Separation of Operator and Anesthesia Professional Responsibilities

Formerly Position Statement 2.3

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Certified Registered Nurse Anesthetists (CRNAs) are called upon to provide sedation, regional anesthesia, or general anesthesia care for a variety of procedures. These services require vigilant patient monitoring and the ability to respond immediately to any acute changes in patient status. Vigilant patient monitoring includes the collection and interpretation of data obtained from various sources (e.g., technology) as well as the assessment skills of the CRNA. The use of technology may contribute to an overall decrease in errors1,2; however, technology may also contribute to errors.2  When any intrusion in patient monitoring occurs because a CRNA is performing duties or tasks unrelated to the anesthetic, vigilance may be compromised.  Interruptions in vigilance and focus have been identified as contributors to negative patient safety outcomes.3 The provision of anesthesia care requires the complete attention of a qualified anesthesia professional. Similarly, therapeutic or diagnostic procedures require the continuous and committed attention of the operator (e.g., surgeon). 

It is the opinion of the American Association of Nurse Anesthetists that a qualified anesthesia professional providing anesthesia services should not also be engaged with tasks associated with the diagnostic or therapeutic procedure.  Ideally, there should be three appropriately credentialed individuals involved in any procedure requiring anesthesia services:  the operating clinician, a qualified licensed anesthesia professional, and an assistant to the operating clinician. This type of team structure is essential to avoid errors and achieve optimal patient outcomes.1


  1. Salas E, Wilson KA, Murphy CE, King H, Baker D. What crew resource management training will not do for patient safety: Unless... J Patient Saf. June 2007; 3(2): 62-64.
  2. Helmreich RL, Davies JM. Culture, threat, and error: Lessons from aviation. Can J Anaesth. June 2004; 51(Suppl 1): R1-R4.
  3. Grogan EL, Stiles RA, France DJ, et al. The impact of aviation-based teamwork training on the attitudes of health-care professionals. J Am Coll Surg. Dec 2004;199(6):843-848.


Adopted by AANA Board of Directors May 1988.
Reaffirmed by AANA Board of Directors June 1997, and February 2005.
Revised and adopted by AANA Board of Directors August 2010.