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H7740A
2026 -- H 7740 SUBSTITUTE A
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LC005183/SUB A/2
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STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
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A N A C T
RELATING TO BUSINESSES AND PROFESSIONS -- NURSES
Introduced By:
Representatives McNamara, Corvese, and Chippendale
Date Introduced:
February 12, 2026
Referred To:
House Health & Human Services
It is enacted by the General Assembly as follows:
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SECTION 1. Chapter 5-34 of the General Laws entitled "Nurses" is hereby amended by
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adding thereto the following section:
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5-34-3.1. Administration of deep sedation and general anesthesia.
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(a) Applicability.
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This section applies solely to nursing practice authority arising under chapters 34 and 34.2
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of title 5 and shall not be construed to regulate, restrict, define, expand, diminish, supersede, or
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otherwise affect the scope of practice, licensure authority, delegated authority, credentialing,
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privileging, supervision, or lawful professional activities of any healthcare professional licensed
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under any other chapter of title 5.
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(b) Nursing limitations relating to elective deep sedation and general anesthesia.
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(1) A registered nurse or nurse practitioner who is not licensed as a certified registered
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nurse anesthetist pursuant to chapter 34.2 of title 5 shall not administer, initiate, titrate, bolus, or
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maintain medications classified as general anesthetics for inducing or maintaining procedural deep
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sedation or general anesthesia for elective, scheduled, non-emergent procedures outside of
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emergency, urgent, resuscitative, trauma, critical care, or urgent bedside procedural circumstances
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where delay would materially risk patient health or safety.
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(2) Nothing in this section shall be construed to prohibit a registered nurse enrolled as a
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bona fide student in a nurse anesthesia program approved by the Council on Accreditation of Nurse
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Anesthesia Educational Programs (COA), or its successors or predecessors, from participating in
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the administration of deep sedation or general anesthesia when acting under the supervision of a
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certified registered nurse anesthetist or anesthesiologist
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(c) Moderate sedation and sedation continuum protections.
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(1) Nothing in this section shall be construed to prohibit a registered nurse or nurse
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practitioner from participating in or administering minimal sedation or moderate sedation
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consistent with lawful scope of practice, credentialing, institutional privileges, professional
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standards, and facility policies;
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(2) The general assembly recognizes that sedation exists along a clinical continuum and
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that patients may transition between levels of sedation despite the practitioner’s intended sedation
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target.
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(3) Moderate sedation shall include the clinical practice of initiating, administering, and
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titrating sedative medications in response to patient condition and procedural needs, including
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circumstances in which a patient transiently or unplanned enters a deep sedation; provided,
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however, that nothing in this subsection shall be construed to authorize conduct prohibited by
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subsection (b)(1) of this section.
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(4) A transient or unplanned progression to a deep sedation during lawful moderate
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sedation practice shall not, standing alone, constitute the unlawful administration of elective deep
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sedation or general anesthesia under this section.
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(d) Definitions.
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For purposes of this section, the terms “minimal sedation,” “moderate sedation,” “deep
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sedation” and “general anesthesia” shall have the meanings and clinical interpretations assigned to
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those terms under applicable Joint Commission standards governing the provision of sedation and
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anesthesia services.
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(e) Construction.
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(1) Nothing in this section shall be interpreted, construed, or applied to:
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(i) Narrow, diminish, supersede, amend, redefine, impair, or otherwise affect the scope of
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practice, licensure authority, delegated authority, clinical authority, credentialing authority,
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privileging authority, supervision authority, or lawful professional activities of any healthcare
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professional licensed under any chapter of title 5 other than chapters 34 and 34.2;
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(ii) Restrict emergency stabilization obligations under state or federal law;
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(iii) Prevent hospitals or licensed healthcare facilities from establishing additional
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credentialing, privileging, supervision, staffing, patient safety, or clinical practice requirements;
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(iv) Create any negative inference regarding the preexisting lawful authority of licensed
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clinicians to administer sedating medications within applicable scope of practice, delegated
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authority, institutional privileges, or facility policies; or
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(v) Amend, limit, supersede, expand, or otherwise alter the licensure authority, scope of
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practice, credentialing authority or professional practice standards applicable to certified registered
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nurse anesthetists under chapter 34.2 of title 5.
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(2) Nothing in this section shall permit facility credentialing, privileging, delegated
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authority, standing orders, supervision arrangements, protocols, policies, or medical staff bylaws
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to authorize a registered nurse or non-CRNA nurse practitioners to engage in conduct prohibited
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by subsection (b) of this section.
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(3) This section and chapter 34.2 of title 5 shall be construed harmoniously so as to preserve
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the lawful authority of certified registered nurse anesthetists while clarifying limitations applicable
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to nursing practice under this chapter.
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(f) The department of health shall promulgate rules and regulations necessary to implement
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the provisions of this section no later than January 31, 2027, and shall report to the general assembly
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regarding implementation issues, including but not limited to access to care, workforce shortages,
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procedural delays, cancelled elective procedures, patient safety considerations, operational impacts
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on hospitals and healthcare facilities, and all reportable patient incidents no later than January 31,
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2028. Pursuant to § 23-17-40(f)(15) a reportable incident includes an unplanned progression to
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deep sedation or general anesthesia resulting in the insertion of a supraglottic airway, endotracheal
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intubation, unplanned hospital admission, transfer to a high level of care, cardiac arrest, permanent
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neurologic injury or death, excluding certified registered nurse anesthetists, physicians privileged
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in procedural sedation and all physicians in the specialties of emergency medicine, anesthesiology,
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and critical care.
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SECTION 2. Section 23-17-40 of the General Laws in Chapter 23-17 entitled "Licensing
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of Healthcare Facilities" is hereby amended to read as follows:
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23-17-40. Hospital and freestanding emergency-care facility events reporting.
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(a) Definitions. As used in this section, the following terms shall have the following
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meanings:
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(1) “Adverse event” means injury to a patient resulting from a medical intervention, and
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not to the underlying condition of the patient.
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(2) “Checklist of care” means predetermined steps to be followed by a team of healthcare
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providers before, during, or after a given procedure to decrease the possibility of adverse effects
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and other patient harm by articulating standards of care.
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(b) Reportable events as defined in subsection (c)
of this section
shall be reported to the
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department of health division of facilities regulation on a telephone number maintained for that
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purpose. Hospitals and freestanding emergency-care facilities shall report incidents as defined in
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subsection (c)
of this section
within twenty-four (24) hours of when the accident occurred or, if
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later, within twenty-four (24) hours of receipt of information causing the hospital or freestanding
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emergency-care facility to believe that a reportable event has occurred.
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(c) Reportable events are defined as follows:
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(1) Fires or internal disasters in the facility that disrupt the provisions of patient-care
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services or cause harm to patients or personnel;
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(2) Poisoning involving patients of the facility;
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(3) Infection outbreaks as defined by the department in regulation;
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(4) Kidnapping and inpatient psychiatric elopements and elopements by minors;
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(5) Strikes by personnel;
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(6) Disasters or other emergency situations external to the hospital or freestanding
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emergency-care facility environment that adversely affect facility operations; and
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(7) Unscheduled termination of any services vital to the continued safe operation of the
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facility or to the health and safety of its patients and personnel.
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(d) Any hospital or freestanding emergency-care facility filing a report with the attorney
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general’s office concerning abuse, neglect, and mistreatment of patients, as defined in chapter 17.8
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of this title, shall forward a copy of the report to the department of health. In addition, a copy of all
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hospital notifications and reports made in compliance with the federal Safe Medical Devices Act
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of 1990, 21 U.S.C. § 301 et seq., shall be forwarded to the department of health within the time
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specified in the federal law.
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(e) Any reportable incident in a hospital that results in patient injury, as defined in
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subsection (f)
of this section
, shall be reported to the department of health with seventy-two (72)
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hours or when the hospital has reasonable cause to believe that an incident, as defined in subsection
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(f)
of this section
, has occurred. The department of health shall promulgate rules and regulations to
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include the process whereby healthcare professionals with knowledge of an incident shall report it
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to the hospital; requirements for the hospital to conduct a root-cause analysis of the incident or
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other appropriate process for incident investigation and to develop and file a performance-
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improvement plan; and additional incidents to be reported that are in addition to those listed in
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subsection (f)
of this section
. In its reports, no personal identifiers shall be included. The hospital
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shall require the appropriate committee within the hospital to carry out a peer-review process to
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determine whether the incident was within the normal range of outcomes, given the patient’s
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condition. The hospital shall notify the department of the outcome of the internal review, and if the
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findings determine that the incident was within the normal range of patient outcomes, no further
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action is required. If the findings conclude that the incident was not within the normal range of
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patient outcomes, the hospital shall conduct a root-cause analysis or other appropriate process for
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incident investigation to identify causal factors that may have lead to the incident and develop a
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performance-improvement plan to prevent similar incidents from occurring in the future. The
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hospital shall also provide to the department of health the following information:
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(1) An explanation of the circumstances surrounding the incident;
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(2) An updated assessment of the effect of the incident on the patient;
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(3) A summary of current patient status, including follow-up care provided and post-
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incident diagnosis;
and
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(4) A summary of all actions taken to correct identified problems to prevent recurrence of
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the incident and/or to improve overall patient care and to comply with other requirements of this
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section.
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(f) Incidents to be reported are those causing or involving:
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(1) Brain injury;
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(2) Mental impairment;
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(3) Paraplegia;
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(4) Quadriplegia;
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(5) Any type of paralysis;
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(6) Loss of use of limb or organ;
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(7) Hospital stay extended due to serious or unforeseen complications;
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(8) Birth injury;
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(9) Impairment of sight or hearing;
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(10) Surgery on the wrong patient;
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(11) Subjecting a patient to a procedure other than that ordered or intended by the patient’s
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attending physician;
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(12) Any other incident that is reported to their malpractice insurance carrier or self-
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insurance program;
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(13) Suicide of a patient during treatment or within five (5) days of discharge from an
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inpatient or outpatient unit (if known);
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(14) Blood transfusion error;
and
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(15) An unplanned progression to deep sedation or general anesthesia resulting in the
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insertion of a supraglottic airway, endotracheal intubation, unplanned hospital admission, transfer
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to a higher level of care, cardiac arrest, permanent neurologic injury or death, excluding certified
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registered nurse anesthetists, physicians privileged in procedural sedation and all physicians in the
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specialties of emergency medicine, anesthesiology, and critical care; and
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(15)
(16)
Any serious or unforeseen complication, that is not expected or probable, resulting
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in an extended hospital stay or death of the patient.
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(g) This section does not replace other reporting required by this chapter.
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(h) Nothing in this section shall prohibit the department from investigating any event or
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incident.
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(i) All reports to the department under this section shall be subject to the provisions of §
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23-17-15. In addition, all reports under this section, together with the peer-review records and
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proceedings related to events and incidents so reported and the participants in the proceedings, shall
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be deemed entitled to all the privileges and immunities for peer-review records set forth in § 23-
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17-25.
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(j) The department shall issue an annual report by March 31 each year providing aggregate,
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summary information on the events and incidents reported by hospitals and freestanding
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emergency-care facilities as required by this chapter. A copy of the report shall be forwarded to the
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governor, the speaker of the house, the senate president, and members of the health care quality
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steering committee established pursuant to § 23-17.17-6.
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(k) The director shall review the list of incidents to be reported in subsection (f) at least
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biennially to ascertain whether any additions, deletions, or modifications to the list are necessary.
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In conducting the review, the director shall take into account those adverse events identified on the
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National Quality Forum’s List of Serious Reportable Events. In the event the director determines
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that incidents should be added, deleted, or modified, the director shall make such recommendations
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for changes to the legislature.
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SECTION 3. This act shall take on January 1, 2027.
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO BUSINESSES AND PROFESSIONS -- NURSES
***
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This act would provide and clarify procedures for the administration of deep sedation and
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general anesthesia by certain types of nurses.
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This act would take on January 1, 2027.
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