2024 -- S 3035

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LC005994

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2024

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A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- NURSES -- NURSE ANESTHETISTS

     Introduced By: Senators F. Lombardi, Ciccone, Burke, Felag, Gallo, Rogers, and de la
Cruz

     Date Introduced: May 02, 2024

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 5-34-3 of the General Laws in Chapter 5-34 entitled "Nurses" is

hereby amended to read as follows:

     5-34-3. Definitions.

     As used in this chapter:

     (1) “Advanced practice registered nurse” (APRN) is the title given to an individual licensed

to practice advanced practice registered nursing within one of the following roles: certified nurse

practitioner (CNP), certified registered nurse anesthetist (CRNA) as defined in chapter 34.2 of this

title, or certified clinical nurse specialist (CNS), and who functions in a population focus. An APRN

may serve as a primary- or acute-care provider of record.

     (2) “Advanced practice registered nursing” means an independent and expanded scope of

nursing in a role and population focus approved by the board of nurse registration and nursing

education that includes the registered nurse scope of practice and may include, but is not limited

to, performing acts of advanced assessment, diagnosing, prescribing, and ordering. Each APRN is

accountable to patients, the nursing profession, and the board of nursing for complying with the

requirements of this chapter and the quality of advanced nursing care rendered; recognizing limits

of knowledge and experience; planning for the management of situations beyond the APRN’s

expertise; and for consulting with or referring patients to other healthcare providers as appropriate.

     (3) “Approval” means the process where the board of nursing evaluates and grants official

recognition to basic nursing education programs meeting established criteria and standards.

     (4) “Certified clinical nurse specialist” is an advanced practice registered nurse who

independently provides care to clients; facilitates attainment of health goals; and provides

innovation in nursing practice, based on clinical expertise, evidence-based decision-making, and

leadership skills. The clinical nurse specialist practices with individual clients and populations;

nurses, and other multidisciplinary team members; and organizations to effect systemwide changes

to improve programs of care. The practice may include prescriptive privileges.

     (5) “Certified nurse practitioner” is an advanced practice nurse utilizing independent

knowledge of physical assessment, diagnosis, and management of health care and illnesses. The

practice includes prescriptive privileges. Certified nurse practitioners are members of the healthcare

delivery system practicing in areas including, but not limited to: family practice, pediatrics, adult

health care, geriatrics, and women’s health care in primary, acute, long-term, and critical-care

settings in healthcare facilities and the community. Certified nurse practitioners may be recognized

as the primary-care provider or acute-care provider of record. Certified nurse practitioners are not

licensed or accredited in the formal and advanced training necessary to administer general

anesthesia. The position of "anesthesia sedation nurse practitioner", so called, is not a recognized

subspecialty of the nurse practitioner profession.

     (6) “Certified registered nurse anesthetist” is as defined in chapter 34.2 of this title (“Nurse

Anesthetist”).

     (7) “Department” means the department of health.

     (8) “Health” means optimum well-being.

     (9) “Health care” means those services provided to promote the optimum well-being of

individuals.

     (10) “Licensed” means the status of qualified individuals who have completed a designated

process by which the board of nursing grants permission to individuals accountable and/or

responsible for the practice of nursing and to engage in that practice, prohibiting all others from

legally doing so.

     (11) “Nursing” means the provision of services that are essential to the promotion,

maintenance, and restoration of health throughout the continuum of life. It provides care and

support of individuals and families during periods of wellness, illness, and injury, and incorporates

the appropriate healthcare plan of care prescribed by a licensed advanced practice registered nurse,

certified nurse midwife, licensed physician, dentist, or podiatrist. It is a distinct component of health

services. Nursing practice is based on specialized knowledge, judgment, and nursing skills acquired

through educational preparation in nursing and in the biological, physical, social, and behavioral

sciences.

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     (12) “Population foci” means focus of the patient population. Population focus shall

include:

     (i) Family/Individual across the lifespan;

     (ii) Adult-gerontology;

     (iii) Neonatal;

     (iv) Pediatrics;

     (v) Women’s health/gender-related; and

     (vi) Psychiatric/mental health.

     (13) “Practical nursing” is practiced by licensed practical nurses (L.P.N.s). It is an integral

part of nursing based on a knowledge and skill level commensurate with education. It includes

promotion, maintenance, and restoration of health and utilizes standardized procedures leading to

predictable outcomes that are in accord with the professional nurse regimen under the direction of

a registered nurse. In situations where registered nurses are not employed, the licensed practical

nurse functions under the direction of a licensed physician, dentist, podiatrist, or other licensed

healthcare providers authorized by law to prescribe. Each L.P.N. is responsible for the nursing care

rendered.

     (14) “Professional nursing” is practiced by registered nurses (R.N.s). The practice of

professional nursing is a dynamic process of assessment of an individual’s health status;

identification of healthcare needs; determination of healthcare goals with the individual and/or

family participation; and the development of a plan of nursing care to achieve these goals. Nursing

actions, including teaching and counseling, are directed toward the promotion, maintenance, and

restoration of health and evaluation of the individual’s response to nursing actions and the medical

regimen of care. The professional nurse provides care and support of individuals and families

during periods of wellness and injury and incorporates, where appropriate, the medical plan of care

as prescribed by a licensed physician, dentist, podiatrist, or other licensed healthcare providers

authorized by law to prescribe. Each R.N. is directly accountable and responsible to the consumer

for the nursing care rendered.

     (15) “Psychiatric and mental health nurse clinical specialist” is a certified clinical nurse

specialist working in the population foci of psychiatric/mental health as an advanced practice nurse

utilizing independent knowledge in psychiatric mental-health assessment; diagnosis, health

promotion, psychotherapeutic modalities, and management of mental health and illnesses. The

practice may include prescription privileges within their scope of practice. The practice may also

include consultation and education.

     SECTION 2. Section 5-34.2-2 of the General Laws in Chapter 5-34.2 entitled "Nurse

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Anesthetists" is hereby amended to read as follows:

     5-34.2-2. Definitions.

     (a) “Board” means the board of nurse registration and nurse education established in § 5-

34-4.

     (b) “Certified registered nurse anesthetist” (CRNA) means a registered nurse who has

successfully met the requirements stated in this chapter.

     (c) “Practice of certified registered nurse anesthesia” means providing certain healthcare

services in collaboration with anesthesiologists, licensed physicians, or licensed dentists in

accordance with § 5-31.1-1(17) which requires substantial specialized knowledge, judgment, and

skill related to the administration of anesthesia, including preoperative and postoperative

assessment of patients; administering anesthetics; monitoring patients during anesthesia;

management of fluid in intravenous therapy; and management of respiratory care. It also includes,

in connection with the immediate perioperative care of a patient, the ability to issue a medication

order for drugs or medications to be administered by a licensed, certified, or registered healthcare

provider; to order and evaluate laboratory and diagnostic test results and perform point-of-care

testing that the CRNA is qualified to perform; and order and evaluate radiographic imaging studies

that the CRNA is qualified to order and interpret. For the purposes of this section, the immediate

perioperative care of a patient shall be defined as the period commencing on the day prior to surgery

and ending upon discharge of the patient from post-anesthesia care. CRNAs shall comply with the

requirements set forth in this chapter, including § 5-34.2-5(b) regarding scope of practice, and the

requirements set forth in chapter 34 of this title, as applicable. In the case of any conflict between

this chapter and chapter 34 of this title with regard to the licensure and practice of CRNAs, this

chapter shall control. The elective and/or independent administration of propofol and all FDA

classified general anesthetics for any surgery or procedure is limited to licensed certified registered

nurse anesthetists, and is not within the "scope of practice" of nurse practitioners as defined in § 5-

34-3 which is prohibited.

     SECTION 3. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- NURSES -- NURSE ANESTHETISTS

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     This act would establish that the elective and/or independent administration of propofol,

and all FDA classified general anesthetics, for any surgery or procedure, is not within the "scope

of practice" of nurse practitioners as defined in § 5-34-3.

     This act would take effect upon passage.

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