Do Texas state laws and regulations require physician supervision of Certified Registered Nurse Anesthetists (CRNAs)?

There are no Texas laws or regulations that require physician supervision of CRNA practice. Section 157.058 of the Texas Occupations Code allows physicians to delegate tasks to CRNAs without imposing a supervision requirement:


(a)  In a licensed hospital or ambulatory surgical center, a physician may delegate to a certified registered nurse anesthetist the ordering of drugs and devices necessary for the nurse anesthetist to administer an anesthetic or an anesthesia-related service ordered by the physician.

Attorney General Opinion JC-0117, issued on September 28, 1999, states:

“[A] CRNA practicing in accordance with a proper delegation from a physician is within the scope of practice of the practice of nursing.”

The opinion specifically states that Section 157.058 of the Medical Practice Act does not require a physician to supervise a CRNA’s selection and administration of anesthesia:

“Nothing in either the Nursing Practice Act or the Medical Practice Act requires a physician to ‘supervise’ a CRNA’s performance under section 157.058 of the Occupations Code.”

In a Letter From the Texas Board of Nursing (BON), dated December 13, 2004, Ms. Katherine Thomas, Executive Director of the BON stated:

“CRNAs, like other registered nurses, are not required to be supervised by physicians when carrying out nursing functions.  For CRNAs, the administration of anesthesia or anesthesia-related service is a nursing function.”

Attorney General Opinion KP-0353, issued on February 9, 2021, again reaffirmed that state law does not require supervision:

“Chapter 157 of the Occupations Code does not, by itself, require a physician who properly delegates anesthesia related acts to a CRNA to supervise the CRNA’s performance of those acts.”