Rhode Island Scope of Practice: Permitted, Direct-Supervision & Excluded Duties

Rhode Island Scope of Practice: Permitted, Direct-Supervision & Excluded Duties

Most states describe nurse-aide scope in generalities. Rhode Island itemizes it. Section 22.12.1 of 216-RICR-40-05-22 lists, by name, what a nursing assistant may do routinely, what may be done only under direct supervision, and what may never be done at all. Learn the lists — several items surprise people who trained in another state.

One definition first, because everything hinges on it (§ 22.3(A)(22)):

• Direct supervision — the supervisor is and remains on the premises, in the building, while you perform the duty, and evaluates your performance.
• Indirect supervision — the supervisor is not on the premises but is responsible for assigning your duties and evaluating your performance.

The facility decides which type applies to your ordinary work, except for the three duties below, which always require direct supervision.

Tier 1 — Duties You May Discharge Under Supervision

Personal care skills

Assist with complicated feeding and 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 and 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 and unoccupied bed
• Measure intake and output
• Reinforce simple non-sterile dressings
• Remind a 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 (TPR and blood pressure)

Rehabilitation skills

Ambulate · encourage self-help · positioning · normal range of motion · restraining and use of appropriate alternatives · transfer from bed, wheelchair, chair, commode · transfer using mechanical lift · use of assistive devices in ambulation, eating and dressing.

Environment

Care of the patient environment · handling of blood/body fluid spills · clean patient care area · basic domestic chores such as laundry, ironing, dishes, and food preparation where appropriate.

Recognition and reporting

Infection (redness, swelling, fever, chills, drainage) · respiratory problems (shortness of breath, rapid respirations, Cheyne-Stokes respirations, cough) · cardiac problems (chest pain, cyanosis of lips or nails, rapid pulse) · GI and GU problems (abdominal pain, nausea, vomiting blood, difficulty urinating, diarrhea) · endocrine problems (drowsiness, thirst, sweating).

💡 Things Rhode Island permits that surprise transplants. Applying a condom catheter and changing a urinary drainage bag (short of any sterile procedure) are routine duties here, as are reinforcing simple non-sterile dressings, applying topical OTC products to intact skin, giving a sitz bath to intact skin for comfort, and performing post-mortem care. Several states reserve some of these for licensed staff.

Tier 2 — Duties Requiring DIRECT Supervision

Section 22.12.1(B) lists exactly three:

Note the contrast with Tier 1: a dry heat pack on intact skin is routine; a moist heat device or heat lamp is direct-supervision-only. And note the ostomy split — assisting with an ostomy appliance is routine, but irrigating a colostomy is not.

Tier 3 — Excluded Duties

Section 22.12.1(C): a nursing assistant shall not perform functions that otherwise require a professional license, certification or registration and shall not perform, among others:

Medications

Section 22.12.1(D): a nursing assistant may only remind a patient to take medication, unless separately licensed by RIDOH as a Medication Aide.

The Medication Aide Boundary

A Medication Aide is a Rhode Island nursing assistant with additional training and a separate RIDOH license (§ 22.4(A)(2)). Note the title: Rhode Island licenses a Medication Aide, not a "medication technician" or "medication assistant."

What a Medication Aide may administer under supervision: oral, sublingual and buccal medications; eye, ear, nasal, rectal, and vaginal medications; skin ointments and topical medications including patches and transdermal products to intact skin only; premeasured medication by aerosol or nebulizer; and medications by metered hand-held inhaler. Under direct supervision, a Medication Aide may apply oxygen.

What a Medication Aide may never do: administer drugs or biologicals in an acute care setting; administer any Schedule II controlled substance; administer medications to patients who reside at home; or administer by central line and other prohibited routes.

What the Licensed Nurse Does That You Do Not

Refusing a Task and Expanding a Task

Refuse — immediately, directly, and with a stated reason — any task that is outside this scope, that you have not been trained and checked off on, that requires nursing judgment, or that is unclear or unsafe. Delegation cannot enlarge your legal scope, and a nurse's instruction does not make an excluded duty lawful.

Lawful expansion exists but is narrow. Section 22.12.1(B)(4) permits a facility to assign nursing duties beyond the standard lists — but never any duty excluded under (C) — only where:

1. The duties are clearly delineated in facility policies, and
2. Documented evidence of training and competency evaluation for each additional duty is filed in your personnel file.

No verbal, on-the-spot expansion is valid. If a supervisor asks you to do something not on the list and not in a written policy you have been trained and checked off on, the answer is no.

Two More Rhode Island Duties That Attach to You

• Pain assessment. All nursing assistants and medication aides must assess patient pain in accordance with the RIDOH Rules and Regulations Related to Pain Assessment (§ 22.5(C)).
• Title protection. No one may use the title "nursing assistant" or a similar title without a RIDOH license, and the only abbreviation a Rhode Island nursing assistant may use is "N.A." (§ 22.5(B)).