AANA Statement on Hospital Requirements for RRNA/SRNA Participation in Anesthesia Teaching Cases

The American Association of Nurse Anesthesiology (AANA) is aware of questions regarding the Centers for Medicare & Medicaid Services’ (CMS) requirements and hospital accreditation standards related to the participation of Student Registered Nurse Anesthetists (SRNAs), also referred to as Resident Registered Nurse Anesthetist (RRNA), in anesthesia teaching cases.

CMS requirements do not prohibit SRNAs from participating in anesthesia care as part of their nurse anesthesia education under appropriate supervision. There is no basis to warrant the removal of SRNAs or the need for facility bylaw overhauls.

This is consistent with CMS hospital facility requirements and existing Medicare teaching and payment policies, which recognize the role of SRNAs in clinical education. Nothing in the Medicare hospital Conditions of Participation or corresponding hospital interpretive guidelines restrict a SRNA from being involved in anesthesia teaching cases in hospitals. CMS Teaching Rules, available at 42 § 414.61 (see also: 42 § 414.46 and Section 140.5 of Chapter 12 Medicare payment policy) explicitly recognizes for a 1:2 supervision ratio of Certified Registered Nurse Anesthetist (CRNA) or physician anesthesiologist to SRNAs regardless of setting. CMS requires that the CRNA devote their time to those two cases, be present for pre- and post-anesthesia care and be available during the procedure. The supervision requirements and ratios for SRNAs allow for essential clinical experience opportunities for professional registered nurses who are enrolled in nurse anesthesia education programs. This educational training model is also consistent with Council on Accreditation of Nurse Anesthesia Educational Programs (COA) clinical supervision standards.

The Joint Commission’s 2026 hospital accreditation standards also do not prohibit SRNAs from participating in anesthesia care as part of an approved educational program under appropriate supervision. The updated standards do not require hospitals to exclude SRNAs from anesthesia teaching cases. This doesn’t have any impact on the requirements stated above.

Hospitals can continue to provide SRNAs the hands-on clinical experience through supervised clinical education. CRNAs/Nurse anesthesiologists are clinicians and educators who play an essential role in preparing the next generation. AANA supports protecting the clinical education opportunities that are essential to preparing the next generation of nurse anesthesiologists.

For more information, see here.