Considerations for Addition of New Activities to Individual CRNA Scope of Practice

 
Legislators and regulatory agencies look to the American Association of Nurse Anesthetists (AANA) for resources that represent the professional practice of the Certified Registered Nurse Anesthetist (CRNA).  The AANA develops documents and information to support scope of practice and policy decisions for the delivery of safe and effective anesthesia services. The Scope of Nurse Anesthesia Practice embodies the broad continuum of nurse anesthesia practice rather than a detailed list of nurse anesthesia services.  Throughout their careers, CRNAs will incorporate new techniques and technologies into their practice to improve patient outcomes. 
 
The decision to add a new activity is complex and based on considerations unique to the individual CRNA, facility, and state. This document is intended to provide the CRNA with a tool to conduct an analysis to clarify whether a specific procedure or technique is related to anesthesia and within the individual CRNA’s scope of practice. This analysis checklist is not intended to be sequential, only to provide a framework for the individual CRNA to make an informed decision regarding his or her scope of nurse anesthesia practice.
 

Nurse Anesthesia Professional Scope, Standards, Guidelines, and Ethics

State and Federal Statutes, Regulations, and Rules
  • Do you hold the appropriate licensure or authorization to practice in the state?
  • Is the act expressly permitted or prohibited by the state nurse practice act, nursing rules and regulations, or other applicable state statute or regulations? 
  • Has the state board of nursing (or applicable governing body) rendered an opinion on whether the act is within CRNA scope of practice? You may consider consulting your state licensing board, which is typically the board of nursing.
  • Is performance of the act in compliance with applicable federal authorities, such as Centers for Medicare & Medicaid Services (CMS) regulations?

CRNA

  • Would a reasonable and prudent CRNA perform this activity in this setting?
  • Are you prepared to accept the responsibility of your actions?
  • Is your performance of the act consistent with evidence-based care?
  • Do you possess the knowledge, skills, and ability to perform the act safely and effectively?
  • Do you have access to the equipment and resources to perform the act safely and effectively?
  • Have you demonstrated and maintained the competencies necessary for the privilege? (The AANA recommends that you maintain evidence of education, training, competence assessment, peer review, and outcomes, when available.)
  • Does the procedure meet applicable reimbursement criteria set by health care payers? Will you be reimbursed for the service?
  • Will your professional liability carrier provide coverage for the procedure?

Facility

  • Is performance of the act in compliance with state laws and regulations that apply to the facility in which the act will be performed (e.g., hospital, ambulatory surgical center, physician’s office)?
  • Is performance of the act in compliance with accreditation standards that apply to the facility in which the act will be performed (e.g., hospital, ambulatory surgical center, physician’s office)?
  • Has the facility approved policies and procedures, bylaws (if necessary), a quality improvement process, or other structures to support performance of the act?
  • Do you have the specific education and documentation of competency to apply for privileges to perform the act?
  • Are you appropriately credentialed and privileged at your facility to perform this procedure or act?
Insurance Considerations
CRNAs are encouraged to consult with their malpractice insurance carrier to confirm coverage for the specific procedures at issue.  CRNAs who are insured under their facility’s malpractice insurance should address coverage questions with the facility’s risk management department. 
 
State Association Resources
CRNAs should consider contacting their state nurse anesthetist association for additional information regarding state scope of practice.  The state nurse anesthetist association may be aware of resources addressing your question, including relevant state board of nursing documents.
 
Contact the AANA
If you have questions as you work through or have completed the scope of nurse anesthesia practice analysis, please contact the Professional Practice Division at practice@aana.com or 847-655-8870.
 
AANA Resources
Additional resources are on the AANA website at www.aana.com.  All Professional Practice documents can be accessed at www.aana.com > Resources > Professional Practice > Professional Practice Documents.
Other Resources
  • State Board of Nursing
  • State Nurse Practice Act
  • Facility Policies, Procedures, Bylaws and Privileges

References

  1. American Nurses Association.  Scope of Practice: Domains and Questions.  Accessed at http://www.nursingworld.org/EspeciallyForYou/AdvancedPracticeNurses/Scope-of-Practice-2/Scope-of-Practice/Scope-of-Practice-Domains-and-Questions.pdf.
  2. Klein, TA.  Scope of Practice and the Nurse Practitioner: Regulation, Competency, Expansion, and Evolution.  Accessed at http://www.medscape.org/viewarticle/506277.
  3. Louisiana State Board of Nursing.  Guidelines for Interpreting Scope of Practice for Advanced Practice Registered Nurses in Louisiana.  Accessed at http://www.lsbn.state.la.us/Portals/1/Documents/Forms/apscope.pdf.
  4. Maine State Board of Nursing. Scope of Practice Decision Tree.  Accessed at http://www.maine.gov/boardofnursing/questions/ScopeOfPracticeDecisionTree.htm.
  5. Nevada Board of Nursing.  Determining Your Scope of Practice.  Accessed at http://nevadanursingboard.org/wp-content/uploads/2011/10/Scope-of-practice-decision-tree.pdf.
  6. South Carolina Board of Nursing. Scope of Practice Decision Tree.  Accessed at http://www.llr.state.sc.us/POL/Nursing/PStatements/ScopeofPracticeDecisionTreeApproved072910.pdf.
  7. Washington State Department of Health.  Scope of Practice Decision Tree.  Accessed at http://www.doh.wa.gov/Portals/1/Documents/Pubs/609305.pdf.
 

This information is not intended as legal advice or a legal opinion.  For legal advice, please consult an attorney in your state. 

 

Approved by AANA Board of Directors February 2014