What Is the CRNA Scope of Practice? Overview and FAQ
Certified registered nurse anesthetists (CRNAs) are advanced practice registered nurses (APRNs) who administer anesthesia to patients undergoing medical procedures and surgeries. As this role requires very specialized training and certifications, CRNAs must follow a scope of practice that differs from that of other types of APRNs. But what exactly is the CRNA scope of practice and how is it shaped by different rules and regulations?
As a facility leader, ensuring that your CRNAs are staying within their scope of practice is essential for keeping patients safe and minimizing legal risks. In this article, we’ll provide an overview of how CRNAs are permitted to practice in the U.S. so that you can enforce appropriate care protocols at your facility.
Scope of Practice for CRNAs: FAQs
Each state enforces its own set of laws called the Nurse Practice Act (NPA), which governs everything related to nursing practice. Scope of practice guidelines are established within these laws for each level of nursing, including APRNs and, more specifically, CRNAs. Below we’ll answer some of the most frequently asked questions about the CRNA scope of practice.
What is the CRNA scope of practice?
The nursing scope of practice is the regulatory framework defining what nursing professionals can and cannot do based on their level of education and training. Since CRNAs receive advanced and specialized training in anesthesia administration, they must follow their own set of practice guidelines to meet appropriate standards of care.
The exact scope of practice for CRNAs varies by state and facility. However, according to the American Association of Nurse Anesthesiology (AANA), the duties of a CRNA broadly include:
- Educating patients during the preoperative and postoperative phases.
- Consulting patients and obtaining informed consent before procedures.
- Assessing and monitoring patients’ responses to analgesia and pain meds.
- Developing and implementing care plans related to pain management and recovery.
- Selecting, ordering, and prescribing medications for pain control.
- Performing advanced airway management and point-of-care testing.
- Ordering and interpreting diagnostic lab tests and radiological studies.
- Ordering specialized consults or treatments (e.g., physical therapy).
How does the CRNA’s scope of practice differ by state and facility?
The differences in the CRNA scope of practice by state are mainly driven by the level of authority that CRNAs are granted. However, some facilities may not grant CRNAs as much autonomy as their state’s law. Because of this, facility-level practice protocols often matter more than state regulations when it comes to CRNAs.
For example, Minnesota permits CRNAs to work completely independently. However, Mayo Clinic, which is a hospital system operated in Minnesota, requires all of their CRNAs to be supervised by an anesthesiologist. As a general rule of thumb, the larger the practice setting is, the more supervision a CRNA will typically require.
What are the most common practice models for CRNAs?
Under state regulations and organizational protocols, there are three main practice models that CRNAs can work under. These models are outlined in the table below.
| Model | Description | Commonly Applied Settings |
|---|---|---|
| CRNA-Only Model | CRNAs practice in lieu of anesthesiologists, independently overseeing all anesthesia care. | Outpatient care clinics, dental clinics, plastic surgery centers, rural hospitals |
| Collaborative Care Model | CRNAs consult anesthesiologists on their team but still work fairly independently to provide care. | Mid-size community hospitals, obstetrics departments, general surgery centers |
| Anesthesia Care Model | Two to four CRNAs are supervised and directed by an anesthesiologist. | Larger hospital systems and teaching hospitals |
What can an anesthesiologist do that a CRNA can’t?
Anesthesiologists are doctors who complete medical school and residency. Since they have more extensive training than CRNAs, they follow a wider scope of practice. Anesthesiologists typically take on more complicated surgical cases and may also provide care for patients with serious medical conditions. They also oversee larger surgical teams and have full practice authority nationwide.
What happens if CRNAs step outside of their scope of practice?
If a CRNA steps outside of their scope of practice, this means that they’ve carried out a task that they’re not properly trained or authorized to do. This ultimately risks the safety of patients and compromises the professional integrity of the entire care team.
CRNAs who violate practice rules and regulations can face disciplinary action from the board of nursing, with penalties ranging from remedial education to license suspension. If a CRNA’s actions lead to patient harm, they could even face a malpractice lawsuit.
It’s important for facility leaders to enforce clear practice protocols that adhere to rules established by the NPA. You can find more CRNA practice resources and guidelines on the AANA scope of practice information center.
Stay Up-To-Date on Regulations Impacting Your Staff
Keeping up with the CRNA scope of practice and other nursing regulations can feel overwhelming, especially when the industry is constantly evolving. Minimize the stress of staying informed and get expert-written healthcare insights delivered straight to your inbox.
Legal Disclaimer: This article contains general legal information, but it is not intended to constitute professional legal advice for any particular situation and should not be relied on as professional legal advice. Any references to the law may not be current, as laws regularly change through updates in legislation, regulation, and case law at the federal and state level. Nothing in this article should be interpreted as creating an attorney-client relationship. If you have legal questions, you should seek the advice of an attorney licensed to practice in your jurisdiction.