Regulations surrounding how certified registered nurse anesthetists can practice have been a hot-button issue in healthcare for years — and continues to be a contested one in 2024.
Policies regarding how independently CRNAs can practice vary by state, although national policy changes have been proposed. In 2019, CMS passed a provision allowing CRNAs "to perform the anesthetic risk and evaluation on the patient they are anesthetizing" in ASCs, and it allows them to review and verify notes in patient medical records rather than having to re-document them.
A recent Medscape survey of advanced practice registered nurses found that 75% of CRNAs practiced independently in 2023, with no collaborating physician. The other 25% indicated that they practice under a collaborating physician or a practice agreement. In 2021, only 25% of CRNAs said they practice independently.
Worsening physician shortages have strained healthcare — particularly ASCs. More than 2,872 anesthesiologists left the workforce from 2021 to 2022, according to a report from Definitive Healthcare. And as labor and supply costs continue to rise, allowing CRNAs more practice flexibility has been proposed as a potential solution.
As of July, 23 states and Washington, D.C., allow CRNAs to practice without the direct supervision of a physician. A list of those states can be found here.
Below are 11 states where CRNA policy has changed in the last five years:
Alabama: In April 2022, Gov. Kay Ivey signed into law a provision that allows CRNAs to provide anesthesia services in coordination with a physician, podiatrist or dentist.
Alaska: In January 2022, the Alaska Board of Nursing adopted rules that eliminated the requirement for CRNAs and other advanced practice registered nurses to submit to the state "consultation and referral plans" to provide anesthesia services.
Colorado: Gov. Jared Polis sent a letter to CMS requesting the removal of supervision requirements for CRNAs in the state in October.
Delaware: In June, Delaware opted out of federal regulations requiring physician supervision of CRNAs.
Florida: In December, state lawmakers Rep. Mike Giallombardo and Sen. Blaise Ingoglia proposed legislation that would eliminate the current requirement for CRNAs to have a written supervisory agreement with a physician.
Maine: In April 2021, Gov. Janet Mills signed a law requiring payers to cover and reimburse certified registered nurse anesthetists. It also prohibited players from barring CRNAs from participating in provider networks.
Maryland: CRNA scope of practice in Maryland in June 2022 was expanded to include the ability to order and prescribe medications, including controlled substances.
Michigan: Michigan opted out of physician supervision requirement for CRNAs in May 2022.
Oklahoma: In May 2019, the state Legislature passed a bill allowing CRNAs to administer anesthesia in collaboration with rather than under the supervision of a physician.
Oregon: Oregon repealed "redundant provisions" and clarified guidelines for CRNAs practicing in the state with the passage of a bill in July. The bill reaffirms the Oregon State Board of Nursing's authority to establish CRNA scope of practice.
Wyoming: In May, Wyoming opted out of federal regulations that require physician supervision of CRNAs for hospitals with 25 licensed beds or fewer.