Impact of Legislation on Scope of Practice Among Nurse Anesthetists

•A novel tool to measure scope of practice is introduced and validated for advanced practice nurses.•Thirty-five percent of certified registered nurse anesthetists report their practice does not reflect their education and training.•The removal of supervision of nurse anesthesia practice has resulted in greater scope of practice.•Certified registered nurse anesthetists in rural areas exhibit higher mean scope of practice scores.

Certified registered nurse anesthetists (CRNAs) are vital in delivering anesthesia services. Despite rigorous training and proven quality outcome metrics, their scope of practice (SOP) is often limited. Using a national sample of CRNAs (N = 1,202), we investigated the impact of locale and the absence of physician supervision on SOP. CRNAs practicing in rural locations had higher SOP scores; those in states opting out of physician supervision had higher SOP scores. CRNAs who experienced a change in practice after opt-out legislation had the highest SOP of all groups (all P < .001). Restrictions in excess of state laws negatively impacted SOP.