Certified Registered Nurse Anesthetists

Certified registered nurse anesthetists, known as CRNAs, administer anesthesia and anesthesia-related care. Practice authority for CRNAs varies by state and defines their power to practice with or without physician oversight. Prescriptive authority refers to a CRNA’s power to prescribe medications beyond perioperative and routine anesthesia services. Some states require CRNAs to have a relationship with a physician that outlines procedures the CRNA may perform and requirements for consulting with the physician, including outlining the CRNA’s prescribing authority. 

In some states, statute specifies whether CRNAs must complete a transition-to-practice period before practicing or prescribing independently. In other states, CRNAs have full independent practice and prescriptive authority, meaning they practice independently with no physician oversight.  

The Centers for Medicare & Medicaid Services requires physician supervision of CRNAs for hospitals to be eligible for Medicaid and Medicare reimbursement for anesthesia services. State governors are allowed to opt out of this requirement under certain circumstances. As of June 2024, 25 states, Washington, D.C., and Guam have opted out.

Practice and prescriptive authority for the 50 states, the District of Columbia and the territories are shown in the two maps below. 

The first map below shows the range of practice authority for CRNAs by state, the District of Columbia and the territories, including: 

• Full independent practice authority. 
• Physician relationship required. 
• Transition to independent practice period. 

CRNAs are not required to have prescriptive authority to provide anesthesia care. They may order and directly administer controlled substances and other drugs perioperatively within their scope of practice.  

Prescriptive authority under federal law refers to pharmacologic and non-pharmacologic therapies beyond medications that are ordered or administered preoperatively, intraoperatively and postoperatively that are beyond routine anesthesia services defined within CRNA scope of practice.

The second map below shows the range of prescriptive authority for CRNAs by state, the District of Columbia and the territories, including: 

• Full independent prescriptive authority. 
• Physician relationship required. 
• Transition to independent prescribing period. 
• No prescriptive authority.