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 provides:

Sec. 157.058.  DELEGATION TO CERTIFIED REGISTERED NURSE ANESTHETIST. 

(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.

(b)  The physician's order for anesthesia or anesthesia-related services is not required to specify a drug, dose, or administration technique.

(c)  Pursuant to the physician's order and in accordance with facility policies or medical staff bylaws, the nurse anesthetist may select, obtain, and administer those drugs and apply the medical devices appropriate to accomplish the order and maintain the patient within a sound physiological status.

(d)  This section shall be liberally construed to permit the full use of safe and effective medication orders to use the skills and services of certified registered nurse anesthetists.

Section 157.058 of the Occupations Code was not changed by the enactment of SB 406 relating to prescriptive authority agreements in the 2013 Legislative session. 

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.

The Texas Board of Nursing (BON) has the legal authority to regulate the practice of Advanced Practice Register Nurses (APRNs), including the practice of CRNAs.  In a letter 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. 

The delegation of the ordering of drugs and devices necessary for the administration of an anesthetic or anesthesia-related services may be done by either the operating physician or by an anesthesiologist.  The delegating order may be an order for “Anesthesia per CRNA” and does not have to specify the drug, dose, or technique/route of administration. Related materials below:

BON States That CRNA Supervision is Not Required
December 12, 1995 
In 1995, the BON issued a letter clarifying physician supervision over CRNAs. This letter states that CRNAs may administer anesthesia and anesthesia-related services pursuant to a physician order and consistent with medical staff bylaws or policies and when doing so are not required to be supervised by a physician.

Texas AG Opinion JC-0117 CRNA supervision not required
September 28, 1999
In 1999, Texas Attorney General John Cornyn, issued an Attorney General (AG) Opinion stating CRNA supervision is not required.