Memorandum in Support -
S769 (Senator Cooney)
Relates to certified registered nurse anesthetists
The New York State Association of Nurse Anesthetists (NYSANA) strongly supports
S769 (Cooney), which creates licensure with a scope of practice for certified registered nurse
anesthetists. NYSANA is the statewide professional association representing the interests of
over 1,900 Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse
Anesthetists (SRNAs) providing high-quality, safe and cost-effective anesthesia care to residents
across New York State.
Currently in New York, CRNA practice is not codified in law. Instead, the scope of
practice for CRNAs is defined through educational requirements and Health Department
regulations. This legislation would create a scope of practice for CRNAs, allowing a CRNA to
obtain a license, and practice to the full extent of their education and training. Oversight of the
license will be under the NY State Education Department Office of Professions, as with all other
nursing specialties.
CRNAs have been providing anesthesia care to patients for more than 150 years.
Anesthesia is a recognized area of specialty in medicine and nursing. Regardless of whether the
educational background is in nursing or medicine, all anesthesia providers provide anesthesia to
facilitate diagnostic, therapeutic and surgical procedures. Nurse anesthesia is the nation’s oldest
advanced practice nursing specialty, dating back to the Civil War.
Anesthesia is safer today than at any other time. Current data demonstrates there is no
significant difference in patient outcomes based on different types of anesthesia providers.
Studies show the provision of anesthesia with a CRNA-only model costs hospitals significantly
less than any other model utilized. Furthermore, the value and need for CRNAs was highlighted
at a new level during the COVID-19 pandemic when CRNAs stepped into key leadership roles in
treating COVID-19 patients. Just a few of the ways CRNAs helped was by educating nursing
staff on advanced critical care skills, organizing COVID-19 airway teams, functioning as
advanced practice registered nurses in the ICU and standardizing airway management and
procedures. CRNAs rose to the challenge in ways that show their value, and the need for New
York to finally adopt a defined scope of practice for the profession is upon us.
Unfortunately, New York is the only state that does not fully recognize CRNA practice.
The time has come for New York to grant full recognition of CRNAs, which will lead to greater
access to high quality care and help resolve problems that question liability, supervision and
authority to administer anesthesia.
This legislation is based on the model used in the Nurse Practitioner Modernization Act
of 2015. For newly graduated CRNAs with less than 3,600 hours experience, they will work
under a written practice agreement with a licensed physician. For experienced CRNAs with over
3,600 hours of experience, there will be a collaborative relationship with a licensed physician.
Given that all supervision requirements have been waived by executive order during the COVID-
19 pandemic, and a years’ worth of data proves that there were no negative patient outcomes as
the result of supervision removal, we believe we are well past time for this legislation to be
adopted.
For these reasons, NYSANA strongly supports S769 (Cooney), which creates a scope of
practice for certified registered nurse anesthetists and urges its swift passage.
Memorandum in Support - S769 (Senator Cooney)
Relates to certified registered nurse anesthetists
Our organizations strongly support S769, which would create licensure with a scope of
practice for certified registered nurse anesthetists (CRNAs). CRNAs are masters and doctorate
educated advance practice professionals, who are required to undergo robust education and
training. This legislation would grant CRNAs the full authority to administer patient care
commensurate with their advanced education, training and experience and to ensure anesthesia
services are safe and affordable for every patient in New York.
New York is the only state in the entire country that does not recognize CRNAs and the
critical services they provide. This legislation will increase access to high quality anesthesia
services in rural, and other underserved areas, and encourage CRNAs to practice in this state and
provide these needed services.
For these reasons, our organizations know that we must act promptly to remedy this
situation and create a license and scope of practice for CRNAs, which is why we strongly
support S769 and urge its swift passage.
American Nurses Association - New York
Council of Associate Degree Nursing In New York State, Inc.
Healthcare Association of New York State
NY Council of PeriOperative Registered Nurses
New York Organization for Nursing Leadership
The Nurse Practitioner Association New York State
S 769 (Cooney)
MEMORANDUM IN SUPPORT
Amending the Education Law in relation to creating the profession of nurse anesthetist
NYSNA represents more than 42,000 registered nurses throughout New York and is a leading advocate
for universal access to high quality health care for all New Yorkers, regardless of ability to pay. As a
union representing nurses, we also advocate for the establishment of safe standards of patient care and
regulation of professional nursing scope of practice.
The proposed legislation (S 769) would create a new licensed title of certified registered nurse anesthetist
(CRNA) and establish formal parameters and regulations applicable to CRNA practice.
Under current law, CRNA practice is not formally codified and CRNAs are permitted to provide
anesthesia services if they meet required education and training criteria and are under the direct
supervision of an anesthesiologist or other licensed anesthetist who is present or readily available during
the procedure.
The legislation would clearly define the scope of practice of CRNAs and allow licensed CRNAs to
practice more independently and without direct physician supervision. CRNAs with less than 3,600
hours of practical experience would be required to maintain a written practice agreement with a physician
who would oversee their practice. CRNAs with 3,600 or more hours of experience would be able to
independently provide anesthesia services under a collaborative agreement with a physician.
This legislation is directly patterned on a similar model that successfully expanded the role and scope of
practice of Nurse Practitioners, allowing them to fill an increasingly important role as primary and acute
care providers.
New York is one of the few remaining states that does not formally recognize CRNAs as a licensed
professional title. During the COVID pandemic, however, the restrictions on CRNA practice were
suspended in order to maintain the availability of anesthesia services as medical staff shifted to treating
COVID patients. There were no issues or negative effects on patient care reported. CRNAs have played
a significant role in providing anesthesia services throughout the state, and their role is particularly
important in medically underserved areas.
NYSNA believes that CRNAs should be allowed to independently practice to the full extent of their
training and the scope of practice provided for in this legislation. After enactment of this law and the
establishment of the new CRNA professional title, we would urge the legislature to consider further
legislation to expand the right CRNAs to practice independently and to the full scope of their license.
NYSNA strongly supports enactment of this legislation.
MEMORANDUM OF SUPPORT: S.769
Given the importance of this issue and as part of our ongoing effort to let our members know of action
taken on key issues, we will be informing them how their legislators vote on this legislation.
March 31, 2023
BILL NUMBER: S.769 (Cooney)
TITLE OF BILL: An act to amend the education law, in relation to creating the profession of nurse
anesthetist.
PURPOSE OF BILL: This bill creates a scope of practice for certified registered nurse anesthetists.
STATEMENT OF SUPPORT: The provision of quality, accessible health care services to New Yorkers is an
ongoing goal of AARP New York. We believe that nurses should achieve higher levels of education and
training and should practice to the full extent of their education and training. Such policies put patients
first by allowing New Yorkers to get the care they need whenever and wherever they need it.
CRNAs are master’s-educated nurses who are required to undergo a vigorous licensure process in order
to obtain certification. Studies in anesthesiology safety have demonstrated that there is no difference in
the quality of care provided by CRNAs and their physician counterparts.
1
By providing high-quality
anesthesia care with reduced expense to patients and insurance companies, CRNAs help to control
escalating healthcare costs.
However, without title recognition, there is no guarantee that those individuals representing themselves
as CRNAs have, in fact, fulfilled the necessary licensure requirements. This compromises patient safety,
especially in rural and underserved communities, where CRNAs are often the sole anesthesia providers.
Title recognition will ensure that only nurses who have been properly educated will provide specialized
care and will prohibit health care facilities from improperly using unqualified individuals as CRNAs.
Without title recognition, CRNAs are unable to apply for direct reimbursement for services to patients
provided through state sponsored Medicaid programs. This roadblock not only increases costs but limits
the state’s ability to provide care to millions of uninsured low-income residents.
Title recognition for CRNAs is not only essential for the public’s protection, but also an important step
towards safer and cost-effective health care that puts New York’s patients first.
For the above reasons, AARP supports this legislation.
Please contact Bill Ferris or David McNally at (518) 434-4194 with any questions.
1
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2008.0966
1 Empire Drive, Rensselaer, NY 12144
Position Statement
S-769 (Senator Cooney)
The New York Organization for Nursing Leadership (NYONL) SUPPORTS title recognition for
Certified Registered Nurse Anesthetists (CRNA).
RATIONALE: As written the bills:
• Ensure that only licensed and certified individuals/nurses will engage in this specialized
scope of practice.
• Establish a unified standard of care.
• Promote improved access to high quality care in all areas of NewYork State.
• Provide for cost effective health care while preventing inappropriate substitution in the
healthcare setting.
CRNAs are nationally certified advanced practice nurses with advanced education at the
masters or doctor of nursing practice level, who have completed a rigorous educational
program in the specialty, including extensive clinical training and have passed the national
examination in the specialty. In order to ensure that only those properly prepared provide this
level of specialized care, the title should be formally recognized in New York State. It is
imperative that patients in all areas of New York receive the same level of quality service.
There is a history of over 125 years of care being given by those in this first nursing specialty.
Given that research has documented that there are substantially comparable outcomes of care
provided by CRNAs, that CRNAs are currently the major providers of millions of anesthesia
cases performed especially in rural settings in New York and in the military, and that extending
full scope of practice privileges to CRNAs will expand access to healthcare services, NYONL
supports a bill reflecting title protection with full scope of practice, without requirements
for collaborative practice agreements and collaborating physicians
Therefore NYONL, which is made up of the Nurse Executives to whom the CRNAs frequently
report, applauds the formal recognition of the title protection and supports passage of an
amended version of this legislation which will provide for full scope of practice.
