States That Allow CRNAs to Practice Without Physician Supervision

State Laws Dictate CRNA Work

Female anesthesiologist sedating patient for surgical procedure in hospital
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Certified Registered Nurse Anesthetists (CRNAs) are anesthesia professionals who safely administer approximately 43 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists (AANA) 2016 Practice Profile Survey. Nurse anesthetists have been providing anesthesia care to patients in the United States for more than 150 years. The CRNA credential came into existence in 1956.

CRNAs provide anesthesia in collaboration with surgeons, anesthesiologists, dentists, podiatrists, and other qualified healthcare professionals. When anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing; when administered by an anesthesiologist, it is recognized as the practice of medicine. Regardless of whether their educational background is in nursing or medicine, all anesthesia professionals give anesthesia the same way.

CRNAs are the primary providers of anesthesia care in rural America, enabling healthcare facilities in these medically underserved areas to offer obstetrical, surgical, pain management and trauma stabilization services. In some states, CRNAs are the sole providers in nearly 100 percent of the rural hospitals.

States That Allow CRNAs to Practice Without Physician Supervision

Federal law requires that CRNAs practice under the supervision of a licensed physician, usually a surgeon or anesthesiologist.

However, in 2001, a new rule was created which allows states to "opt-out" of the federal requirement for physician supervision of CRNAs. Which states have opted out to allow CRNAs to practice independently, without physician supervision?

According to the AANA, the following states have opted out of the federal law requiring physician supervision.

Therefore, in these 17 opt-out states, CRNAs are legally able to practice without physician supervision. As advanced practice registered nurses, CRNAs practice with a high degree of autonomy and professional respect. They carry a heavy load of responsibility and are compensated accordingly.

The states are listed in alphabetical order:

  • Alaska
  • California
  • Colorado
  • Iowa
  • Idaho
  • Kansas
  • Kentucky
  • Minnesota
  • Montana
  • Nebraska
  • New Hampshire
  • New Mexico
  • North Dakota
  • Oregon
  • South Dakota
  • Washington
  • Wisconsin

Educational Requirements

The minimum education and experience required to become a CRNA include:

  • A baccalaureate or graduate degree in nursing or other appropriate major.
  • An unencumbered license as a registered professional nurse and/or APRN in the United States or its territories.
  • A minimum of one-year full-time work experience, or its part-time equivalent, as a registered nurse in a critical care setting.
  • Graduation with a minimum of a master’s degree from a nurse anesthesia educational program accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs. As of August 2016, there were 115 accredited nurse anesthesia programs in the United States utilizing more than 2,100 active clinical sites; 46 nurse anesthesia programs are approved to award doctoral degrees for entry into practice. Nurse anesthesia programs range from 24-42 months, depending on university requirements. Programs include clinical settings and experiences.
  • Pass the National Certification Examination following graduation.

Note: Programs have admission requirements in addition to the above minimums.

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