Defines the practice of certified registered nurse anesthetist; requires collaboration with a licensed physician qualified to determine the need for anesthesia services; requires licensing; defines qualifications.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A6958A
SPONSOR: Reyes TITLE OF BILL:
An act to amend the education law, in relation to creating the profes-
sion of nurse anesthetist
PURPOSE OF THE BILL: This bill creates a scope of practice for certi-
fied registered nurse anesthetists
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 of this bill creates a new Article 139-A of the education law
and defines the scope of practice for certified registered nurse anesth-
etist.
Section 2 amends the references to who can use the title of nurse.
Section 3 expands the number of members on the state board of nursing.
Section 4 is the effective date.
JUSTIFICATION:
Certified registered nurse anesthetists (CRNAs) practice is not codified
in law in New York. Instead, the scope of practice for CRNAs is defined
through educational requirements and Health Department regulations. This
bill would create the profession of CRNAs and outline a scope of prac-
tice that is reflective of their training and education in New York.
Existing requirements for training, education, and certification of
CRNAs have resulted in high quality, professional care, and it is time
to codify and further define the existing requirements.
CRNAs have been providing anesthesia care to patients for more than 15C
years. The value and need for CRNAs was highlighted at a new level
during the COVID-19 pandemic when CRNAs stepped into key leadership
roles in treating COVID-19 patients. Given the need and value of CRNAs,
it is imperative to codify a scope of practice for CRNAs.
PRIOR LEGISLATIVE HISTORY:
2021-22: S.5435B, referred to Higher Education
FISCAL IMPLICATIONS:
None to the State.
EFFECTIVE DATE:
This act shall take effect immediately.
STATE OF NEW YORK
________________________________________________________________________
6958--A
2023-2024 Regular Sessions
IN ASSEMBLY
May 9, 2023
___________
Introduced by M. of A. REYES, PAULIN, MAMDANI, CARROLL, O'DONNELL,
JOYNER, BENDETT -- read once and referred to the Committee on Higher
Education -- committee discharged, bill amended, ordered reprinted as
amended and recommitted to said committee
AN ACT to amend the education law, in relation to creating the profes-
sion of nurse anesthetist
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The education law is amended by adding a new article 139-A
2 to read as follows:
3 ARTICLE 139-A
4 CERTIFIED REGISTERED NURSE ANESTHETIST
5 Section 6912. Introduction.
6 6913. Definition of practice of certified registered nurse
7 anesthetist.
8 6914. Practice of certified registered nurse anesthetist and use
9 of the title "certified registered nurse anesthetist" or
10 "nurse anesthetist".
11 6915. State board for nursing.
12 6916. Requirements for a license as a certified registered nurse
13 anesthetist.
14 6917. Limited permits.
15 6918. Exempt persons.
16 6919. Special provisions.
17 § 6912. Introduction. This article applies to the profession of certi-
18 fied registered nurse anesthetist. The general provisions for all
19 professions contained in article one hundred thirty of this title apply
20 to this article.
21 § 6913. Definition of practice of certified registered nurse anesthe-
22 tist. 1. In addition to the provisions of practice for registered
23 professional nursing outlined in section sixty-nine hundred two of this
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD02498-03-3
A. 6958--A 2
1 title, the practice of a certified registered nurse anesthetist further
2 includes, but is not limited to, administration of anesthesia and
3 sedation to a patient; performing and documenting a preanesthetic
4 assessment and evaluation of the patient, including requesting consulta-
5 tions and diagnostic studies; selecting, obtaining, ordering, and admin-
6 istering preanesthetic medications and fluids; obtaining informed
7 consent for anesthesia, developing and implementing an anesthetic plan;
8 initiating the anesthetic technique; monitoring the patient including
9 selecting, applying, and inserting appropriate noninvasive and invasive
10 monitoring modalities for continuous evaluation of the patient's phys-
11 ical status; selecting, obtaining, and administering the anesthetics,
12 adjuvant and accessory drugs, and fluids necessary to manage anesthetics
13 and acute and chronic pain; ordering and evaluating laboratory and diag-
14 nostic tests and performing point-of-care testing; ordering and evaluat-
15 ing radiographic imaging studies; managing a patient's airway and
16 cardiopulmonary status using current practice modalities; facilitating
17 emergence and recovery from anesthesia by selecting, obtaining, ordering
18 and administering medications, fluids, and ventilatory support;
19 discharging the patient from a postanesthesia care area and providing
20 postanesthesia follow-up evaluation and care; implementing acute and
21 chronic pain management modalities; responding to emergency situations
22 by providing airway management, administration of emergency fluids and
23 drugs, and using basic or advanced cardiac life support techniques; and
24 prescribe tests, drugs and other treatments necessary to anesthesia care
25 provided by a nurse anesthetist.
26 2. A certified registered nurse anesthetist licensed under this arti-
27 cle and practicing for thirty-six hundred hours or less shall do so
28 under the direction of a physician, dentist or podiatrist. For purposes
29 of this section, direction shall mean the coordination and communication
30 between the physician, dentist or podiatrist and the certified regis-
31 tered nurse anesthetist for the care of the patient. After practicing
32 for more than thirty-six hundred hours, a certified registered nurse
33 anesthetist shall function in an interdependent role as a member of a
34 health care team in which the medical care of a patient is overseen by a
35 physician, dentist or podiatrist.
36 3. Prescriptions for drugs, devices, and anesthetic agents, anesthesia
37 related agents, and analgesics may be issued by a certified registered
38 nurse anesthetist necessary to anesthesia care provided by a nurse
39 anesthetist. The certified registered nurse anesthetist shall obtain a
40 certificate from the department upon successfully completing a program
41 including an appropriate pharmacology component, or its equivalent, as
42 established by the commissioner's regulations, prior to prescribing
43 under this subdivision. The license issued under this article shall
44 state whether the certified registered nurse anesthetist has successful-
45 ly completed such a program or equivalent and is authorized to prescribe
46 under this subdivision.
47 4. Nothing in this section shall be deemed to limit or diminish the
48 practice of the profession of nursing as a registered professional nurse
49 under article one hundred thirty-nine of this title or any other law,
50 rule, regulation or certification, nor to deny any registered profes-
51 sional nurse the right to do any act or engage in any practice author-
52 ized by article one hundred thirty-nine of this title or any other law,
53 rule, regulation or certification.
54 § 6914. Practice of certified registered nurse anesthetist and use of
55 the title "certified registered nurse anesthetist" or "nurse anesthe-
56 tist". Only a person licensed or otherwise authorized under this article
A. 6958--A 3
1 shall practice as a certified registered nurse anesthetist or nurse
2 anesthetist, provided that any person who was practicing as a certified
3 registered nurse anesthetist in the state before the effective date of
4 this article shall have the right to continue using the title. Contin-
5 ued use of such title after that shall be dependent upon such person
6 applying for and obtaining a license from the department as a certified
7 registered nurse anesthetist pursuant to this article within three years
8 from the effective date of this article.
9 § 6915. State board for nursing. The state board for nursing as estab-
10 lished in section sixty-nine hundred four of this title shall be the
11 governing state board for certified registered nurse anesthetists.
12 § 6916. Requirements for a license as a certified registered nurse
13 anesthetist. To qualify for a license as a certified registered nurse
14 anesthetist, an applicant shall fulfill the following requirements:
15 1. Application: file an application with the department;
16 2. License: be New York state licensed and currently registered as a
17 registered professional nurse;
18 3. Education: have received a master's degree or higher in a program
19 of nurse anesthesia from a program registered by the department or
20 determined by the department to be substantially equivalent or meet the
21 requirements of section sixty-nine hundred nineteen of this article;
22 4. Examination: pass an examination satisfactory to the board and in
23 accordance with the commissioner's regulations;
24 5. Character: be of good moral character as determined by the depart-
25 ment;
26 6. Fees: pay a fee of one hundred fifty dollars to the department for
27 an initial license and a fee of fifty dollars for each triennial regis-
28 tration period; and
29 7. Information and documentation: in conjunction with and as a condi-
30 tion of each triennial registration a certified registered nurse anesth-
31 etist shall provide to the department, and the department shall collect,
32 such information and documentation required by the department, in
33 consultation with the department of health, as is necessary to enable
34 the department of health to evaluate access to needed services in this
35 state, including, but not limited to, the location and type of setting
36 wherein the certified registered nurse anesthetist practices and other
37 information the department, in consultation with the department of
38 health, deems relevant. The department of health, in consultation with
39 the department, shall make such data available in aggregate, de-identi-
40 fied form on a publicly accessible website. Additionally, in conjunc-
41 tion with each triennial registration, the department, in consultation
42 with the department of health, shall provide information on registering
43 in the donate life registry for organ and tissue donation, including the
44 website address for such registry.
45 § 6917. Limited permits. 1. A permit to practice as a certified regis-
46 tered nurse anesthetist may be issued by the department upon the filing
47 of an application for a license as a certified registered nurse anesthe-
48 tist and submission of such other information as the department may
49 require to (a) graduates of schools of nurse anesthesia registered by
50 the department or (b) graduates of schools of nurse anesthesia approved
51 in another state, province, or country.
52 2. Such limited permit shall expire one year from the date of issuance
53 or upon notice to the applicant by the department that the application
54 for license has been denied. The limited permit may be renewed, at the
55 discretion of the department, for one additional year.
A. 6958--A 4
1 3. A limited permit shall entitle the holder to practice nurse anes-
2 thesia only in a health care facility under the personal, on-premise
3 supervision of a certified registered nurse anesthetist or collaborating
4 physician currently registered in this state and with the endorsement of
5 the employing agency.
6 4. Fees. The fee for each limited permit shall be thirty-five dollars.
7 § 6918. Exempt persons. This article shall not be construed:
8 1. as applying to any activity authorized, pursuant to statute, rule
9 or regulation, to be performed by a registered professional nurse in a
10 hospital as defined in article twenty-eight of the public health law;
11 2. as prohibiting the furnishing of nurse anesthesia assistance in
12 case of an emergency;
13 3. as prohibiting such performance of nurse anesthesia service by
14 students enrolled in department registered nurse anesthesia programs or
15 students enrolled in other nurse anesthesia programs that are authorized
16 pursuant to section two hundred twenty-four of this chapter to place
17 such students in clinical rotations in New York state;
18 4. as prohibiting or preventing the practice of nurse anesthesia in
19 this state by any legally qualified nurse or practical nurse of another
20 state, province, or country whose engagement requires him or her to
21 accompany and care for a patient temporarily residing in this state
22 during the period of such engagement provided such person does not
23 represent or hold himself or herself out as a certified registered nurse
24 anesthetist registered to practice in this state;
25 5. as prohibiting or preventing the practice of nurse anesthesia in
26 this state during an emergency or disaster by any legally qualified
27 nurse anesthetist of another state, province, or country who may be
28 recruited by the American National Red Cross or pursuant to authority
29 vested in the state civil defense commission for such emergency or
30 disaster service, provided such person does not represent or hold
31 himself or herself out as a certified registered nurse anesthetist
32 registered to practice in this state;
33 6. as prohibiting or preventing the practice of nurse anesthesia in
34 this state, in obedience to the requirements of the laws of the United
35 States, by any commissioned nurse anesthetist officer in the armed forc-
36 es of the United States or by any nurse anesthetist employed in the
37 United States veterans administration or United States public health
38 service while engaged in the performance of the actual duties prescribed
39 for him or her under the United States statutes, provided such person
40 does not represent or hold himself or herself out as a certified regis-
41 tered nurse anesthetist registered to practice in this state; or
42 7. as prohibiting the care of the sick when done in connection with
43 the practice of the religious tenets of any church.
44 § 6919. Special provisions. 1. A certified registered nurse anesthe-
45 tist licensed under this article, while providing services to patients
46 in New York state, is required to purchase and maintain, or otherwise be
47 covered by, professional liability insurance in an amount not less than
48 one million dollars per claim with an aggregate liability for all claims
49 during the year of three million dollars. Professional liability insur-
50 ance required by this section shall cover all acts within the scope of
51 practice of registered nurse anesthetist.
52 2. It shall be lawful for an individual practicing as a certified
53 registered nurse anesthetist in this state as of the effective date of
54 this section that does not meet the educational requirements to continue
55 such practice provided that such certified registered nurse anesthetist:
56 (a) submits evidence of certification as a certified registered nurse
A. 6958--A 5
1 anesthetist by an appropriate national certifying body; and (b) has
2 continually maintained active, up-to-date recertification status as a
3 certified registered nurse anesthetist by an appropriate national recer-
4 tifying body.
5 § 2. Section 6903 of the education law, as amended by chapter 323 of
6 the laws of 2006, is amended to read as follows:
7 § 6903. Practice of nursing and use of title "registered professional
8 nurse" or "licensed practical nurse". Only a person licensed or other-
9 wise authorized under this article shall practice nursing and only a
10 person licensed under section sixty-nine hundred five of this article
11 shall use the title "registered professional nurse" and only a person
12 licensed under section sixty-nine hundred six of this article shall use
13 the title "licensed practical nurse". No person shall use the title
14 "nurse" or any other title or abbreviation that would represent to the
15 public that the person is authorized to practice nursing unless the
16 person is licensed or otherwise authorized under this article or article
17 one hundred thirty-nine-A of this title.
18 § 3. Section 6904 of the education law, as amended by chapter 994 of
19 the laws of 1971 and as renumbered by chapter 50 of the laws of 1972, is
20 amended to read as follows:
21 § 6904. State board for nursing. A state board for nursing shall be
22 appointed by the board of regents on recommendation of the commissioner
23 for the purpose of assisting the board of regents and the department on
24 matters of professional licensing and professional conduct in accordance
25 with section sixty-five hundred eight of this title. The board shall be
26 composed of not less than [fifteen] seventeen members, eleven of whom
27 shall be registered professional nurses and four of whom shall be
28 licensed practical nurses and two of whom shall be certified registered
29 nurse anesthetists all licensed and practicing in this state for at
30 least five years. An executive secretary to the board shall be
31 appointed by the board of regents on recommendation of the commissioner
32 and shall be a registered professional nurse registered in this state.
33 § 4. This act shall take effect one year after it shall have become a
34 law.
