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Certified Registered Nurse Anesthetists (CRNAs) have safely administered anesthesia for more than 150 years. CRNAs are dedicated, highly-educated professionals who safely and cost-effectively provide more than 50 million anesthetics each year across the United States. In Texas, TxANA is intricately involved in ensuring safe and affordable access to anesthesia care services for Texans, and monitors these issues both in legislative and regulatory environments. The Texas Board of Nursing (BON) issues licenses to graduates of approved nursing education programs seeking licensure by exam and to nurses licensed in other states seeking Texas licensure by endorsement.
The BON requires all nurses to renew their licenses on a biennial basis with evidence of required continuing nursing education. The BON licenses qualified registered nurses to enter practice as advanced practice registered nurses (APRNs), including nurse anesthetists, nurse practitioners, clinical nurse specialists, and nurse midwives. All nurses with an active Texas license are required to demonstrate continuing competency for relicensure. More information on licensure and continuing education requirements can be found here.
Texas law has never required physician supervision of CRNAs. Under current Texas law, the administration of anesthesia by a CRNA is a delegated function, but one that does not require any supervision by a physician. The following highlights provide valuable information on Texas code and regulatory statute regarding CRNA practice in Texas:
- In Texas Attorney General Opinion JC - 0117, issued in 1999, then-Texas Attorney General John Cornyn clarified that Section 157.058 of the Medical Practice Act does not require a physician to directly supervise a CRNA’s selection and administration of anesthesia because a CRNA practicing in accordance with proper delegation from a physician is acting within the scope of nursing practice.
- Section 301.002 of the Nursing Practice Act (Texas Occupations Code) provides a definition of professional nursing that includes a statement that physician orders are required to administer medications; however, when the nurse carries out the order, it becomes a nursing act for which the registered nurse is responsible and accountable. Thus, a CRNA must have a physician’s order to administer anesthesia or an anesthesia-related service, but there is no requirement that the order specify the drugs, dosages, or routes of administration because these functions are within the CRNA’s scope of practice.
- Rule 221 of the Texas Board of Nursing (Rules and Regulations Relating to Professional Nurse Education, Licensure and Practice) specifies that advanced practice registered nurses, including nurse anesthetists, “…act independently and/or in collaboration with the health team in the observation, assessment, diagnosis, intervention, evaluation, rehabilitation, care and counsel, and health teachings of persons who are ill, injured or infirm or experiencing changes in normal health processes; and in the promotion and maintenance of health or prevention of illness.”
- Section 157.058, Delegation to Certified Registered Nurse Anesthetists, Medical Practice Act (Texas Occupations Code), expressly permits CRNAs to select, obtain and administer anesthesia and anesthesia-related medications and apply appropriate medical devices necessary to accomplish the order and maintain the patient within a sound physiological status.
- Section 157.060, Physician Liability for Delegated Act, Medical Practice Act (Texas Occupations Code), states: “Unless the physician has reason to believe the physician assistant or advanced practice nurse lacked the competency to perform the act, a physician is not liable for an act of a physician assistant or advanced practice nurse solely because the physician signed a standing medical order, a standing delegation order, or another order or protocol authorizing the physician assistant or advanced practice nurse to administer, provide, carry out, or sign a prescription drug order.”