fee as set forth in the Rules and Regulations
Pertaining to the Fee Structure for Licensing, Laboratory and Administrative Services
Provided by the Department of Health 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.
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5.4
Any nursing assistant and/or medication aide 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 as set forth in the Rules and Regulations Pertaining to
the Fee Structure for Licensing, Laboratory and Administrative Services Provided by the
Department of Health unless the registration has been suspended or revoked.
5.5
A nursing assistant 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.
5.6
A medication aide applicant seeking renewal shall have been employed as a medication aide for
at least eight (8) hours within the prior twenty-four (24) months; or have completed a
medication aide training program within the past twenty-four (24) months.
5.7
A nursing assistant 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.
5.8
A medication aide applicant seeking renewal shall have been employed as a medication aide in a
Rhode Island-licensed nursing 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; or an adult day
services program licensed under the provisions of Chapter 42-66 of the Rhode Island General
Laws, as amended.
5.9
Any nursing assistant and/or medication aide 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 training
and/or medication aide training program, and all required examinations, prior to being reinstated as
a nursing assistant and/or medication aide..
5.10
A nursing assistant applicant seeking renewal shall have his/her employment verified by the
employer on the renewal form provided by the Department.
Continuing Education Requirements: Medication Aides
5.11
Beginning with the 1 July 2010 renewal period, every medication aide seeking renewal of a license
under the provisions of the Act and the rules and regulations herein shall provide satisfactory
evidence to the Department that in the preceding two (2) years the licensee has completed four (4)
required continuing education hours as established in this section.
5.12
Continuing education hours related to medication administration will be accepted by the Board for
course work that has been presented, accepted, or approved by recognized professional nursing
organizations, schools of pharmacy, health care facilities, employing organizations, or other
11
professional, labor organization, or accrediting agency as may be approved by the Board.
5.13
At the time of license renewal, each medication aide will be required to sign a statement attesting
to the completion of the above continuing education requirements.
5.14
It shall be the sole responsibility of the individual medication aide to obtain documentation (e.g.,
course descriptions, proof of attendance) from the sponsoring organization, agency, or institution
of his/her participation in a continuing education program and/or activity. These documents shall
be retained by each licensee for no less than four (4) years and are subject to random audit by the
Department.
5.15
Failure to produce satisfactory documentation of completion of the requirements of this section,
upon request by the Board, constitutes grounds for disciplinary action under the provisions of the
Act.
Removal of Name from Nurse Aide Registry
5.16
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.
5.17
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 5.16 (above).
5.18
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 Nursing Assistant License
5.19
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;
12
Photocopy of active license/registration from the state where employed as a
nursing assistant;
Reinstatement processing fee as set forth in the Rules and Regulations
Pertaining to the Fee Structure for Licensing, Laboratory and Administrative
Services Provided by the Department of Health;
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;
Verification from current state of licensure that the applicant for reinstatement is
and has been in good standing in that jurisdiction.
Section 6.0 Denial, Revocation or Suspension of Registration/Disciplinary Proceedings: Nursing
Assistants and Medication Aides
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 and/or medication aide is unfit or incompetent by
reason of negligence, habits or other causes;
b)
upon proof that such nursing assistant and/or medication aide 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 and/or medication aide services;
c)
upon proof that such nursing assistant and/or medication aide 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 and/or medication aide 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.
13
Practices and Procedures
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.
14
PART II
Section 7.0 Application for and Approval of Training Programs
7.1
Approval of training programs 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 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 training program certification shall be as set forth in the Rules and
Regulations Pertaining to the Fee Structure for Licensing, Laboratory and Administrative Services
Provided by the Department of Health. 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 Nursing Assistant 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 1.23 herein.
7.5
A nursing assistant training program conducted in a health care facility shall be completed within
ninety (90) days.
7.6
The course of instruction shall be designed to prepare students to perform all the nursing assistant
15
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
1.23 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:
a)
classroom, offices, and conference rooms accessible to and adequate for the number of
students;
16
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:
a)
communication and interpersonal skills;
b)
infection control;
c)
safety emergency procedures;
d)
promotion of patients' independence;
17
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.
Standards for Medication Aide Training Program Approval
7.16
Medication aide training programs shall be offered by a college or university that is approved
by an appropriate accrediting authority. Correspondence courses and on-line learning programs
shall not be approved.
7.17
Approval of a medication aide 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.
7.18
Training programs for medication aides that are approved by the Department shall include the
following components:
a)
Require written documentation for entry into the medication aide training program from
a director of nursing or an administrator at an adult day services program, nursing
facility, or assisted living residence licensed in Rhode Island;
b)
A minimum of forty-five (45) hours of classroom instruction in a medication
administration training program that includes theoretical and practical instruction;
c)
Skills demonstration, performed within one (1) year of successful completion of the
medication aide training program, under the supervision of a registered nurse and
approval of a registered nurse in the employing facility;
d)
Written guidelines, policies, and procedures that define the specific tasks the
medication aide shall be expected to perform;
e)
A stipulation of how the medication aide's competency is to be assessed (i.e.,
examination and practicum).
Curriculum for a Department-approved Training Program for Medication Aides
7.19
Training programs for medication aides that are approved by the Department shall include, but not
18
be limited to, the following course content:
Legal constraints;
Dose forms;
Laxatives, vitamins, cold and cough remedies, and other over-the-counter drugs
Psychiatric medications;
Antidiabetic and antiemetic drugs;
Asthma and chronic obstructive pulmonary disease (COPD);
Hormones (including steroids);
Antibiotics;
Systems of measurement and medical abbreviations;
Anti-Parkinson drugs and muscle relaxers;
Cardiac drugs;
Seizures and pain.
Communication techniques;
Security and safety of drugs;
Glossary of terms;
Drug orders;
Over –the-counter and legend medications;
Common side effects of drugs;
Drug administration preparation;
Prescribers;
Directions for use;
Commonly-used abbreviations and symbols;
Number of dosage units;
Strengths and systems of measurement;
Routes of administration;
Frequency of administration;
Interpreting directions for use;
Infection control procedures;
Patient instruction;
Calculations and conversions;
Administration of topical medications;
Patient monitoring of health indicators;
“Five rights” of medication administration: right patient, right drug, right dose, right
time, and right route of administration;
Proper documentation in patient medication records;
Accurate administration of the appropriate quantity of drug product.
Personnel for a Department-approved Training Program for Medication Aides
7.20
All instructors in a Department-approved training program for medication aides shall be licensed
pharmacists (R.Ph.) with no less than a bachelor’s degree in pharmacy. Provided, however,
pharmacist instructors may engage competent resource personnel from other health fields, such as
nursing, to deliver discrete lectures in their area(s) of expertise.
7.21
Instructors shall have completed a course in teaching adults or have experience in teaching adults
and shall have at least one (1) year of experience in their respective fields.
19
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, five (5) of whom shall be registered nurses, one
(1) of whom shall be a nursing assistant, two (2) of whom shall be administrators of health care
facilities, one (1) of whom shall be a public member, and two (2) of whom shall be licensed
practical nurses. All Board members shall be currently licensed in Rhode Island, where required,
and shall be actively working in his/her profession.
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.
20
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, medication aides and the practice of nursing assistants and
medication aides. 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
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.
21
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
Restraining and use of appropriate alternatives
Transfer from bed, wheel chair, chair, commode
22
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 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
23
Vaginal Irrigations
Cutting toenails
Giving advice on medical/nursing matters
Any treatment to non-intact skin
Changing a Foley catheter
Oxygen application
Tracheostomy tube care
Medications: may only remind patient to take medication, unless he or she is registered with the
Department as a medication aide 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.
24
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
Basic Nutrition
Food and nutrition
25
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
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.
26
Appendix III
DUTIES OF MEDICATION AIDES:
Medication aides shall consistently apply the community standard of care that includes but is
not limited to:
(a) Establish competency as a medication aide;
(b) Maintain competency as a medication aide;
(c) Perform within authorized duties;
(d) Follow written instructions of a licensed health care professional authorized to prescribe
medications within the scope of his/her practice and as transcribed in the medication
administration record (MAR); and
(e) Accurately record on the medication administration record (MAR) medications
administered, medications withheld or refused, and the reason why a medication was
withheld or refused.
A medication aide duly registered in this state may discharge the following duties under
supervision, as described herein:
Under the supervision of a licensed nurse, medication aides may administer:
(a) Oral, sublingual and buccal medications;
(b) Eye medications;
(c) Ear medications;
(d) Nasal medications;
(e) Rectal medications;
(f) Vaginal medications;
(g) Skin ointments, topical medications including patches and transdermal medications to intact
skin only;
(h) Premeasured medication delivered by aerosol/nebulizer; and
(i) Medications delivered by metered hand-held inhalers.
Under the direct supervision of a licensed nurse, medication aides may apply oxygen.
Administration of PRN Medications
Medication aides may administer PRN medications to clients according to physician's, nurse
practitioner's, or physician assistant’s orders.
Medication aides may not administer medications by the following routes:
(a) Central lines;
27
(b) Colostomy;
(c)Intramuscular;
(d) Intrathecal;
(e) Intravenous;
(f) Via any tubes (e.g., Nasogastric, gastrostomy)
(g)Subcutaneous;
(h) Intradermal;
(i) Urethral;
(j) Epidural; or
(k)Endotracheal.
Medication aides may not administer the following kinds of medications:
(a) Schedule II controlled substances;
(b) Barium and other diagnostic contrast media; or
(c) Chemotherapeutic agents, except oral maintenance chemotherapy.
Medication aides may not administer medication by medication pumps, including client-
controlled analgesia.
Medication aides may not act as a preceptor to a student in a medication aide training program.
28
APPENDIX IV:
Medication Aide Technique Evaluation Checklist
Yes
No
Remarks
L MEDICATION(s)
1. Understands the order as written on medication sheet and
med card.
2. Brings med sheet or card to med room, closet or cart.
3. Washes hands.
4. Identifies medication container with med sheet or card.
5. Removes medication from shelf or cart.
6. Compares medication label with med sheet or card.
7. Determines dosage and proper amount of medication to
pour.
8. Pours without touching medication.
9. Compares medication label with card or med sheet.
10.
Keeps poured medication and med sheet or card together.
11.
Returns medication to shelf or cart.
LIQUID MEDICATION(s)
12.
Proceeds as for oral medication. Items # 1 – 8 above.
13.
Holds medication with label turned toward palm of hand.
14.
Holds med cup with liquid at eye level to measure.
15.
Wipes bottle before returning to shelf or cart.
16.
Locks medication room, closet, or cart when done.
INPATIENT AREAS
17.
Identifies patient thoroughly.
18.
Offers medication and water.
19.
Remains with patient until medication is swallowed.
20.
Charts correctly.
GENERAL COMMENTS:
SIGNATURES:
Date Completed:
R.N.:
Facility:
Medication Aide:
29
REFERENCES
1.
"Registration of Nursing Assistants", Chapter 23-17.9 of the General Laws of Rhode Island, as
amended. Available online:
http://www.rilin.state.ri.us/Statutes/TITLE23/23-17.9/INDEX.HTM
2.
"Licensing of Health Care Facilities", Chapter 23-17 of the General Laws of Rhode Island, as
amended. Available online:
http://www.rilin.state.ri.us/Statutes/TITLE23/23-17/INDEX.HTM
3.
"Confidentiality of Health Care Information Act," Chapter 5-37.3 of the General Laws of Rhode
Island, as amended. Available online:
http://www.rilin.state.ri.us/Statutes/TITLE5/5-37.3/INDEX.HTM
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. Available online:
http://www2.sec.state.ri.us/dar/regdocs/released/pdf/DOH/DOH_2945.pdf
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." Available online:
http://www.rilin.state.ri.us/Statutes/TITLE16/16-40/INDEX.HTM
7.
Rules and Regulations Related to Pain Assessment (R5-37.6-PAIN), Rhode Island Department
of Health, May 2003 and subsequent amendments thereto. Available online:
http://www2.sec.state.ri.us/dar/regdocs/released/pdf/DOH/DOH_2531.pdf
8.
Rules and Regulations for the Licensing of Nurses and Standards for the Approval of Basic
Nursing Education Programs (R5-34-NUR/ED), Rhode Island Department of Health, June
2007 and subsequent amendments thereto.
Available online: http://www2.sec.state.ri.us/dar/regdocs/released/pdf/DOH/4666.pdf
NursingAsst_Final_Sept2012.doc
Monday, 17 September 2012