CERTIFIED REGISTERED NURSE ANESTHETISTS
Purposes and Definitions
(1) Purposes of these rules:
(a) To implement the provisions of ORS 678.245 to 678.285 governing the licensing of Certified Registered Nurse Anesthetists (CRNA) by the Oregon State Board of Nursing.
(b) To establish standards for safe practice for the CRNA.
(c) To serve as a guide for the Board to evaluate CRNA practice.
(d) To define the scope of practice of the CRNA.
(2) Definitions as used in these rules:
(a) "Adjuvant drug" means medications not specifically classified as anesthetics that are auxiliary or necessary to maintain safe, effective patient care during the anesthesia plan.
(b) "Anesthesia plan" means a plan of intervention by a CRNA for services within the CRNA scope of practice (851-052-0010).
(c) "Anesthesiologist" means a physician who has completed a residency program in anesthesiology that meets or exceeds the standards adopted by the Board of Medical Examiners. ORS 678.245(1).
(d) "Approved accrediting body" means a national organization with deemed status by the U.S. Department of Education to accredit nurse anesthesia programs, and recognized by the Oregon State Board of Nursing for purpose of identifying qualified nurse anesthesia educational programs.
(e) "Approved certifying body" means a national organization which engages in certification and/or recertification of nurse anesthetists and is approved by the Oregon State Board of Nursing for purpose of recognition of such certification.
(f) "Certified registered nurse anesthetist" means a registered nurse licensed by the Oregon State Board of Nursing as a certified registered nurse anesthetist. ORS 678.245(2).
(g) "Collaboration" means a process involving two or more parties working together, each responsible for his or her own particular area of expertise.
(h) "Direct supervision" means the CRNA or anesthesiologist is physically present in the facility and available to intervene if necessary.
(i) "Graduate Registered Nurse Anesthetist (GRNA)" means an individual who has graduated from an accredited nurse anesthesia program, and is eligible to receive a limited Oregon license to practice within the CRNA scope of practice prior to attaining full certification, subject to the requirements of 851-052-0020(3) and (4).
(j) "National Certification Examination" means the examination given by an approved certifying body for purpose of determining eligibility for certification.
(k) "Nurse Anesthesia Student" means a student in good standing in a nurse anesthesia program accredited by an approved accrediting body.
(l) "Physician" means a doctor of medicine or osteopathy licensed in Oregon under ORS chapter 677. ORS 678.245(4).
CRNA Scope of Practice
(1) Except as provided to the contrary by the rules and regulations or bylaws governing medical procedures in a hospital or ambulatory surgical center, a CRNA shall collaborate with a physician or dentist, or with other health care professionals whose scope of practice includes the authority to provide anesthesia care to a patient.
(2) Assessment of the health status of the patient as that status relates to the relative risks associated with anesthetic management of the patient (ORS 678.275(a)). The CRNA may:
(a) Perform and document a preanesthetic assessment and evaluation of the patient;
(b) Request and obtain consultations, laboratory and diagnostic studies;
(c) Select, obtain, order or administer pre-anesthetic medications and fluids; and
(d) Obtain informed consent or confirm that the patient has given informed consent for the services to be furnished.
(3) Determination and administration of an appropriate anesthesia plan, including but not limited to selection, ordering and administration of anesthetic agents, airway management and monitoring and recording of vital signs, life support functions, mechanical support use, fluid management and electrolyte and blood component balance (ORS 678.275(b)). The CRNA may:
(a) Select and initiate the anesthetic technique;
(b) Select, apply and insert invasive and non-invasive monitoring modalities;
(c) Select and provide supports for airway management;
(d) Select, obtain, order or administer anesthetic agents and adjuvant drugs;
(e) Select and provide mechanical support; and
(f) Select and provide fluids, electrolytes and blood components.
(4) Action necessary to counteract problems that may develop during implementation of the anesthesia plan (ORS 678.275(c)). The CRNA may:
(a) Conduct ongoing assessment to identify problems and provides corrective or preventive action;
(b) Order laboratory tests, blood gases and other necessary interventions;
(c) Select, obtain, order or administer drugs, fluid, blood and electrolyte components;
(d) Direct and implement emergency resuscitative techniques; and
(e) Provide clinical support functions.
(5) Necessary or routine post anesthesia care (ORS 678.275(d)). The CRNA may:
(a) Select, obtain, order or administer drugs for implementing and managing pain management techniques during the post anesthesia period, and to prevent or manage complications; and
(b) Perform post anesthesia evaluation, discharge from post anesthesia care unit, and follow-up evaluation and care.
(6) A CRNA shall practice in accordance with the bylaws, rules and regulations of the practice setting, Oregon statute, and Oregon State Board of Nursing administrative rules.
(7) The CRNA is responsible for recognizing his or her limits of knowledge and experience, and for consulting with or referring clients to other health care practitioners as appropriate.
(8) The CRNA may only provide anesthesia services within the scope of practice for which he or she is educationally prepared and for which competency has been established and maintained. Educational preparation includes academic course work, workshops or seminars, provided both theory and clinical experience are included.
Eligibility for Licensure
(1) As of September 1, 1998, an individual shall meet the requirements and receive a license as a CRNA in order to use the title CRNA, Certified Registered Nurse Anesthetist or Nurse Anesthetist, and engage in the scope of practice of a CRNA.
(2) An applicant for licensure as a CRNA shall:
(a) Hold or obtain a current registered nurse license in Oregon;
(b) Be a graduate of nurse anesthesia educational program accredited by an approved accrediting body;
(c) Meet the practice requirement, which is to either have:
(A) Graduated from the nurse anesthesia program within the past two years; or
(B) Practiced 850 hours as a CRNA within the two years preceding the application for licensure, including but not limited to direct care, teaching, consulting, supervision and research related to CRNA scope of practice; and
(d) Hold current full certification or recertification from an approved certifying body; or
(3) A Graduate Registered Nurse Anesthetist (GRNA) may receive a limited license to practice within the CRNA scope of practice prior to attaining full certification if the applicant:
(a) Is a graduate of an accredited nurse anesthesia educational program;
(b) Meets all requirements for CRNA licensure other than full certification;
(c) When providing anesthesia care, a GRNA shall have available for consultation a CRNA or anesthesiologist in the facility, until full certification from an approved certifying body is achieved.
(d) The limited license shall expire 9 months following the date of graduation, or on issue of the CRNA license after full certification is attained, whichever is earlier.
(4) Applicants who graduate from an approved anesthesia educational program on or after January 1, 2001 shall be required to hold a Master's degree in anesthesia practice, or in a related practice area approved by the board.
(5) If an applicant does not meet the practice requirement in 851-052-0030(2)(c), the applicant shall:
(a) Submit for Board approval, a detailed plan for supervised practice which includes objectives, names and qualifications of preceptor(s), and describes the nature of the clinical experience.
(A) If the applicant has practiced at least 850 hours within the past five (5) years, the practice plan shall provide for 850 hours of preceptorship. Documented practice hours within the past two (2) years may be recognized and may reduce the required hours, except that, in no case shall the supervised practice be less than 400 hours.
(B) If the applicant has practiced at least 850 hours within the past ten (10) years, the practice plan shall provide for 1275 hours.
(C) If the applicant has not practiced at least 850 hours within the past (10) years, the practice plan shall provide for 1700 hours, and the applicant shall pass the certification examination offered by an approved certifying body.
(b) Submit evidence of continuing education credits granted by an approved accrediting body to total 20 hours for each year out of practice, completed within the period the applicant was out of practice or concurrent with the preceptorship.
(c) Obtain a limited license for supervised practice. For purpose of this section, the limited license will be issued and valid for one (1) year from the date of issue:
(A) Upon application and payment of fee; and
(B) Board approval of the plan for supervised practice; and
(C) Evidence of provisional certification by an approved certifying body.
(d) Successfully complete the planned hours of clinical practice supervised by a CRNA or anesthesiologist. Successful completion shall be verified by a final evaluation submitted by the supervising practitioner to the Board to verify that the applicant's knowledge and skills are at a safe and acceptable level and that the number of required hours of supervised practice were completed.
(e) Obtain full certification from an approved certifying body.
(6) Revocation, suspension, or any other encumbrance of a registered nurse license, or any special authority to practice anesthesia care, in another state, territory of the United States, or any foreign jurisdiction may be grounds for denial of CRNA licensure in Oregon.
(7) The applicant shall submit all fees required by the Board with the application. The fees are not refundable. An application which remains incomplete after one calendar year shall be considered void.
Stat. Auth.: ORS 678.285
Stats. Implemented: ORS 678.285
Hist.: BN 9-1998, f. 7-16-98, cert. ef. 9-1-98
Renewal of CRNA License
Renewal of the CRNA license shall be on the same schedule as the renewal of the registered nurse license. The requirements for renewal are:
(1) Current unencumbered license as a registered nurse in Oregon; and
(2) Current active practice as a CRNA for no less than 850 hours within the two years prior to renewal or preceptorship as established in OAR 851-052-0020(5); and
(3) Current certification or recertification by the American Association of Nurse Anesthetists (AANA) Council on Certification or Re-Certification of Nurse Anesthetists.
(4) The applicant shall submit the required fees with the application. Fees are not refundable. An application shall be void if not completed during the current biennial renewal cycle. Any individual whose CRNA license or national certification is expired or delinquent may not practice or represent themselves as a CRNA in Oregon, subject to civil penalty.
Stat. Auth.: ORS 678.285
Stats. Implemented: ORS 678.285
Hist.: BN 9-1998, f. 7-16-98, cert. ef. 9-1-98; BN 5-2005, f. & cert. ef. 6-30-05
Clinical Practicum in Oregon for Certified Registered Nurse Anesthetist Students Enrolled in a Non-Oregon Based Graduate Program
(1) A nurse anesthesia student enrolled in a Non-Oregon Based Graduate Program may not participate in a clinical practicum in Oregon without prior Board authorization.
(2) Prior authorization will be predicated upon approval of the following:
(a) A completed registration form;
(b) Verification of a current, unencumbered registered nurse license in Oregon;
(c) Verification of enrollment in a graduate program accredited by a United States Department of Education or the Council of Higher Education Accreditation approved national accrediting body;
(d) Verification of regional accreditation and/or Board of Nursing approval from the state in which the program originates;
(e) Proof of approval by the Office of Degree Authorization of the Non-Oregon Based Graduate Program;
(f) Submission of a written signed agreement between the Non-Oregon Based Graduate Program responsible for the student and the Oregon licensed preceptor;
(g) Identification of the faculty advisor accountable for general supervision from the Non-Oregon Based Graduate Program; and
(h) Identification of the Oregon licensed nurse anesthesia faculty providing direct clinical evaluation of the nurse anesthesia student.
(3) Oregon licensed preceptors are responsible for validating that the student has registered and received Board authorization prior to participating in a clinical practicum in Oregon.
(4) A nurse anesthesia student shall practice under the direct supervision of a CRNA or anesthesiologist who agrees to serve as preceptor, and general supervision of a faculty member as approved in the clinical practicum registration.
(5) Oregon faculty will be approved by the Board based on congruence of clinical scope and expertise to the student’s clinical placement.
(6) The student’s assigned preceptor may not simultaneously serve as their designated faculty of record. The faculty of record must provide on-site evaluation of both the student and the preceptor.
Stat. Auth.: ORS
Stats. Implemented: ORS 678.285
Hist.: BN 9-1998, f. 7-16-98, cert. ef. 9-1-98; BN 7-2012, f. 5-7-12, cert. ef. 6-1-12; BN 15-2012(temp), f. & cert. ef. 11-15-12 thru 5-1-13; BN 4-2013, f. 2-28-13, cert. ef. 4-1-13
Disciplinary Action on CRNA License
(1) The Board may deny, suspend or revoke the authority of a CRNA to administer anesthesia agents, including adjuvant drugs, for the causes identified in ORS 678.111(1).
(2) In addition to standards identified in 851-045-0015, the abuse of the anesthesia or authority to select, obtain, order, or administer drugs constitutes conduct derogatory to nursing standards and is defined as:
(a) Selecting, obtaining, ordering, administering, or distributing anesthesia agents or other drugs for purposes other than anesthesia care;
(b) Selecting, obtaining, ordering, administering, or distributing anesthesia agents or adjuvant drugs to an individual who is not the CRNA's client;
(c) Selecting, obtaining, ordering, administering, or distributing anesthesia agents or adjuvant drugs in an unsafe manner or without adequate instructions to the client according to acceptable and prevailing standards of practice;
(d) Selling, purchasing, trading, or offering to sell, purchase or trade any drug sample.
Stat. Auth.: ORS 678.111 & ORS 678.150
Stats. Implemented: 678.111
Hist.: BN 9-1998, f. 7-16-98, cert. ef. 9-1-98