Are CRNAs Required to Be Licensed in Every State
Are CRNAs Required to Be Licensed in Every State?
Yes, Certified Registered Nurse Anesthetists (CRNAs) are required to have an active registered nurse (RN) license and meet specific state requirements to practice.
Licensing and practice regulations for CRNAs vary significantly by state, reflecting differences in healthcare policies, population needs, and professional standards.
Licensure Requirements for CRNAs
CRNAs must first obtain licensure as an RN in the state where they intend to practice. In addition, they must complete a nurse anesthesia program accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) and pass the National Certification Examination (NCE) administered by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA).
“As of 2025, over 57,000 CRNAs and student nurse anesthetists are practicing in the United States, making this one of the most highly regulated and critical roles in the healthcare system.” — American Association of Nurse Anesthetists (AANA)
State-Specific Requirements
After obtaining national certification, CRNAs must meet state-specific requirements. These may include:
- Applying for Advanced Practice Registered Nurse (APRN) licensure, which often involves additional application fees and documentation.
- Providing proof of malpractice insurance in states that require it.
- Completing state-specific continuing education or professional development requirements for licensure renewal.
Some states also require a collaborative agreement or supervision by a physician, while others grant CRNAs full practice authority.
Independent Practice and Supervision
In 22 states and the District of Columbia, CRNAs are allowed to practice independently without the requirement of physician supervision. This practice model is often referred to as “opt-out,” reflecting a federal regulation established in 2001 that allows states to exempt CRNAs from supervision under Medicare rules.
“Studies have consistently shown that CRNAs provide safe, cost-effective, and high-quality care, even in independent practice settings. States granting full practice authority report improved access to anesthesia services, especially in rural and underserved areas.” — Health Affairs Journal
Key Statistics
According to the AANA, CRNAs administer approximately 50 million anesthetics each year in the United States.
- CRNAs are the sole anesthesia providers in nearly 100% of rural hospitals in some states.
- 21 states and the District of Columbia have opted out of the federal physician supervision requirement for CRNAs as of 2025.
- CRNAs have been shown to lower healthcare costs without compromising patient outcomes, making them a critical resource in cost-efficient healthcare delivery.
Benefits of Licensing and Regulation
Requiring CRNAs to be licensed in every state ensures consistency in quality and safety standards across the nation. The rigorous educational and certification process prepares CRNAs to manage a wide variety of anesthesia services, including general, regional, and local anesthesia, as well as pain management and emergency airway management.
“Licensure and regulation are critical to maintaining public trust and ensuring that CRNAs meet the highest standards of patient care.” — National Academy of Medicine
CRNAs play an essential role in the U.S. healthcare system, particularly in ensuring access to anesthesia care in rural and underserved areas. By requiring licensure in every state and setting rigorous educational and professional standards, the profession ensures that patients receive safe, high-quality care. Whether practicing independently or under supervision, CRNAs consistently demonstrate their value as highly skilled, cost-effective providers of anesthesia services.