Why don't CRNAs have prescriptive authority like NPs?

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!

Specializes in Former NP now Internal medicine PGY-3.
On 9/25/2021 at 4:53 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.

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

On 10/25/2021 at 11:39 PM, matthewandrew said:

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

affirmative.

Specializes in Family Nursing & Psychiatry.
30 minutes ago, offlabel said:

affirmative.

Maybe that’s why the VA didn’t grant them FPA and did for all other APRN roles. 

2 hours ago, matthewandrew said:

Maybe that’s why the VA didn’t grant them FPA and did for all other APRN roles. 

doubt it.

Specializes in CRNA, Finally retired.
On 11/17/2021 at 12:35 PM, offlabel said:

affirmative.

Can you give me an example of a scenario in which a CRNA would want to dispense a prescription?  We have the authority to "dispense and administer" drugs during the operative process.   

matthewandrew said:

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. 

Well to be fair, the anesthesiologist went through the entirety of medical school and years of residency that include multiple specialties -- the CRNA has been trained specifically to focus on anesthesia and anesthesia related health issues/procedures (pain management, blood patches, etc...). The CRNA's scope of training doesn't generally include the use of augmentin or terbinafine outside of the basic pharmacology class that all APRNs have to take. 
The anesthesiologist, however, did have to learn all of that to make it through residency before starting to specialize in anesthesiology. 

mrphil79 said:

Well to be fair, the anesthesiologist went through the entirety of medical school and years of residency that include multiple specialties -- the CRNA has been trained specifically to focus on anesthesia and anesthesia related health issues/procedures (pain management, blood patches, etc...). The CRNA's scope of training doesn't generally include the use of augmentin or terbinafine outside of the basic pharmacology class that all APRNs have to take. 
The anesthesiologist, however, did have to learn all of that to make it through residency before starting to specialize in anesthesiology. 

I can't think of a reason why an anesthesiologist would ordinarily prescribe Augmentin or an anti fungal agent except maybe for his kid or his neighbor who asked him for something. I guarantee you most if not all of the anesthesiologists I work with don't keep prescription pads handy or even know where to grab one if they needed to. The reality is that many anesthesia groups require prescriptive authority and a DEA license for their CRNA staff because of medical staff bylaws. I have both but would not if not required. There was a time when it was not and there was no difference in my practice. There would be no reason for me to prescribe an antibiotic or anything else on an outpatient basis because I don't see outpatients. 

offlabel said:

I can't think of a reason why an anesthesiologist would ordinarily prescribe Augmentin or an anti fungal agent except maybe for his kid or his neighbor who asked him for something. I guarantee you most if not all of the anesthesiologists I work with don't keep prescription pads handy or even know where to grab one if they needed to. The reality is that many anesthesia groups require prescriptive authority and a DEA license for their CRNA staff because of medical staff bylaws. I have both but would not if not required. There was a time when it was not and there was no difference in my practice. There would be no reason for me to prescribe an antibiotic or anything else on an outpatient basis because I don't see outpatients. 

Yeah... perhaps my point is being a bit twisted here...
I'm not arguing that anesthesiologists should be regularly prescribing all kinds of medicines or that they in fact do - I'm just stating why they have the ability to do so compared to a CRNA, which was the exact question I was responding to. 
At the end of the day, the anesthesiologist (just like a psychiatrist or radiologist) has the education and training to prescribe basic meds like that if they so choose - the CRNA, unless they're also a NP, doesn't generally get that same training. 

mrphil79 said:

Yeah... perhaps my point is being a bit twisted here...
I'm not arguing that anesthesiologists should be regularly prescribing all kinds of medicines or that they in fact do - I'm just stating why they have the ability to do so compared to a CRNA, which was the exact question I was responding to. 
At the end of the day, the anesthesiologist (just like a psychiatrist or radiologist) has the education and training to prescribe basic meds like that if they so choose - the CRNA, unless they're also a NP, doesn't generally get that same training. 

You're missing a pretty big point here. General advanced practice training is pretty much across the board but I'd argue nurse anesthesia programs are head and shoulders above any NP training program in pharmacology in terms of scope and intensity. Specific drugs themselves as applied to patients in a particular care specialty or sub-specialty become very familiar to the prescriber and are not necessarily emphasized during training.  I have well over 100 drugs in my anesthesia cart and I know there isn't an NP specialty around that has that scope and range that they routinely prescribe. We just administer the drugs we prescribe. 

offlabel said:

You're missing a pretty big point here. General advanced practice training is pretty much across the board but I'd argue nurse anesthesia programs are head and shoulders above any NP training program in pharmacology in terms of scope and intensity. Specific drugs themselves as applied to patients in a particular care specialty or sub-specialty become very familiar to the prescriber and are not necessarily emphasized during training.  I have well over 100 drugs in my anesthesia cart and I know there isn't an NP specialty around that has that scope and range that they routinely prescribe. We just administer the drugs we prescribe. 

I'm offering an actual fact in response to the original question about why anesthesiologists can prescribe most meds, whereas CRNAs can't... But for some reason you seem to be hearing my words as "CRNAs are undereducated cavemen" and want to be defensive about it. 
I'm fully aware that people in a specialty are familiar with their common drugs, and I never disparaged CRNAs in any way whatsoever in my response.  
Not sure why you want my words to be a pi$$ing contest, when I'm really doing nothing but stating straight up facts. 
Kind of an odd response, really...

Specializes in Adult Critical Care.

The act of providing anesthesia in the OR doesn't require prescriptive authority.  It doesn't matter who's doing it....physician or CRNA. Only reason to do it is hospital bylaws.   For some reason, I see this frequently cited as a reason for CRNA supervision...even though it's irrelevant to practice.

Crnas who have completed one of the one year CRNA pain fellowships should absolutely have outpatient prescriptive authority; they do in many states.  I would point out that most pain docs are physician anesthesiologists; only about 1/3 of them completed a pain fellowship or are board certified in pain.  I notice no one ever bats an eye at that.  But I guess the MD magic degree really gives you cart blanche to do literally anything to the human body.

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