States That Allow CRNAs to Practice Without Physician Supervision

State Laws Dictate CRNA Work

Female anesthesiologist sedating patient for surgical procedure in hospital
Steve Debenport / Getty Images

Certified Registered Nurse Anesthetists (CRNAs) are anesthesia professionals who safely administer approximately 49 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists (AANA) 2019 Practice Profile Survey. Nurse anesthetists have been providing anesthesia care to patients in the United States for more than 150 years. The CRNA credential came into existence in 1956.

CRNAs provide anesthesia in collaboration with surgeons, anesthesiologists, dentists, podiatrists, and other qualified healthcare professionals. When anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing; when administered by an anesthesiologist, it is recognized as the practice of medicine. Regardless of whether their educational background is in nursing or medicine, all anesthesia professionals give anesthesia the same way.

CRNAs are the primary providers of anesthesia care in rural America, enabling health care facilities in these medically underserved areas to offer obstetrical, surgical, pain management and trauma stabilization services. In some states, CRNAs are the sole providers in nearly 100 percent of the rural hospitals.

States That Allow CRNAs to Practice Without Physician Supervision

Federal law requires that CRNAs practice under the supervision of a licensed physician, usually a surgeon or anesthesiologist. However, in 2001, a new rule was created which allows states to "opt-out" of the federal requirement for physician supervision of CRNAs.

Therefore, in these opt-out states, CRNAs are legally able to practice without physician supervision. As advanced practice registered nurses, CRNAs practice with a high degree of autonomy and professional respect. They carry a heavy load of responsibility and are compensated accordingly.

The states are listed in alphabetical order:

  • Alaska
  • California
  • Colorado
  • Iowa
  • Idaho
  • Kansas
  • Kentucky
  • Minnesota
  • Montana
  • Nebraska
  • New Hampshire
  • New Mexico
  • North Dakota
  • Oregon
  • South Dakota
  • Washington
  • Wisconsin

Educational Requirements

The minimum education and experience required to become a CRNA include:

  • A baccalaureate or graduate degree in nursing or other appropriate major.
  • An unencumbered license as a registered professional nurse and/or APRN in the United States or its territories.
  • A minimum of one year of full-time work experience, or its part-time equivalent, as a registered nurse in a critical care setting.
  • Graduation with a minimum of a master’s degree from a nurse anesthesia educational program accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs.
  • Pass the National Certification Examination following graduation.

Nurse anesthesia programs have admission requirements in addition to the above minimums. They range from 24-51 months, depending on university requirements. These programs include clinical settings and experiences.

As of August 2019, there were 121 accredited nurse anesthesia programs in the United States utilizing more than 1,800 active clinical sites; 91 nurse anesthesia programs are approved to award doctoral degrees for entry into practice.

Was this page helpful?

Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. CRNA Fact Sheet. AANA. Aug 8, 2019.

  2. Fact Sheet Concerning State Opt-Outs And November 13, 2001 CMS Rule. American Association of Nurse Anestheticists. Sept 2018

  3. Education of Nurse Anesthetists in the U.S. AANA. Aug 8, 2019.