Chapter 06. Practice of Nurse Anesthetist
Regulation .01 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“A.A.N.A.” means the American Association of Nurse Anesthetists.
(2)
“Advanced practice registered nurse (APRN)” means a registered nurse who is certified by the Board as:
(a)
A certified nurse midwife (CNM);
(b)
A certified registered nurse anesthetist (CRNA);
(c)
A certified nurse practitioner (CRNP); or
(d)
A clinical nurse specialist (CNS).
(3)
“Anesthesiologist” means a Maryland-licensed physician who:
(a)
Has had special training in the field of anesthesiology;
(b)
Administers anesthesia on a regular basis; and
(c)
Devotes a substantial portion of the physician's medical practice to the practice of anesthesiology.
(4)
“Board” means the Board of Nursing.
(5)
“Certification” means the permission to practice nurse anesthesia granted by the Board to a registered nurse who has:
(a)
Met all the specified requirements of a national certifying body recognized by the <MLF>Board; and
(b)
Complied with the requirements of this chapter.
(6)
“Certified registered nurse anesthetist (CRNA)” means an advanced practice registered nurse who is certified by the Board to practice as a nurse anesthetist in this State.
(7)
“Licensed physician or dentist” means a Maryland-licensed physician or dentist who has knowledge and experience in resuscitation, anesthetic drugs, and their reactions.
(8)
“Multistate licensure privilege” has the meaning set forth in COMAR 10.27.01.01B.
(9)
“Perioperative assessment and management” means the assessment and management of the patient preoperatively, intraoperatively, and postoperatively.
(10)
“Practice of nurse anesthesia” means the performance of acts in collaboration with an anesthesiologist, licensed physician, or dentist, which require substantial specialized knowledge, judgment, and skill related to the administration of anesthesia, including:
(a)
Perioperative assessment and management of patients requiring anesthesia services;
(b)
Administering anesthetics;
(c)
Management of fluid in intravenous therapy; and
(d)
Respiratory care.
(11)
“Qualified anesthesia provider” means a physician, dentist, or certified registered nurse anesthetist trained and duly authorized under the respective provisions of the Health Occupations Article to administer local, regional, and general anesthesia.
(12)
“Registered Nurse” means an individual who is licensed by the Board to practice registered nursing or has a multistate licensure privilege to practice registered nursing in this State under the Nurse Licensure Compact.
Regulation .02 Certification.LinkCopy Citation
A.
An applicant for certification as a CRNA shall:
(1)
Hold a current Maryland license in good standing or a multistate licensure privilege to practice registered nursing in this State under the Nurse Licensure Compact;
(2)
Have graduated from an education program in nurse anesthesia approved by the Board;
(3)
Hold current national certification from the Council on Certification of Nurse Anesthetists or from another national certifying body recognized by the Board;
(4)
Submit to the Board a completed application for certification as a nurse anesthetist;
(5)
Comply with all the requirements set forth in COMAR 10.27.01.04;
(6)
Demonstrate oral and written competency in the English language; and
(7)
Pay all fees.
B.
If the applicant’s nurse anesthetist program was completed after January 1, 2008, the applicant for certification as a CRNA shall also provide to the Board documentation that the applicant graduated from a graduate level accredited nurse anesthetist program with a master’s degree or higher.
Regulation .03 Practice Before Certification.LinkCopy Citation
A.
A registered nurse who has completed a program for preparation of nurse anesthetists and who has applied to take a national certifying examination acceptable to the Board may practice as a nurse anesthetist graduate before certification in the State, on approval of the Board, if the nurse:
(1)
Has a current license or multistate privilege to practice registered nursing in the State;
(2)
Submitted in full the application for State certification as a CRNA;
(3)
Paid all fees established by the Board;
(4)
Completed a nurse anesthetist program approved by the Board;
(5)
Practices under the supervision of an anesthesiologist or CRNA and the supervisor is on site and immediately available to the nurse anesthetist graduate;
(6)
Provides the Board a copy of the admission document to the national certification examination which must be taken not later than 6 months after program completion; and
(7)
Immediately notifies the Board and the supervising anesthesiologist or CRNA of the results of the certification examination.
B.
A nurse anesthetist graduate who fails the national certification examination shall immediately cease practice as a nurse anesthetist graduate.
Regulation .04 Renewal of Certification.LinkCopy Citation
A.
Certification as a nurse anesthetist expires at the same time as the nurse anesthetist's registered nursing license unless the certification is renewed.
B.
Before a nurse anesthetist’s certification expires, the nurse anesthetist may renew the certification biennially, if the nurse anesthetist:
(1)
Is otherwise entitled to be certified;
(2)
Pays all appropriate renewal fees set by the Board; and
(3)
Submits to the Board:
(a)
A completed renewal application on the form required by the Board; and
(b)
Documentation of a current national certification as a nurse anesthetist from the Council on Certification of Nurse Anesthetists or some other national certifying body recognized by the Board.
C.
Nurse anesthetist renewal applicants who are authorized to practice registered nursing in this State under a multistate privilege shall be periodically required to submit to a criminal history records check in accordance with the schedule and requirements set forth in COMAR 10.27.01.13J—N.
D.
The nurse anesthetist shall ensure that the Board has a record of the renewed national certification if the national certification expires before the renewal date.
E.
Practicing on an expired national certification is prohibited and subject to disciplinary action under Health Occupations Article, §8-316, Annotated Code of Maryland.
Regulation .05 Scope of Practice.LinkCopy Citation
A.
A nurse anesthetist may perform the following functions:
(1)
Perioperative assessment and management of patients requiring anesthesia services;
(2)
Administration of anesthetic agents;
(3)
Management of fluids in intravenous therapy;
(4)
Respiratory care; and
(5)
In accordance with §D of this regulation, prescribe, order, and administer drugs, including a drug that is classified as a controlled dangerous substance under Criminal Law Article, Title 5, Subtitle 4, Annotated Code of Maryland.
B.
A nurse anesthetist has the right and obligation to refuse to perform a delegated act if, in the nurse anesthetist’s judgment, the act is:
(1)
Unsafe;
(2)
An invalidly prescribed medical act; or
(3)
Beyond the clinical skills of the nurse anesthetist.
C.
Section A of this regulation may not be construed to authorize a nurse anesthetist to:
(1)
Diagnose a medical condition;
(2)
Provide care that is not consistent with the scope of practice of nurse anesthetists; or
(3)
Provide care for which the nurse anesthetist does not have proper education and experience.
D.
A nurse anesthetist may prescribe drugs in accordance with §A of this regulation:
(1)
Only in an amount that does not exceed a 10-day supply;
(2)
Only for an individual with whom the nurse anesthetist has, at the time of prescription, established a client or patient record; and
(3)
Only in connection with the delivery of anesthesia services.
Regulation .06 Standards of Practice.LinkCopy Citation
A.
A nurse anesthetist shall collaborate with an anesthesiologist, licensed physician, or dentist in the following manner:
(1)
An anesthesiologist, licensed physician, or dentist shall be physically available to the nurse anesthetist for consultation at all times during the administration of, and recovery from, anesthesia;
(2)
An anesthesiologist shall be available for consultation to the nurse anesthetist for other aspects of the practice of nurse anesthesia; and
(3)
If an anesthesiologist is not available, a licensed physician or dentist shall be available to provide this type of consultation.
B.
The nurse anesthetist shall assure that a qualified anesthesia provider:
(1)
Performs a thorough and complete preanesthetic assessment;
(2)
Obtains informed consent for the planned anesthetic intervention from the patient or responsible other; and
(3)
Formulates a patient-specific plan for anesthesia care.
C.
The nurse anesthetist as part of the standards of practice shall:
(1)
Implement and adjust the anesthesia care plan as needed to adapt to the patient's response to the anesthesia;
(2)
Monitor the patient's physiologic condition for untoward identifiable reactions and initiate appropriate corrective actions as required;
(3)
Enter prompt, complete, and accurate documentation of pertinent information on the patient's record;
(4)
Transfer responsibility for care of the patient to other qualified providers in a manner which assures continuity of care and patient safety;
(5)
Ensure that appropriate safety precautions are taken to minimize the risks of fire, explosion, electrical shock, and equipment malfunction;
(6)
Maintain appropriate infection control standards;
(7)
Evaluate anesthesia care to assure its quality;
(8)
Maintain continual competence in anesthesia practice;
(9)
Respect and maintain the basic rights of patients; and
(10)
Maintain medical records in accordance with Health-General Article, Title 4, Subtitle 4, Annotated Code of Maryland.
Regulation .07 Unlawful Practices.LinkCopy Citation
A.
Under Health Occupations Article, Title 8, Subtitle 7, Annotated Code of Maryland, a person may not:
(1)
Practice nurse anesthesia unless certified under this chapter, or otherwise permitted by law to engage in these activities; or
(2)
Use the title nurse anesthetist, or any other words, letters, or symbols with the intent to represent that the individual is a nurse anesthetist unless certified by the Board.
B.
A person certified under this chapter is subject to the disciplinary sanctions set forth in Health Occupations Article, Title 8, Annotated Code of Maryland.
C.
This chapter does not limit or prohibit a registered nurse from performing those functions which constitute the practice of registered nursing as defined by law.
Regulation .08 CRNA Peer Review/Advisory Committee.LinkCopy Citation
A.
The Board shall appoint at least four CRNAs to act as the Board's advisory committee.
B.
The Committee shall:
(1)
Meet at least four times a year;
(2)
Report at least annually on its overall activities; and
(3)
Function at the Board's direction and provide the Board with expert advice related to the practice of nurse anesthesia.
C.
Members of the Committee shall be appointed for a 4-year term and may be reappointed for one additional 4-year term.
Chapter annotations
Authority: Health Occupations Article, §§8-205(a)(1), (3), (4), and (5), and 8-513; Annotated Code of Maryland
History: Effective date: December 1, 1979 (6:21 Md. R. 1709)
History: Regulations .01—.09 repealed and new Regulations .01—.08 adopted effective April 3, 2000 (27:6 Md. R. 642)
History: Regulation .01B amended effective June 17, 2019 (46:12 Md. R. 544)
History: Regulation .02 amended effective November 23, 2006 (33:23 Md. R. 1796); June 17, 2019 (46:12 Md. R. 544)
History: Regulation .02B amended effective June 18, 2007 (34:12 Md. R. 1067)
History: Regulation .03 amended effective June 17, 2019 (46:12 Md. R. 544)
History: Regulation .04B amended effective June 17, 2019 (46:12 Md. R. 544)
History: Regulation .04C—E adopted effective June 17, 2019 (46:12 Md. R. 544)
History: Regulation .05 amended effective June 17, 2019 (46:12 Md. R. 544)
History: Regulation .05A amended effective January 19, 2026 (53:1 Md. R. 20)
History: Regulation .05D adopted effective January 19, 2026 (53:1 Md. R. 20)
History: Regulation .06A, C amended effective June 17, 2019 (46:12 Md. R. 544); October 13, 2025 (52:20 Md. R. 1002)