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Scope of Practice
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CRNA Scope of Practice

Certified Registered Nurse Anesthetists (CRNAs) are registered nurses who have become anesthesia specialists by taking a graduate curriculum which focuses on the development of clinical judgment and critical thinking. They are qualified to make independent judgments concerning all aspects of anesthesia care based on their education, licensure, and certification. CRNAs are legally responsible for the anesthesia care they provide and are recognized in state law in all 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands. More information concerning how CRNAs are regulated in the states is at www.aana.com > Resources > State Legislative & Regulatory Requirements.

As anesthesia professionals, CRNAs provide anesthesia and anesthesia-related care upon request, assignment, or referral by the patient’s physician or other healthcare provider authorized by law, most often to facilitate diagnostic, therapeutic, and surgical procedures. In other instances, the referral or equest for consultation or assistance may be for management of pain associated with obstetrical labor and delivery, management of acute and chronic ventilatory problems, or management of acute and chronic pain through the performance of selected diagnostic and therapeutic blocks or other forms of pain management.

 

 

 

 

Responsibilities and Functions

  1. The scope of practice of CRNAs includes, but is not limited to, the following:
  2. Performing and documenting a preanesthetic assessment and evaluation of the patient, including requesting consultations and diagnostic studies; selecting, obtaining, ordering, and administering preanesthetic medications and fluids; and obtaining informed consent for anesthesia.
  3. Developing and implementing an anesthetic plan.
  4. Initiating the anesthetic technique which may include: general, regional, local, and sedation.
  5. Selecting, applying, and inserting appropriate noninvasive and invasive monitoring modalities for continuous evaluation of the patient’s physical status.
  6. Selecting, obtaining, and administering the anesthetics, adjuvant and accessory drugs, and fluids necessary to manage the anesthetic.
  7. Managing a patient’s airway and pulmonary status using current practice modalities.
  8. Facilitating emergence and recovery from anesthesia by selecting, obtaining, ordering, and administering medications, fluids, and ventilatory support.
  9. Discharging the patient from a postanesthesia care area and providing postanesthesia follow-up evaluation and care.
  10. Implementing acute and chronic pain management modalities.
  11. Responding to emergency situations by providing airway management, administration of emergency fluids and drugs, and using basic or advanced cardiac life support techniques.

Additional nurse anesthesia responsibilities which are within the expertise of the individual CRNA include the following:

  1. Administration/management: scheduling, material and supply management, development of policies and procedures, fiscal management, performance evaluations, preventative maintenance, billing, data management, and supervision of staff, students or ancillary personnel.
  2. Quality assessment: data collection, reporting mechanism, trending, compliance, committee meetings, departmental review, problem-focused studies, problem solving, interventions, documents and process oversight.
  3. Education: clinical and didactic teaching, BCLS/ACLS instruction, in-service commitment, EMT training, supervision of residents, and facility continuing education.
  4. Research: conducting and participating in departmental, hospital-wide, and university-sponsored research projects.
  5. Committee appointments: assignment to committees, committee responsibilities, and coordination of committee activities.
  6. Interdepartmental liaison: interface with other departments such as nursing, surgery, obstetrics, postanesthesia care units (PACU), outpatient surgery, admissions, administration, laboratory, pharmacy, etc.
  7. Clinical/administrative oversight of other departments: respiratory therapy, PACU, operating room, surgical intensive care unit, pain clinic, etc.

The functions listed above are a summary of CRNA clinical practice and are not intended to be all-inclusive. A more specific list of CRNA functions and practice parameters is detailed in Guidelines for Core Clinical Privileges for Certified Registered Nurse Anesthetists found on the American Association of Nurse Anesthetists (AANA) website at www.aana.com/clinicalprivileges.aspx.

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