216 R.I. Code R. 216-RICR-40-05-22.12

Current through December 26, 2024

Section 216-RICR-40-05-22.12 - Duties and Training Program Curriculum

22.12.1Duties of Nursing Assistants

A. A nursing assistant duly registered in this State may discharge the following duties under supervision as described in this Part.

1. Personal Care Skills

a. Assist with complicated feeding, hydration

b. Bed bath, tub bath, shower

c. Care of skin and back

d. Foot care, foot soak, applying foot lotion

e. Nail care

f. Oral hygiene

g. Shampoo hair (sink, tub, bed) comb/brush

h. Shave

2. Basic Nursing Skills

a. Application of dry heat and cold packs to intact skin

b. Sitz bath to intact skin for comfort measures and pain relief only

c. Application of topical over-the-counter (OTC) drugs to intact skin

d. Apply lamb's wool

e. Apply elastic stockings

f. Care of patients on precautions

g. Make an occupied, unoccupied bed

h. Measure intake and output

i. Reinforce simple non-sterile dressings

j. Remind patient to take medication

k. Care for a patient when death is imminent

l. Post-mortem care

m. Specimen collection

n. Apply condom catheter

o. Empty catheter bag, commode, urinal

p. Assist with ostomy appliance

q. Assist with commode, toilet, bedpans and urinals

r. Change urinary drainage bag, excluding any sterile procedures

s. Assist with bowel/bladder retraining

t. Report and record weight and height

u. Take and record vital signs (temperature, pulse, and respiration (TPR) and blood pressure)

3. Rehabilitation Skills

a. Ambulate

b. Encourage self-help

c. Positioning

d. Normal range of motion

e. Restraining and use of appropriate alternatives

f. Transfer from bed, wheel chair, chair, commode

g. Transfer using mechanical lift

h. Use of assistive devices in ambulation, eating and dressing

4. Environment

a. Care of patient environment

b. Handling of blood/body fluid spills

c. Clean patient care area

d. Do basic domestic chores (e.g., laundry, ironing, dishes, food preparation, where appropriate)

5. Recognition of and Reporting Signs and Symptoms

a. Infection

b. Redness

c. Swelling

d. Fever, chills

e. Drainage

6. Respiratory Problems

a. Shortness of breath

b. Rapid respirations

c. Cheyne-Stokes respirations

d. Cough

7. Cardiac Problems

a. Chest pains

b. Cyanosis lips/nails

c. Rapid pulse

8. GI/GU problems

a. Abdominal pain

b. Nausea

c. Vomiting blood

d. Urine/stool: difficulty urinating; diarrhea

9. Endocrine problems

a. Drowsiness

b. Thirst

c. Sweating

B. Duties Which a Nursing Assistant May Perform Under Direct Supervision:

1. Enema

2. Colostomy irrigation

3. Application of hot packs using moist heat device or heat lamp

4. In addition, nursing assistants may be assigned nursing duties beyond those listed in §§22.12.1(A) and (B) of this Part (but in no case may they may be assigned any of the duties excluded in §22.12.1(C), 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.

C. Excluded from the Duties of a Nursing Assistant

1. 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:

a. Sterile dressing application

b. Gastric lavage or gavage, including any tube feeding

c. Injections

d. Vaginal Irrigations

e. Cutting toenails or fingernails for diabetic

f. Cutting toenails

g. Giving advice on medical/nursing matters

h. Changing a Foley catheter

i. Tracheostomy tube care

j. Any treatment to non-intact skin

k. Oxygen application

D. Medications

1. A nursing assistant may only remind a patient to take medication, unless the nursing assistant is licensed with the Department as a medication aide.

2. Medication aides shall not administer drugs or biologicals under any circumstances in an acute care setting, and shall not administer any Schedule II controlled substances.

22.12.2Curriculum Outline Basic Nursing Assistant Training Program

A. Minimum requirement of:

1. Eighty (80) classroom hours

2. Forty (40) hours of practical experience

B. Being A Nursing Assistant - Introduction

1. Function of the nursing assistant

a. In health care institutions

b. In the home

2. Working with the health care team

3. Ethical responsibilities

a. Accountability

b. Confidentiality

4. Policies and procedures

5. State Rules and Regulations related to the registration of nursing assistants

6. Communication and interpersonal skills

7. Infection control

8. Safety/emergency procedures

9. Promoting patients' independence

10. Respecting patients' rights

C. Basic Human Needs

1. Patients as human beings

a. Physical, emotional, spiritual and mental health needs of patients throughout the life cycle

b. Modifying the nursing assistant's behavior in response to patient's behavior

c. Identifying developmental tasks associated with the life cycle

d. Behavior management (reinforcement, reduction, elimination of behaviors)

e. Allowing maximum independence in relation to patient's ability

f. Working with the patient's family

D. Caring for Patients

1. Admission and discharge procedures

2. Personal care skills To include instruction relative to all those personal care duties outlined in §22.12.1 of this Part, which a nursing assistant may discharge under supervision.

3. Basic nursing skills:

a. Taking and recording vital signs

b. Measuring and recording vital signs

c. Caring for patient's environment

d. Observing, reporting and documenting abnormal signs and symptoms of common diseases

e. Caring for patients when death is imminent

f. Specimen collection (urine, stool, sputum)

g. Heimlich maneuver

4. Basic Nutrition: Food and nutrition

5. Fluid balance:

a. Intake and output

b. Maintaining proper hydration

E. Basic Restorative Services

1. Rehabilitation

a. Basic body mechanics

b. Anatomy/physiology

2. Training the patient in self-care, according to ability

3. Use of assistive devices in transferring, ambulation, eating and dressing

4. Maintenance of range of motion

5. Proper turning and positioning in bed and chair

6. Bowel and bladder training

7. Care and use of prosthetic and orthotic devices

F. Care of Patients with Specific Problems

1. The patient with cognitive impairment or other behavioral health conditions

a. Techniques for addressing the unique needs and behaviors of individuals with dementia (Alzheimer's disease and others)

b. Communicating with patients

c. Understanding behavior

d. Appropriate responses to behavior

e. Methods for reducing the effects of cognitive impairment

2. Care of patients with diseases of other body systems

a. Circulatory problems

b. Respiratory problems

c. Digestive system problems

d. Bowel and bladder problems

e. Musculoskeletal problems

f. Neurological problems

g. Endocrine problems

h. Skin problems

G. Patient's Rights

1. Privacy/confidentiality

2. The right to personal choices

3. Giving assistance in resolving grievances and disputes

4. Maximizing participation in resident and family groups

5. Maintaining care and security of personal possessions/property

6. Providing care which maintains the patient free from abuse

7. Reporting abuse, mistreatment and neglect

8. The use of restraints; avoiding the use of restraints

H. Practical Training

1. 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 §22.12.1 of this Part.

2. The practical training must be integrated with the didactic portion of the curriculum for a meaningful learning experience.

22.12.3Duties of Medication Aides

A. Medication aides shall consistently apply the community standard of care that includes but is not limited to:

1. Establish competency as a medication aide;

2. Maintain competency as a medication aide;

3. Perform within authorized duties;

4. Follow written instructions of a licensed health care professional authorized to prescribe medications within the scope of his or her practice and as transcribed in the medication administration record (MAR); and

5. Accurately record on the medication administration record (MAR) medications administered, medications withheld or refused, and the reason why a medication was withheld or refused.

B. A medication aide licensed in this State may discharge the following duties under supervision as described in this Part:

1. 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.

2. Under the direct supervision of a licensed nurse, medication aides may apply oxygen.

C. Administration of PRN Medications

1. Medication aides may administer PRN medications to clients according to physician's, nurse practitioner's, or physician assistant's orders.

2. Medication aides are not allowed to administer medications by the following routes:

a. Central lines;

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. Endotrachea.

3. Medication aides are not allowed to 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.

4. Medication aides are not allowed to administer medication by medication pumps, including client-controlled analgesia.

5. Medication aides are not allowed to act as a preceptor to a student in a medication aide training program.

216 R.I. Code R. 216-RICR-40-05-22.12

Adopted effective 5/21/2022
Amended effective 2/1/2023