Certified Registered Nurse Anesthetist Arizona Legislative History

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1 Certified Registered Nurse Anesthetists Arizona Legislative history On March 10, 1923 Governor George W. P. Hunt signed House Bill 146. The new law stated, That all regularly graduated and registered nurses within the State of Arizona, shall be empowered to administer anesthetics under the direction of and in the immediate presence of a licensed physician or surgeon, provided such nurses has taken a prescribed course of anesthesia in good standing, or is a graduate in the science of anesthesia from some recognized school or college. (House Bill 146, 1923) (Struckmeyer, 1930) In 1928 and in 1939 the code was revised and changed to A.R.S but no changes to the statutory language. (Struckmeyer, 1930) (Ross, 1940) On October 18 th 1968 Gary K Nelson the Arizona Attorney General released a legal opinion NO L (R-116) Gary K Nelson Arizona Attorney General released a legal opinion that the definition of immediate presence was, For the reason that the term immediate presence is not defined in the statute, and does not appear to be a technical or ambiguous term, the words would have to be given the ordinary or general meaning. It is the opinion of this office the word presence preceded and qualified by the word immediate in A.R.S would have to be interpreted as meaning in the same room or similar close contact as opposed to within the surgical or obstetrical suite. (Nelson, 1968) Since it is common practice for CRNAs to practice without a physician or Surgeon immediately present as defined by the Attorney General the law was revised in 1970 to change the definition of immediately presence to include within the same surgical or obstetrical suite. On April 10, 1970 House Bill 68 amended to read: A licensed registered nurse may administer anesthetics under the direction of and in the presence of a licensed physician or surgeon if the nurse has completed a nationally accredited program in the science of anesthesia. As used in this section, presence means within the same room, an adjoining room or within the same surgical or obstetrical suite. (Bolin, 1971) In 1958 Senate Bill 1058 amended to Read A. A licensed registered nurse may administer anesthetics under the direction of and in the presence of a licensed physician or surgeon if the nurse has completed a nationally accredited program in the science of anesthesia B. As used in SUBSECTION A, presence means within with in the same room, OR an adjoining room or within the same surgical or obstetrical suite. (Mofford, 1985) 1999 The Arizona State Board of Nursing adopted rules to allow CRNAs prescriptive authority: 1

2 R Prescribing Authority of a Certified Registered Nurse Anesthetist A. The Board shall authorize a CRNA to prescribe medication, meaning to order drugs or medication for administration to a patient, only if in the best interest of the public and the CRNA meets the following requirements: 1. Current licensure as a professional nurse in good standing; 2. Graduated from an educational program accredited by the American Association of Nurse Anesthetists Council on Accreditation of Nurse Anesthesia Educational Programs or a predecessor and that has the objective of preparing a nurse to practice nurse anesthesia; 3. Initial certification by the American Association of Nurse Anesthetists Council on Certification of Nurse Anesthetists and recertification, as applicable, by the American Association of Nurse Anesthetists Council on Recertification of Nurse Anesthetists; 4. Submission of a completed application form provided by the Board and an application packet that includes the following information and documentation: a. Name, address, phone number; b. Professional nurse license number; c. Certification number d. Business address and phone number; e. Documentation verifying current certification by the American Association of Nurse Anesthetists Council on Certification of Nurse Anesthetists, or as applicable, by the American Association of Nurse Anesthetists Council on Recertification of Nurse Anesthetists; f. Responds to questions addressing the following subjects i. Prior disciplinary action, ii. Pending investigation or disciplinary action iii. Pending criminal charges, iv. Prior misdemeanor or undesignated offense conviction v. Prior felony conviction and date of absolute discharge of sentence, vi. Use of a chemical substance, and vii. Prior civil judgment resulting from the malpractice or negligence in connection with practice in a health profession; g. Applicant s sworn statement verifying the truthfulness of the information provided, and h. Application fees. B. An Applicant denied medication prescribing authority may request a hearing by filling a written request with the Board within 30 days of service of the Boards order denying the application for prescribing authority. Board hearings shall comply with A.R.S. title 41 Chapter 6, Article 10, and 4 A.A.C. 19, Article 6. C. A CRNA granted prescribing authority may prescribe drugs or medication to be administered by a licensed, certified or registered health care provider pre-operatively, post-operatively, or 2

3 as part of a procedure performed in a health care facility; the office of a health care provider licensed pursuant to A.R.S. Title 32, chapter 7, 11, 13, and 17; or in an ambulance, D. A CRNA with prescribing authority shall ensure that all prescription orders contain the following: 1. The CRNA s name 2. The prescription date; 3. The name of the patient and patient identification number; and 4. The name of the medication, strength, dosage, and route of administration. In 2005 the rules were renumbered from R to R In 2005 Arizona State board of nursing passed R further defining a Registered Nurse Anesthetist scope of practice. R Registered Nurse Anesthetist; Notification of the Board; Nurse Anesthetist Programs; Scope of Practice A. A registered nurse who does not have prescribing authority under R and wishes to administer anesthetics under A.R.S shall provide the nurses name, RN license number, and the following information to the Board before using the title nurse anesthetist, registered nurse anesthetists, or certified registered nurse anesthetists (CRNA) or carrying out any activities under A.R.S : 1. An official transcript that provides evidence that the nurse graduated from a nationally accredited program in the science of anesthesia and 2. Whether the applicant has applied for national certification as a certified registered nurse anesthetist, including the date of the application, the name of the certifying agency, and results of any certifying exam; or application, the name of the certifying agency, and results of any certifying exam; or application, the name of the certifying agency, and results of any certifying exam; or 3. Evidence of current registered nurse anesthetist certification from an approved under R B. An Administrator of an educational institution that wishes to provide a course of study that allows nurses to administer anesthetics under A.R.S shall inform the Board and furnish evidence of accreditation by an approved national nursing accrediting agency recognized by the Board under R before accepting students. C. In addition to the scope of practice permitted a registered nurse under A.R.S , a registered nurse governed by this Section may perform one or more of the following acts: 1. Assess the health status of an individual as that status relates to the relative risk associated with anesthetic management of an individual: 2. Obtain informed consent: 3. Order and interpret laboratory and other diagnostic tests and perform those tests that the nurse is qualified to perform; 3

4 4. Order and interpret radiographic imaging studies that the nurse is qualified to order and interpret; 5. Identify, develop, implement, and evaluate an anesthetic plan of care for a patient to promote, maintain, and restore health; 6. Take action necessary in response to an emergency situation; 7. Perform Therapeutic procedures that the nurse is qualified to perform; or 8. Perform additional acts that the nurse is qualified to perform. In May 2011 Auditor General in its standard sunset audit of the Arizona State Board of Nursing found that, one rule appears to exceed the Boards statutory authority. Specifically, Arizona Administrative Code R provides that the Board can authorize a Certified Registered Nurse Anesthetist (CRNA) to prescribe medication. However A.R.S authorizes CRNAs to only administer anesthetics, not to prescribe medications. (General, May 2011) In 2012 to satisfy the Auditor Generals concerns Senate Bill 1362 was passed into law to clarify the difference between the practice of a CRNA and other advanced practice nurses who write prescriptions, the consensus language provided that CRNA s could order medication instead of prescriptive authority. This language does not change the practice of CRNA s as they continue to give and write orders for medications pre-operatively, post-operatively, or as part of the procedure. as has been their practice for over 90 years. (Arizona State Board of Nursing, 2014) Senate Bill 1362 was passed creating , and Qualifications for certified registered nurse anesthetist; temporary certificate A. The board may certify a registered nurse who is licensed pursuant to this chapter as a certified registered nurse anesthetist if the registered nurse meets the following requirements: 1. Submits an application as prescribed by the board. 2. Has completed a program in the science of anesthesia accredited by the council on accreditation of nurse anesthesia educational programs or another national accrediting body recognized by the board. 3. Is certified by a national certifying body such as the national board of certification and recertification for nurse anesthetists or another national certifying body recognized by the board. 4. Pays the certification fee prescribed pursuant to section B. The board may issue a temporary certificate to a person who meets the requirements of subsection A, paragraphs 2 and 3 of this section. A temporary certificate expires on the date specified in the certificate and may be renewed at the discretion of the executive director. 4

5 certified registered nurse anesthetist; scope of practice A. A certified registered nurse anesthetist may administer anesthetics under the direction of and in the presence of a physician or surgeon in connection with the preoperative, intraoperative or postoperative care of a patient or as part of a procedure performed by a physician or surgeon in the following settings: 1. A health care institution. 2. An office of a health care professional who is licensed pursuant to chapter 7, 11, 13 or 17 of this title. 3. An ambulance. B. In connection with the preoperative, intraoperative or postoperative care of a patient or as part of the procedure in the settings prescribed in subsection A of this section, a certified registered nurse anesthetist as part of the care or procedure may: 1. Issue a medication order for drugs or medications to be administered by a licensed, certified or registered health care provider. 2. Assess the health status of an individual as that status relates to the relative risks associated with anesthetic management of an individual. 3. Obtain informed consent. 4. Order and evaluate laboratory and diagnostic test results and perform point of care testing that the certified registered nurse anesthetist is qualified to perform. 5. Order and evaluate radiographic imaging studies that the certified registered nurse anesthetist is qualified to order and interpret. 6. Identify, develop, implement and evaluate an anesthetic plan of care for a patient to promote, maintain and restore health. 7. Take action necessary in response to an emergency situation. 8. Perform therapeutic procedures that the certified registered nurse anesthetist is qualified to perform. C. A certified registered nurse anesthetist's authority to administer anesthetics or to issue a medication order as prescribed by this section does not constitute prescribing authority, In 2012 the Board of Nursing repealed R and R as the rules were considered duplicated by the newly passed statutes in Senate bill

6 Works Cited Arizona State Board of Nursing. (2014). History of Senate Bill Pheonix: Arizona State Board of Nursing. Bolin, W. (1971) Session Laws state of Arizona. Phoenix. General, D. K. (May 2011). Arizona State Board of Nursing. Phoenix Az: Office of the Auditor General. (1923). House Bill 146. Phoenix: Executive Department of Arizona Office of the Governor. Mofford, R. (1985). Session Laws State of Arizona, Thirty-seventh Legislature, First Regular Session. Phoenix: Arizona Secretary of State. Nelson, G. K. (1968). Department of Law letter of opinion NO l (r-116). Phoenix Arizona: Arizona Attorney General. Ross, C. J. (1940). Arizona Code Indianapolis: The Bobbs-Merrill Company Publishers. Struckmeyer, F. C. (1930). The Revised Code of Arizona Phoenix, Arizona: The Manufactoring Stationers inc. 6