Sedation is a critical component in various medical procedures, ensuring patient comfort and cooperation. While Certified Registered Nurse Anesthetists (CRNAs) are specially trained to administer anesthesia, non-CRNA nurses can administer sedation in certain circumstances, subject to state regulations, hospital policies, the type of sedation, and the nurse’s training and competency.
To understand when non-CRNA nurses can administer sedation, it’s essential to distinguish between the different levels of sedation. Under minimal sedation, patients remain awake and responsive, experiencing minimal cognitive impairment. This level typically involves medications like oral anxiolytics (e.g., benzodiazepines). Under moderate sedation, patients are drowsy but can respond to verbal commands and physical stimulation. They may not remember the procedure but maintain airway reflexes and cardiovascular function. Under deep sedation, patients are difficult to rouse and respond only to repeated or painful stimulation. Airway reflexes may be compromised, requiring closer monitoring. Finally, under general anesthesia, patients are unresponsive and require mechanical ventilation and extensive monitoring 1.
Regulatory guidelines vary by state and country, which determines whether nurses can administer sedation. In the United States, guidelines are primarily set by state nursing boards and influenced by organizations like the American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthesiology (AANA) 2–4.
Many state boards allow registered nurses (RNs) to administer minimal and moderate sedation under specific conditions, such as in the presence of a qualified physician or CRNA who is immediately available to intervene if needed. In addition, hospitals and healthcare institutions may have policies that define and restrict who can administer sedation. These policies typically align with state regulations but can be more restrictive based on institutional capabilities and patient safety protocols 3–5.
For nurses to administer sedation safely, comprehensive training and demonstrated competency are essential. First, RNs must undergo training covering pharmacology, patient assessment, monitoring, and emergency response. These programs often culminate in certification that verifies the nurse’s capability to administer sedation safely. Furthermore, hands-on experience under supervision is also crucial. Nurses must become proficient in recognizing and managing complications such as respiratory depression, hypotension, and allergic reactions. Continuous education and periodic recertification ensure that nurses stay updated with the latest guidelines, techniques, and safety protocols 6,7.
Non-CRNA nurses administer sedation in several clinical settings. In the emergency department, RNs may administer sedation for minor procedures like fracture reductions, laceration repairs, or imaging studies in collaboration with physicians. In endoscopy units, nurses may provide sedation under the supervision of gastroenterologists during procedures like colonoscopies and endoscopies. In radiology and outpatient clinics, sedation for diagnostic imaging or minor surgical procedures can sometimes be managed by trained RNs 4,8.
While non-CRNA nurses can administer sedation in some situations, their role is governed by a complex interplay of regulations, institutional policies, and the nurse’s training and competency. Ensuring patient safety requires rigorous training, supervision, and adherence to best practices.
References
1. Statement on Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. Available at: https://www.asahq.org/standards-and-practice-parameters/statement-on-continuum-of-depth-of-sedation-definition-of-general-anesthesia-and-levels-of-sedation-analgesia.
2. AANA | Professional Practice Manual. Available at: https://www.aana.com/practice/professional-practice-manual/.
3. Non-Anesthesiologists, A. U. R. by the A. S. of A. T. F. on S. and A. by. Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists. Anesthesiology 96, 1004–1017 (2002).
4. Crego, N. Procedural Sedation Practice: A Review of Current Nursing Standards. J. Nurs. Regul. 6, 50 (2015). doi: 10.1016/S2155-8256(15)30010-7
5. LaPointe, L., Guelmann, M. & Primosch, R. State regulations governing oral sedation in dental practice. Pediatr. Dent. (2012).
6. Safe Administration of Moderate Sedation | AORN. Available at: https://www.aorn.org/education/education-for-individuals/courses/safe-administration-of-moderate-sedation.
7. Sedation Certification Online Class⋆CRNAs and RNs Certified. Available at: https://sedationcertification.com/.
8. Cappellini, I. et al. Procedural Sedation in Emergency Department: A Narrative Review. Emerg. Care Med. 2024, Vol. 1, Pages 103-136 1, 103–136 (2024).doi: 10.3390/ecm1020014