An Act amending the act of May 22, 1951 (P.L.317, No.69), known as The Professional Nursing Law, further providing for definitions and for scope of practice for certified registered nurse anesthetists.

PRINTER'S NO. 3109
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 2335
Session of
2026
INTRODUCED BY BOROWSKI, RYNCAVAGE, GUENST, HOWARD, PROKOPIAK,
ABNEY, MALAGARI, McNEILL, KUZMA, CIRESI, WAXMAN, CERRATO,
CEPEDA-FREYTIZ, FLICK, FRITZ, HAMM, TOMLINSON, ROWE, WATRO,
MAYES, KUTZ, GREEN, REICHARD, ARMANINI, STENDER, KOZAK,
KEPHART, McANDREW AND GIRAL, MARCH 30, 2026
REFERRED TO COMMITTEE ON PROFESSIONAL LICENSURE, MARCH 30, 2026
AN ACT
Amending the act of May 22, 1951 (P.L.317, No.69), entitled "An
act relating to the practice of professional nursing;
providing for the licensing of nurses and for the revocation
and suspension of such licenses, subject to appeal, and for
their reinstatement; providing for the renewal of such
licenses; regulating nursing in general; prescribing
penalties and repealing certain laws," further providing for
definitions and for scope of practice for certified
registered nurse anesthetists.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Sections 2(1) and (17) and 8.9 of the act of May
22, 1951 (P.L.317, No.69), known as The Professional Nursing
Law, are amended to read:
Section 2. Definitions.--When used in this act, the
following words and phrases shall have the following meanings
unless the context provides otherwise:
(1) The "Practice of Professional Nursing" means diagnosing
and treating human responses to actual or potential health
problems through such services as casefinding, health teaching,
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health counseling, and provision of care supportive to or
restorative of life and well-being, and executing medical
regimens as prescribed by a licensed physician or dentist. The
foregoing shall not be deemed to include acts of medical
diagnosis or prescription of medical therapeutic or corrective
measures, except as performed by a certified registered nurse
practitioner or certified registered nurse anesthetist acting in
accordance with rules and regulations promulgated by the Board.
* * *
[(17) "Overall direction" means oversight of anesthesia
services and medical management of patient care by a qualified
individual who is present and available onsite, but not
necessarily present in the same procedure room as a certified
registered nurse anesthetist performing anesthesia services for
the duration of the services provided.]
Section 8.9. Scope of Practice for Certified Registered
Nurse Anesthetists.--(a) A certified registered nurse
anesthetist shall have the authority to perform anesthesia
services in cooperation with a physician, podiatrist or dentist
involved in a procedure for which anesthesia care is being
[provided if the anesthesia services are performed under the
overall direction of any of the following:
(1) A physician licensed by the State Board of Medicine or
the State Board of Osteopathic Medicine who has completed an
accredited residency training program in anesthesiology.
(2) A physician licensed by the State Board of Medicine or
the State Board of Osteopathic Medicine who is performing the
procedure for which the certified registered nurse anesthetist
is performing anesthesia services.
(3) A podiatrist licensed by the State Board of Podiatry who
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is performing the procedure for which the certified registered
nurse anesthetist is performing anesthesia services.
(4) A dentist licensed by the State Board of Dentistry and
permitted by the act of May 1, 1933 (P.L.216, No.76), known as
"The Dental Law," or the State Board of Dentistry to administer,
supervise or direct the administration of anesthesia.] provided.
(a.1) Anesthesia services include the authority to
prescribe, dispense and administer prescription drugs, including
prescriptions for controlled substances listed in Schedules II,
III, IV and V under 21 U.S.C. § 812 (relating to schedules of
controlled substances); to order and evaluate laboratory and
diagnostic test results and perform point-of-care testing that
the certified registered nurse anesthetist is qualified to
perform; and to order and evaluate radiographic imaging studies
that the certified registered nurse anesthetist is qualified to
order and interpret. A certified registered nurse anesthetist
may prescribe prescription drugs for a supply of not more than
ten (10) days with no refills and only for an individual for
whom the certified registered nurse anesthetist has, at the time
of the prescription, established a client or patient record.
(a.2) Nothing in this section requires a certified
registered nurse anesthetist to obtain prescriptive authority
from a physician, podiatrist or dentist to select, order and
administer controlled substances in connection with the
procedure for which anesthesia care is being provided.
(a.3) A certified registered nurse anesthetist may perform
the following services and procedures:
(1) be responsible for performing and documenting total
anesthesia care of a patient, including, but not limited to,
preanesthetic preparation and evaluation, requesting
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consultations and diagnostic studies, obtaining informed consent
for anesthesia and selection and administration of anesthetic
agents or other agents administered in the management of
anesthetic care, anesthesia induction, maintenance, emergence
and post anesthesia care;
(2) develop and implement an anesthetic care plan;
(3) select and initiate the planned anesthesia technique
which may include general, regional and local anesthesia and
sedation;
(4) select, apply or insert appropriate noninvasive and
invasive monitoring modalities for collecting and interpreting
patient physiological data;
(5) support life functions during the perioperative period;
(6) select, obtain and administer the anesthetics, adjuvant
drugs, accessory drugs and fluids necessary to manage the
anesthetic to maintain the patient's physiologic homeostasis,
and to correct abnormal responses to the anesthesia or surgery;
(7) recognize and be able to take appropriate action for
untoward patient responses during anesthesia;
(8) observe and manage the patient's emergence from
anesthesia by selecting, obtaining, ordering or administering
medications, fluids or ventilatory support in order to maintain
homeostasis;
(9) discharge patients from a postanesthesia care area;
(10) participate in the life support of the patient,
including, but not limited to, perianesthetic and clinical
support functions;
(11) implement acute and chronic pain management modalities;
(12) respond to emergency situations by providing airway
management, administration of emergency fluids or drugs, or
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using basic or advanced cardiac life support techniques;
(13) supervise anesthesia care being provided by nurse
trainees enrolled in a course approved by the Council on
Accreditation of Nurse Anesthesia Educational Programs; and
(14) direct administration of anesthesia by a graduate of an
approved anesthesia program until the announcement of results of
the first examination given for certification for which the
graduate is eligible.
(b) Nothing in this section shall be construed to:
[(1) prohibit a certified registered nurse anesthetist who
would otherwise require direction from providing brief periods
of care in the event of an emergency that temporarily prevents
or interferes with overall direction;]
(2) restrict the authority of a health care facility to
provide for additional oversight requirements for a certified
registered nurse anesthetist practicing within the facility; or
(3) limit or prohibit a certified registered nurse
anesthetist from engaging in those activities which normally
constitute the practice of professional nursing as defined in
section 2.
(c) For purposes of this section, a licensed physician,
licensed podiatrist or licensed dentist is not liable for any
act or omission of a certified registered nurse anesthetist who
orders or administers anesthetics.
(d) As used in this section, the following words and phrases
shall have the meanings given to them in this subsection unless
the context clearly indicates otherwise:
"Cooperation" means a process in which the certified
registered nurse anesthetist and the physician, dentist or
podiatrist work together with each contributing an area of
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expertise, at their individual and respective levels of
education and training.
Section 2. This act shall take effect in 60 days.
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