## Understanding CRNA Practice Authority
CRNA practice authority varies significantly by state. This guide explains the three main categories and lists every state's current status.
Practice Authority Categories
Full Practice Authority (FPA)
- CRNAs practice without physician supervision
- Can be sole anesthesia provider
- No collaborative agreement required
- 25 states + DC currently
Reduced Practice Authority
- Requires collaborative practice agreement
- May need physician oversight
- CRNAs can still provide full scope of care
- Varies by state
Restricted Practice Authority
- Requires physician supervision
- May limit certain procedures
- Often includes supervision ratios
- Most restrictive states
Full Practice Authority States (2025)
These states allow CRNAs to practice independently:
| State | FPA Since | Notes |
|---|---|---|
| Alaska | 1990s | Rural focus |
| Arizona | 2018 | Growing market |
| Colorado | 2010 | Strong CRNA presence |
| Connecticut | 2019 | Recent expansion |
| Idaho | 1990s | Rural dominant |
| Iowa | 1990s | Long-standing |
| Kansas | 2020 | Recent addition |
| Kentucky | 2022 | Opt-out state |
| Maine | 1990s | Rural focus |
| Minnesota | 1990s | Strong market |
| Montana | 1990s | Rural dominant |
| Nebraska | 1990s | Long-standing |
| Nevada | 2021 | Recent addition |
| New Hampshire | 1990s | Small state |
| New Mexico | 1990s | Rural focus |
| North Dakota | 1990s | Rural dominant |
| Oklahoma | 2019 | Recent expansion |
| Oregon | 1990s | Strong market |
| South Dakota | 1990s | Rural dominant |
| Vermont | 1990s | Small state |
| Washington | 1990s | Strong market |
| Wisconsin | 1990s | Long-standing |
| Wyoming | 1990s | Rural dominant |
| Washington DC | 2019 | Recent addition |
States with Collaborative Practice
These states require some form of agreement but aren't fully restricted:
| State | Requirement | Details |
|---|---|---|
| California | Supervision | Ratio requirements vary |
| Florida | Protocol | Written agreement required |
| Georgia | Supervision | Hospital-dependent |
| Illinois | Collaborative | Agreement required |
| Indiana | Supervision | Physician oversight |
| Louisiana | Collaborative | Hospital scope varies |
| Maryland | Supervision | Facility determines |
| Massachusetts | Supervision | Hospital policies |
| Michigan | Supervision | Varies by facility |
| Missouri | Collaborative | Agreement needed |
| North Carolina | Supervision | Hospital-based |
| Ohio | Supervision | Ratio varies |
| Pennsylvania | Collaborative | Agreement required |
| South Carolina | Supervision | Hospital-dependent |
| Tennessee | Supervision | Practice policies |
| Texas | Supervision | Pending legislation |
| Virginia | Supervision | Hospital protocols |
States to Watch
Texas (High Impact) - Full practice authority legislation pending - Expected passage by 2026 - Would be largest FPA market - Massive impact on CRNA opportunities
California (Large Market) - Incremental scope expansions - Strong lobbying both sides - Slow progress expected - Still significant CRNA employment
Pennsylvania (Active Advocacy) - Bill introduced for FPA - Strong CRNA advocacy presence - Moderate likelihood of change - Watch for 2025-2026 progress
Florida (Large Market) - Discussions ongoing - Strong hospital opposition - Incremental progress possible - Large CRNA employer regardless
Impact on CRNA Jobs
Why FPA Matters
| Factor | FPA State | Supervised State |
|---|---|---|
| Job Availability | Very High | High |
| Rural Opportunities | Excellent | Limited |
| Salary Potential | Higher | Competitive |
| Autonomy | Full | Varies |
| Job Satisfaction | Higher (on average) | Good |
Salary Comparison
| State Type | Average CRNA Salary |
|---|---|
| FPA States | $220,000 |
| Collaborative | $210,000 |
| Restricted | $205,000 |
Note: Many factors affect salary beyond practice authority.
How Practice Authority Changes
The Opt-Out Process
Under Medicare, states can "opt out" of federal supervision requirements:
- Governor requests opt-out from CMS
- Requires written agreement about quality
- Applies to Medicare patients
- State can add for all patients
State Legislative Process
For broader FPA:
- Bill introduced in legislature
- Committee hearings and testimony
- Floor votes in both chambers
- Governor signature
- Implementation period
Key Advocacy Organizations
- AANA (American Association of Nurse Anesthetists) — National
- State CRNA associations — Local advocacy
- NCSBN — National Council for nursing regulation
Choosing a State
For New Graduates
- FPA states offer more direct opportunities
- But don't avoid supervised states—experience is valuable
- Consider mentorship and case volume first
For Experienced CRNAs
- FPA states: Private practice, ownership options
- Supervised states: Often higher salary urban markets
- Consider lifestyle factors beyond practice authority
Conclusion
Full practice authority is expanding, with more states recognizing CRNA capabilities. While FPA offers benefits, excellent opportunities exist in all states. Consider the full picture—salary, cost of living, lifestyle, and job availability—when choosing where to practice.
State information current as of January 2025. Verify current regulations before making decisions.