RNs & anesthesia in TX

[ascRN]

Hello all,

I'm a nurse new to Austin. I've taken a job in an ambulatory surgical center where I'll be doing perioperative care. The center uses RNs to push anesthesia while the physician is performing procedures. I know that back in Chicago, nurses could push fentanyl and versed, but not other things like propofol. Does anyone know what the laws are in Texas surrounding RNs administering anesthesia (specific drugs, settings, requirements for physician supervision, etc)? Just want to make sure I don't overstep my scope of practice at any point. Any links to relevant texas state health code would be helpful too.

Cheers!

Dave

[HouTx, BSN, MSN, EdD]

You're in luck - our BON has a very detailed position paper on this topic http://www.bon.state.tx.us/practice/position.html#15.8

If this does not answer your questions, you should contact the Board directly.

[ascRN]

Thanks for the link, HouTx. It appears that though the board discourages it as a trend, if the physician the RN is assisting is competent in advanced airway management,including intubation, then administration of anesthetics by the RN is permissible (assuming the physician the RN is assisting can quickly abandon the surgical site to help maintain the airway).

Therefore, it is the position of the Board that the administration of anesthetic agents (e.g. propofol, methohexital, ketamine, and etomidate) is outside the scope of practice for RNs and non-CRNA advanced practice registered nurses except in the following situations:

• when assisting in the physical presence of a CRNA or anesthesiologist
  
• when administering these medications as part of a clinical experience within an advanced educational program of study that prepares the individual for licensure as a nurse anesthetist (i.e. when functioning as a student nurse anesthetist)
  
• when administering these medications to patients who are intubated and mechanically ventilated in critical care settings
  
• when assisting an individual with current competence in advanced airway management, including emergency intubation procedures

I think I'll still call the board for clarification. I have ACLS, though it seems the board is encouraging something beyond that as far as airway management is concerned (for which as far as I'm aware, no certification program exists).

[Argo]

Yje part they highlight is meaning a physician with advanced airway training. We make the er, cath lab and intensive care docs take an advanced airway coorifice taught by Anesthesia and includes doing 3 supervised intubationd.