Introduction
The Role of the CRNA on the Procedure Team Position Statement
Patient safety is paramount and should be the guiding principle in healthcare delivery. Certified Registered Nurse Anesthetists (CRNAs), also referred to as nurse anesthesiologists or nurse anesthetists, lead efforts in supporting patient safety as they plan and deliver sedation, analgesia, anesthesia, and pain management services for patients of all complexities across the lifespan.1 CRNAs collaborate with the interdisciplinary team to deliver high-quality care and enhance patient safety through effective communication, leadership, and continuous quality improvement.2-5
Purpose
To delineate the distinct role of CRNAs in order to support patient safety, optimize team efficiency, and maximize the utilization of advanced practice registered nursing skills in healthcare settings.
Audience
This position statement is intended for CRNAs, resident registered nurse anesthetists, members of the interdisciplinary team, administrators involved in policy development and implementation, and other interested stakeholders.
Separation of Non-Anesthesia Proceduralist and Anesthesia Professional Responsibilities
Patient safety may be compromised when the CRNA is asked to serve in a second role during the procedure. The CRNA is responsible for the anesthetic care of the patient and is not available to personally perform or actively assist with the diagnostic or therapeutic procedure. When requested, the CRNA may decide to participate in minor tasks that do not distract from the continuous monitoring and care of the patient. The American Association of Nurse Anesthesiology (AANA) Standards for Nurse Anesthesia Practice emphasize that continuous clinical observation and vigilance are the foundation of safe anesthesia care.6
The procedure team staffing arrangement must support and not compromise patient safety and clinician vigilance. When anesthesia services are requested for a procedure, there should be at least three qualified healthcare providers involved: the proceduralist, a qualified anesthesia professional, and an assistant to the proceduralist. This patient care team structure, with delineated responsibilities, allows each team member to focus on their specific role, promoting optimal outcomes and patient safety.5,7,8 A diagnostic procedure (e.g., MRI, CT scan) may only require two qualified providers. However, specific staffing requirements should also take into consideration the procedure's complexity and the patient's medical condition and comorbidities. Facility policies and procedures should incorporate any accreditation standards that apply.9-11
The CRNA Functioning in an RN Role
The CRNA may be asked to practice in a role traditionally associated with registered nursing (RN) within their healthcare facility. The AANA advises against CRNAs functioning in traditional RN roles, as this approach inefficiently addresses workforce needs, underutilizes their advanced nursing expertise, and may cause role confusion for patients and other members of the healthcare team. The scope of an individual CRNA’s practice is determined by education, experience, local, state and federal law, facility accreditation standards, clinical privileges, and
organizational policy.1 The CRNA may be held accountable to their highest level of education and training and cannot separate themselves from their advanced practice role.12 As affirmed by the Code of Ethics for the Certified Registered Nurse Anesthetist, “the CRNA is responsible and accountable for judgments made and actions taken in his or her professional practice. Requests or orders by physicians, other healthcare professionals, or institutions do not relieve the CRNA of responsibility for judgments made or actions taken.”13
The CRNA should have current competencies for any role they are assuming. The AANA Considerations for Addition of New Activities to Individual CRNA Scope of Practice provides a framework for the CRNA to make an informed decision regarding their practice. 6
Historically, facility requests for CRNAs to perform RN duties have been driven by staff shortages and economic considerations.14 Rather than serving in an RN role, CRNAs can demonstrate their value in other areas of facility operations. By contributing expertise beyond anesthesia care, CRNAs can maximize their impact.12 Their skills in staffing, practice management, and leadership can be leveraged to resolve workforce challenges.1,12,15 CRNAs can collaborate with teams to develop staffing models and case scheduling strategies that optimize the expertise and skills of all clinical team members.16 They can also contribute to planning, optimization of resources, education, and quality improvement programs.12
References
1. Scope of Nurse Anesthesia Practice. Rosemont, IL: American Association of Nurse Anesthesiology; 2020.
2. Rosen MA, DiazGranados D, Dietz AS, et al. Teamwork in healthcare: Key discoveries enabling safer, high-quality care. Am Psychol. May-Jun 2018;73(4):433-450. doi:10.1037/amp0000298
3. Tørring B, Gittell JH, Laursen M, Rasmussen BS, Sørensen EE. Communication and relationship dynamics in surgical teams in the operating room: an ethnographic study. BMC Health Serv Res. Jul 29 2019;19(1):528. doi:10.1186/s12913-019-4362-0
4. Patient-Centered Perianesthesia Communication. Rosemont, IL: American Association of Nurse Anesthesiology; 2014.
5. WakemanD, Langham MR,Jr. Creating a safer operating room: Groups, team dynamics and crew resource management principles. Semin Pediatr Surg. Apr 2018;27(2):107113. doi:10.1053/j.sempedsurg.2018.02.008
6. Standards for Nurse Anesthesia Practice. Rosemont, IL: American Association of Nurse Anesthesiology; 2019.
7. Salas E, Wilson KA, Murphy CE, King H, Baker D. What crew resource management training will not do for patient safety: Unless... J Patient Saf. June 2007;3(2):62-64.
8. Yuan CT, Liu TM, Eidman B, Lin DM, Wick EC, Rosen MA. Critical Behaviors for Perioperative Improvement Teams. Ann Surg Open. Sep 2023;4(3):e300. doi:10.1097/as9.0000000000000300
9. Accreditation Association for Ambulatory Health Care, Inc. Accreditation Handbook for Ambulatory Health Care, v43. Effective January 5, 2023. ASG.210.
10. Accreditation Commission for Health Care, Inc. Accreditation Requirements for OfficeBased Surgery. Effective August 1, 2023. Standard 10.02.01 Adequate Staff Score.
11. QUAD A. Medicare Ambulatory Surgical Center (ASC) Accreditation Standards Manual. Version 8.3. Effective August 5, 2023. Section 11: Personnel, Sub-Section D: Anesthesia Providers.
12. Reede L, Greenier E, Anderson B. Exploring a common practice question: CRNAs asked to function as RNs. AANA NewsBulletin. Sep 2013;67(5):27.
13. Code of Ethics for the Certified Registered Nurse Anesthetist. Rosemont, IL: American Association of Nurse Anesthesiology; 2018.
14. CRNAs Asked to Function as RNs Survey Summary. Rosemont, IL: American Association of Nurse Anesthesiology; 2015.
15. Clinical Privileges and Other Responsibilities of Certified Registered Nurse Anesthetists. Rosemont, IL: American Association of Nurse Anesthesiology; 2019.
16. Anesthesia Staffing Considerations Checklist. Rosemont, IL: American Association of Nurse Anesthesiology; 2017.
Adopted as Separation of Operator and Anesthesia Professional Responsibilities by AANA Board of Directors May 1988.
Reaffirmed by AANA Board of Directors June 1997 and February 2005.
Revised by AANA Board of Directors August 2010.
Revised as The Role of the CRNA on the Procedure Team by the AANA Board of Directors July 2015.
Reaffirmed by AANA Board of Directors September 2017.
Revised by AANA Board of Directors February 2025.
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