1 1 (May 27, 2020)

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               Researh Sevice

Full Practice Authority for VA Registered

Nurse Anesthetists (CRNAs) During the

COVID-19 Pandemic

May 27, 2020
On April 21, 2020, the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA)
issued guidance to VA medical facilities to allow Certified Registered Nurse Anesthetists (CRNAs) to
have full practice authority (maximum breadth of practice allowable for a provider) within the scope of
their license to provide anesthetic care. Specifically, it allows CRNAs to practice without physician
supervision when licensed in a state that allows such practice. CRNAs are advanced practice registered
nurses (APRNs) who have completed postgraduate education and training and have been certified in the
provision and managing of anesthesia. This temporary change in policy has once again brought into focus
the debate, mainly between the American Society of Anesthesiologists (ASA) and the American
Association of Nurse Anesthetists (AANA), about the scope of practice of CRNAs in the provision of
anesthesia services at VA medical facilities. Scope of practice refers to requirements for practicing a skill
or profession including types of patients or case load and practice guidelines that determine the
boundaries within which a physician or other health care professional practices. This Insight briefly
reviews the new directive during the COVID- 19 pandemic and, to provide some context, briefly discusses
the previous policy debate surrounding CRNAs delivering anesthesia services to veterans.

New CRNA Full Practice Authority
The April 21 guidance allows VA medical facilities to amend bylaws and rules to permit CRNAs to
practice independently if their state license permits independent practice. This full practice authority
would be applicable at VA medical facilities located in 18 states that have permanently granted full
practice authority, and at least 9 states (as of April 21) that have granted temporary full practice authority
during the COVID-19 pandemic and were listed in the VA guidance. These states are listed in Table 1.
There are two states (Connecticut and Pennsylvania) that granted this practice authority but were not
included in the list of states in the VA guidance.

                                                               Congressional Research Service

Prepaimed for Mernbeis and
Committees  o.i C- --q .. . . . . . . . ...----------------------------------------------------------------------------------------------------------------------------------------------------------------------

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