Is a physician required to co-sign a Certified Registered Nurse Anesthetist’s anesthesia record or pre-anesthesia assessment?

There is no Texas state law or Texas Board of Nursing regulation requiring physician co-signature of a CRNA's anesthesia record or pre-anesthesia assessment.  Whether a CRNA is practicing in a collaborative model with an anesthesiologist or practicing independently, the CRNA is responsible for adhering to the American Association of Nurse Anesthetists Standards for Nurse Anesthesia Practice.  Facility medical staff bylaws or policies may require a physician to co-sign a CRNA’s pre-anesthesia evaluation or anesthesia record.  The BON requires CRNAs to follow applicable medical staff bylaws and policies established by facilities in which they practice. 

The practice of nurse anesthesia is the practice of professional nursing and is regulated under the sole authority of the BON.  The BON defers to national nursing organizations for Standards of Care and Scope of Practice.  For nurse anesthetists in Texas, the national organization responsible for establishing Standards of Care and Scope of Practice is the American Association of Nurse Anesthetists (AANA).  The AANA Standards for Nurse Anesthesia Practice Standard I, states the CRNA is responsible for performing and documenting a thorough pre-anesthesia assessment and evaluation.  A CRNA is also responsible for adhering to Standard V as it relates to monitoring, evaluating, and documenting the patient’s physiologic condition.