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Prescriptive Authority of CRNAs
Now to the topic at hand. Perhaps a little history on prescriptive authority for advance practice nurses is in order. It is my understanding that prescriptive authority was instituted for APNs who were practicing in remote clinics and in underserved areas where there is not a physician immediately available. That has been expanded as the role and practice settings for APNs have also been expanded.
In some states, as mentioned above nurse anesthetists may apply for perscriptive authority and DEA numbers. In other states, the legislature and regulatory agencies have not seen the need for this option. This has been a highly political and volatile issue in many states.
In the state where I practice the Board of Registered Nursing has ruled that CRNAs do not need prescriptive authority and have given us very broad autonomy for the peri-anesthesia period. Also, we are not required (as APNs are) to have standing orders, standarized procedures, physician oversight, coutersignatures or review.
A large number of CRNAs practice in ambulatory surgery centers and in pain clinics. There is always a mechanism present for obtaining anesthesia and related medications.
Prescriptive authority is not a high priority at the present for the nurse anesthetist profession. That may change in the future, but our very effective lobbying efforts and presence in Washington DC and all state capitals has served us well in the past. Nurse anesthetists and the AANA are considered to be one of the best lobbying professional groups in the country. We have very bright people keeping tuned to changing trends in health care and making sure we are well represented.