AN ACT to require direct supervision of certified registered nurse anesthetists by anesthesiologists when performing anesthesia activities during surgical procedures.

The General Assembly of North Carolina enacts:

SECTION 1.  Article 1 of Chapter 90 of the General Statutes is amended by adding a new section to read:

§ 90‑18.5A.  Limitations on certified registered nurse anesthetists.

(a)        Definitions. – The following definitions apply in this section:

(1)        Anesthesia activities. – Anesthesia induction, maintenance, and emergence of the patient, including all of the following:

a.         Securing, preparing, and providing safety checks on all equipment, monitors, supplies, and pharmaceutical agents used for the administration of anesthesia.

b.         Selecting, implementing, and managing general anesthesia, monitored anesthesia care, and regional anesthesia modalities, including administering anesthetic and related pharmaceutical agents, consistent with the patient's needs and procedural requirements.

c.         Performing tracheal intubation, extubation, and providing mechanical ventilation.

d.         Providing perianesthetic invasive and noninvasive monitoring, recognizing abnormal findings, implementing corrective action, and requesting consultation with appropriately qualified health care providers as necessary.

e.         Managing the patient's fluid, blood, electrolyte, and acid‑base balance.

f.          Evaluating the patient's response during emergence from anesthesia and implementing pharmaceutical and supportive treatment to ensure the adequacy of patient recovery from anesthesia.

(2)        Anesthesiologist. – A physician who has successfully completed an anesthesiology training program approved by the Accreditation Committee on Graduate Medical Education or the American Osteopathic Association or who is credentialed to practice anesthesiology by a hospital or an ambulatory surgical facility.

(3)        Certified registered nurse anesthetist. – A registered nurse who completes a program accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs, is credentialed as a certified registered nurse anesthetist by the Council on Certification of Nurse Anesthetists, and who maintains recertification through the Council on Recertification of Nurse Anesthetists and performs nurse anesthesia activities in collaboration with a physician, dentist, podiatrist, or other lawfully qualified health care provider.

(4)        Direct supervision. – Overseeing the activities of, and accepting responsibility for, the anesthesia services rendered by a certified registered nurse anesthetist.

(5)        Surgical procedure. – Any medical procedure requiring deep sedation or analgesia, major conduction blockade, or general anesthesia, whether conducted in a hospital, ambulatory surgical facility, or other health care facility, or a Level III procedure in an office‑based setting.

(b)        A certified registered nurse anesthetist is required to be under the direct supervision of an anesthesiologist when conducting anesthesia activities for and during a surgical procedure. The anesthesiologist supervising a certified registered nurse anesthetist must be physically present during the performance of anesthesia activities.

SECTION 2.  The North Carolina Medical Board and the North Carolina Board of Nursing shall adopt temporary rules to implement the provisions of this act.

SECTION 3.  This act becomes effective October 1, 2023.