Why don't CRNAs have prescriptive authority like NPs?

Specializes in Family Nursing & Psychiatry.

I wanted to ask why in many states CRNAs do not have prescriptive authority like nurse practitioners. I would assume they are able to as most are autonomous providers. Thanks in advance!

17 Answers

If a CRNA with prescriptive authority starts writing scripts for antibiotics, misc. med refills, or some other non-practice related reasons (like their neighbor needs something) he or she will definitely get the attention of the local board of pharmacy.

Many CRNA's that have prescriptive authority do so only because their group/hospital thinks it will take some kind of liability away from them and compel the CRNA's to have it. Same with a DEA number. Not necessary per se for the general practice CRNA, but many have it. And it doesn't change a single thing. 

PP pain is another thing but is definitely the minority of CRNA business. 

In what clinical scenario would a CRNA prescribe out of the OR? Other than maybe chronic pain management which is still not really a huge role for CRNAs

Specializes in Pediatry , Med/Surg , Anesthesia Tec,MBG.

Aren't the drugs we use in the maintenance of anesthesia, acute drugs (atropine beta blockers, those used for kidney and lung functions actually a prescription or blood? Isn't everything we write on the anesthesia paper actually a prescription?

30 minutes ago, matthewandrew said:

I would hope it would be included in their education as analgesia is within their scope of practice. My point is, CRNAs are autonomous practitioners. The ability to order and prescribe as opposed to working under a protocol is paramount to full practice authority. Not everyone will share that sentiment, but these boards are here for thought provoking discussions within our profession. 

Based on my discussion with many crnas and in working with them often as well as anesthesia pain services nearly daily I do not think crnas working in chronic pain management would be appropriate unless their education changes. Evens anesthesia MDs do a separate fellowship for pain management.

On 9/25/2021 at 1:53 PM, Numenor said:

Based on my discussion with many crnas and in working with them often as well as anesthesia pain services nearly daily I do not think crnas working in chronic pain management would be appropriate unless their education changes. Evens anesthesia MDs do a separate fellowship for pain management.

We work in chronic pain management in all states and practice settings already.  There are many, many pain management fellowships and post-graduate certifications a CRNA can get.  Maybe a few of the older crowd were grandfathered in, but most are required to get a CRNA fellowship of some kind in pain management.  It is no different than the MDA route, for the most part.

3 hours ago, BigPappaCRNA said:

We work in chronic pain management in all states and practice settings already.  There are many, many pain management fellowships and post-graduate certifications a CRNA can get.  Maybe a few of the older crowd were grandfathered in, but most are required to get a CRNA fellowship of some kind in pain management.  It is no different than the MDA route, for the most part.

Right, a separate pain medicine fellowship. No CRNA out of the gate does this. But I will say since I work at a hospital with an anesthesia residency that many MDA residents already get a ton of inpatient and chronic pain management. How do I know this? I consult them at least weekly.

Specializes in CRNA, Finally retired.
On 10/26/2021 at 8:56 PM, Tegridy said:

Yes but according to the nursing armada a 20 hour certification course = fellowship

Hopefully with the DNP they will make  a year long fellowship so the extra schooling isn't a total waste of time.  As for prescriptive authority...it's complicated and political.  You would have to go back to the 90's to get the historical minutae.  But CRNA prescriptive was viciously opposed by the MDA's and they spent a lot of money on the fight.  At the same time, th NP were going through legislation to obtain their own practice privileges and refused to include the CRNA's as NP's because it would have ben toxic to their own cause.  The CRNA's in my state dropped their demand to just get the right to dispense and administer into the regulations so that we could at least do that legally.  We just didn't exist legally as  provider on paper. 

Specializes in Family Nursing & Psychiatry.
On 9/22/2021 at 7:13 PM, Numenor said:

In what clinical scenario would a CRNA prescribe out of the OR? Other than maybe chronic pain management which is still not really a huge role for CRNAs

Looks like you answered your question. 

Specializes in Family Nursing & Psychiatry.
barishan said:

Aren't the drugs we use in the maintenance of anesthesia, acute drugs (atropine beta blockers, those used for kidney and lung functions actually a prescription or blood? Isn't everything we write on the anesthesia paper actually a prescription?

Not necessarily. Could be orders from the surgeon or anesthesiologist. If an anesthesiologist can prescribe, why can't CRNA? If full practice authority is the direction, I think this APRN role needs prescriptive authority. 

On 9/23/2021 at 10:04 PM, matthewandrew said:

Looks like you answered your question. 

No really, I’m talking a hypothetical scenario that never happens. How much education do crnas get in pain management

Specializes in Family Nursing & Psychiatry.
1 hour ago, Numenor said:

No really, I’m talking a hypothetical scenario that never happens. How much education do crnas get in pain management

I would hope it would be included in their education as analgesia is within their scope of practice. My point is, CRNAs are autonomous practitioners. The ability to order and prescribe as opposed to working under a protocol is paramount to full practice authority. Not everyone will share that sentiment, but these boards are here for thought provoking discussions within our profession. 

Specializes in Family Nursing & Psychiatry.
On 10/19/2021 at 5:19 PM, offlabel said:

If a CRNA with prescriptive authority starts writing scripts for antibiotics, misc. med refills, or some other non-practice related reasons (like their neighbor needs something) he or she will definitely get the attention of the local board of pharmacy.

Many CRNA's that have prescriptive authority do so only because their group/hospital thinks it will take some kind of liability away from them and compel the CRNA's to have it. Same with a DEA number. Not necessary per se for the general practice CRNA, but many have it. And it doesn't change a single thing. 

PP pain is another thing but is definitely the minority of CRNA business. 

Okay. So it sounds like CRNAs can obtain prescriptive authority, many just don’t want it. Hmm. 

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