Nurse anesthetists: scope of practice.

Assembly Member Flora proposes to expand the scope and autonomy of nurse anesthetists in California through amendments that would authorize them to provide comprehensive anesthesia services across various healthcare settings. The legislation modifies existing regulations to explicitly define nurse anesthetists' authority to deliver preoperative, intraoperative, and postoperative care when credentialed by acute care facilities, outpatient centers, or dental offices.

The bill establishes that nurse anesthetists may independently select and modify anesthesia approaches based on patient chart orders, while clarifying that their administration of controlled substances does not constitute prescription writing. Beyond traditional perioperative duties, the legislation permits nurse anesthetists to perform additional services including advanced airway management, diagnostic testing interpretation, and pain management for palliative care. The amendments also specify that nurse anesthetists can initiate orders to other staff and request consultations related to patient care.

To maintain professional standards, the legislation requires nurse anesthetist trainees to enroll in accredited doctoral programs and practice under supervision. While non-employed nurse anesthetists must follow facility bylaws and may need to show proof of liability insurance, the bill explicitly states they are not required to work under standardized procedures or direct physician oversight. The amendments emphasize that the presence of other healthcare providers in the same location does not automatically constitute supervision of the nurse anesthetist's practice.

The Board of Registered Nursing retains authority to establish certification requirements, with provisions allowing the board to develop standards beyond those set by national organizations if needed for public safety. These changes aim to create clear operational frameworks while maintaining appropriate oversight of nurse anesthetist practice across California's healthcare system.