Practice authority for advanced practitioner nurses took another stride forward on May 10 when Michigan became the 20th state to opt out of federal regulations that require physician supervision of Certified Registered Nurse Anesthetists (CRNAs).
The American Association of Nurse Anesthesiology (AANA) reports that the governors of 19 additional states and Guam have exercised such exemptions. 
Gov. Gretchen Whitmer’s action in signing the opt-out ensures Michigan’s patients have access to value-based, high-quality care and optimizes healthcare teams across the state, according to Adam Kuz, MS, CRNA, president of the Michigan Association of Nurse Anesthetists (MANA).
In March 2020, to maximize healthcare resources during the outbreak of the COVID-19 pandemic, Gov. Whitmer enacted an executive order removing physician supervision for CRNAs. In July 2021, she signed HB4359 to remove supervision requirements for CRNAs in the state nurse practice act, and HB4359 is now permanent.
Highlights of the law include:
All of the following apply to a registered professional nurse who holds a specialty certification as a nurse anesthetist:
(a) In addition to performing duties within the scope of the practice of nursing, his or her scope of practice includes any of the following anesthesia and analgesia services:
(i) Development of a plan of care.
(ii) Performance of all patient assessments, procedures, and monitoring to implement the plan of care or to address patient emergencies that arise during implementation of the plan of care.
(iii) Selection, ordering, or prescribing and the administration of anesthesia and analgesic agents, including pharmacological agents that are prescription drugs as defined in section 17708 or controlled substances. For purposes of this subparagraph, the authority of a registered professional nurse who holds a specialty certification as a nurse anesthetist to prescribe pharmacological agents is limited to pharmacological agents for administration to patients as described in subdivision (b), (c), or (d), and his or her authority does not include any activity that would permit a patient to self-administer, obtain, or receive pharmacological agents, including prescription drugs or controlled substances, outside of the facility in which the anesthetic or analgesic service is performed or beyond the perioperative, periobstetrical, or periprocedural period.
(b) He or she may provide the anesthesia and analgesia services described in subdivision (a) without supervision and as the sole and independent anesthesia provider while he or she is collaboratively participating in a patient-centered care team.
(See full text of Michigan House Bill 4359 at http://www.legislature.mi.gov/documents/2021-2022/billengrossed/House/htm/2021-HEBH-4359.htm)
“Removing barriers to CRNA practice allows Michigan hospitals to select the anesthesia delivery model that maximizes their workforce and increases access to safe, affordable care for all patients,” said former MANA president Toni Schmittling, DNAP, MBA, CRNA. “By signing this important legislation, Michigan recognizes that CRNAs are qualified to make decisions regarding all aspects of anesthesia care based on their education, licensure, and certification.”
Anesthesia services are provided predominantly by CRNAs in Michigan’s critical access hospitals, which offer surgical services in 99% of its rural hospitals. They comprise 68% of the state’s anesthesia care providers.
“The AANA applauds Gov. Whitmer for recognizing the important role CRNAs have in the delivery of safe anesthesia care in Michigan,” said AANA President Dina Velocci, DNP, CRNA, APRN. “Increased demand, limited resources, and a state with diverse populations, both rural and urban, dictate that a system capable of meeting the needs of all Michigan residents be maintained. By signing the opt-out letter, this has been achieved.”
Throughout the COVID-19 pandemic, nurse anesthetists across the country have, in addition to providing top-of-the-line anesthesia care, served as experts in airway management, hemodynamic monitoring, management of patients on ventilators, and overall management of critically ill patients. Instrumental in addressing the deadliest part of COVID-19, CRNAs have become highly sought-after anesthesia care providers.
- AANA Updates Analgesia and Anesthesia Guidelines for Obstetric Patients - March 31, 2023
- Michigan Becomes 20th State to Allow CRNAs to Work Free of Physician Supervision - May 17, 2022
- Alabama Expands CRNAs Scope of Practice - April 29, 2022