2024 -- S 3035 SUBSTITUTE A

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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 -- 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. Chapter 5-34.2 of the General Laws entitled "Nurse Anesthetists" is hereby

amended by adding thereto the following section:

     5-34.2-2.1 Safe administration of sedation.

     (a) Registered nurses (RNs) and advanced practice registered nurses (APRNs), other than

licensed certified registered nurse anesthetists (CRNAs), as defined in this chapter, and RNs

enrolled in a nurse anesthesiology training program approved by the Council on Accreditation of

Nurse Anesthesia Educational programs (COA) or its predecessors or successors, shall not

administer agents that are primarily used and classified as general anesthetics for minimal,

moderate, deep sedation, or general anesthesia, including, but not limited to, ketamine, propofol,

etomidate, sodium thiopental, methohexital, dexmedetomidine, or volatile gases (e.g. sevoflurane,

isoflurane, desflurane), except as otherwise authorized in this section, nor shall they administer or

manage deep sedation or general anesthesia for any diagnostic, therapeutic, or surgical procedures

using any drug or medication.

     (b) For situations requiring the immediate and emergent facilitation of airway management

(rapid sequence intubation) or to maintain sedation for tracheally intubated and mechanically

ventilated patients, an RN or APRN may initiate, titrate, and bolus intravenous/intraosseous (IV/IO)

agents if a CRNA, other qualified anesthesia provider, or a qualified emergency room, intensive

care, or other physician trained in airway management acting within their scope of practice and

approved by their governing body is immediately present and available if needed to secure the

airway.

     (c) Nothing in this section shall prohibit:

     (1) The administration of local infiltration anesthesia, digital blocks or pudendal blocks by

an APRN acting within the scope of their education and training;

     (2) The injection of local anesthetic agents under the skin or application of topical

anesthetic agents by a RN or APRN when prescribed by a qualified physician, dentist, or APRN

with prescriptive authority who is licensed to practice in this state; provided, however, other than

intravenous administration of lidocaine, this provision shall not permit a registered nurse to

administer local anesthetics perineurally, peridurally, epidurally, intrathecally, or intravenously, or;

     (3) The administration and/or titration of propofol, ketamine, or dexmedetomidine to

emergency room or intensive care unit patients who are being sedated and are tracheally intubated,

by a RN or APRN acting within the scope of their education and training.

     SECTION 2. Chapter 5-34 of the General Laws entitled "Nurses" is hereby amended by

adding thereto the following section:

     5-34-3.1 Safe administration of sedation.

     Certified nurse practitioners, registered nurses (RNs), and advanced practice registered

nurses, who do not hold a valid license or accreditation, other than RNs enrolled in a COA approved

training program, shall not administer deep sedation or general anesthesia for any diagnostic,

therapeutic, or surgical procedure using any drug or medication. The position of "Anesthesia

Sedation Nurse Practitioner", so called, is not a recognized subspecialty of the nurse practitioner

profession.

     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 -- NURSE ANESTHETISTS

***

     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, generally, within

the "scope of practice" of nurse practitioners as defined in § 5-34-3 and would restrict the

administration of anesthesia medication to licensed registered nurse anesthetists with certain

exceptions.

     This act would take effect upon passage.

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