Earn up to 24 contact hours at SGNA's 51st Annual Course in Louisville, May 9-11! Book a room by April 11 to save on accommodations. Learn more.

Midwest

Midwest State Regulations

 

Illinois   Indiana   Iowa   Kansas   Michigan   Minnesota   Missouri   Nebraska   North Dakota   Ohio   South Dakota   Wisconsin

 

Illinois

 

Source: State of Illinois Professional Nursing
Guidance*: No direct guidance is offered by the State Board of Nursing regarding the administration of moderate or deep sedation by Registered Nurses within the state of Illinois.

Source:Illinois Compiled Statutes
Type of Guidance: HEALTH FACILITIES (210 ILCS 5/6.7): Ambulatory Surgical Treatment Center Act (08/13)
Impact: RNs
Guidance*: Section 6.7: Registered nurse administration of limited levels of sedation or analgesia (Source: P.A. 98-214, eff. 8-9-13)

A registered nurse (RN) may administer medications for the delivery of local or minimal sedation ordered by a physician licensed to practice medicine in all its branches, podiatric physician, or dentist provided that:

  • The practice is in keeping with the policy of the ambulatory surgical treatment center.
  • The RN is current with advanced life support certification registered nurse to deliver moderate sedation ordered by a physician licensed to practice medicine
  • The RN is under supervision of a licensed podiatric physician, or dentist and have no other responsibilities during the procedure.

The RN is limited to administering medications for moderate sedation at doses rapidly reversible pharmacologically as determined by rule by the Division of Professional Regulation of the Department of Financial and Professional Regulation.

Read 210 ILCS 5/6.7

Source: Joint Committee on Administrative Rules
Type of Guidance:Administrative Code- Title 68: Professions and Occupations (8/1/2014)
Impact: RNs
Guidance*: Section 1300.370 Provision of Conscious Sedation by Registered Nurses in Ambulatory Surgical Treatment Centers

(a) In accordance with Section 6.7 of the Ambulatory Surgical Treatment Center Act [210 ILCS 5], nothing in that Act precludes a registered nurse from administering medications for the delivery of local or minimal sedation ordered by a physician licensed to practice medicine in all of its branches, podiatrist or dentist.

(d) Registered nurses shall be limited to administering medication for moderate sedation at doses rapidly reversible pharmacologically. [210 ILCS 5/6.7(c)]

Acceptable medications are opioids, benzodiazepines and reversal agents: Meperidine, Fentanyl, Diazepam, Midazolam, naloxone and flumazenil. Nothing prohibits RN from monitoring or adjusting an FDA approved delivery device under the supervision of a physician.

Read Section 1300.370

Other Resources:

Back to Top

Indiana


Source:
Indiana State Board of Nursing
Guidance*: No direct guidance is offered by the State Board of Nursing regarding the administration of moderate or deep sedation by Registered Nurses within the state of Indiana.

Source: Medical Licensing Board of Indiana
Type of Guidance: Indiana Administrative Code: Standards of Professional Conduct and Competent Practice of Medicine (10-18)
Impact: MDs; DOs; RNs
Guidance*: IAC Title 844, Rule 5. Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia (4-24-2008; readopted 12-02-2014; readopted 11-22-2016) –Page18

  • Practitioners* intending to produce a given level of sedation must be able to rescue a patient whose level of sedation becomes deeper than initially intended.
  • Practitioners administering deep sedation/analgesia in an office-based setting, or directing or supervising the administration of deep sedation/analgesia in an office-based setting, must be able to:
  • A health care provider may not administer or monitor an anesthetic agent containing alkylphenols in an office-based setting unless the health care provider is:
    • Trained in the administration of general anesthesia; and
    • Not involved in the conduct of the procedure.

*Practitioner" refers to a person who holds an unlimited license to practice medicine or osteopathic medicine in Indiana.
Read Medical Licensing Board of Indiana; 844 IAC 5-5-19 (page 18)

http://www.in.gov/legislative/iac/iac_title?iact=844

 

Other State Resources:

Back to Top

Iowa

Source:Iowa Board of Nursing
Type of Guidance: RN- Practice: Frequently Asked Questions
Impacts: RNs
Guidance*: Q. Is it within the scope of practice of the RN to administer and monitor anesthetic medications for the purpose of operative, invasive and diagnostic procedures?

A. The Iowa Board of Nursing does not have a rule, regulation or position on the RN administering anesthetic medications for the purpose of operative, invasive and diagnostic procedures. As with any task/function that the nurse carries out, it is important to remember the nurse must be educated and competent in the task/function. The nurse retains accountability for her/his actions.

Read the Nursing Practice FAQ

Other Resources:

Back to Top

Kansas


Source:
Kansas State Board of Nursing
Type of Guidance:Kansas State Board of Nursing Position Statement(03/14)
Impact: RNs
Guidance*: Administration of IV "Conscious Sedation" (Moderate Sedation/Analgesia) by the Registered Professional Nurse (3-25-14)

  • It is within the scope of practice of a registered professional nurse (RN), who is not licensed as a registered nurse anesthetist to administer pharmacologic agents via the intravenous route to produce moderate sedation/analgesia, also called IV "conscious sedation" provided appropriate knowledge and training requirements are met.
  • If practice is questioned the RN must be ready to prove the following:
    • Documentation of education specific to the procedure and the pharmacologic agents utilized
    • Documentation of skill/competence in the procedure and with the medications involved.
    • Confirmation of the physician's order to execute the medical regimen
    • That the procedure was not prohibited by a facility policy and procedure or by some other entity.
    • That the standard of care is and was being met. Industry standards are considered.
    • That the nurse has complied with the appropriate facility policies and procedures covering this process.
  • The registered professional nurse has an independent obligation under her/his license to monitor patient safety and to decline orders for additional medications that may cause the patient to reach a deeper level of sedation or analgesia than proscribed in this position statement.
Read the Board of Nursing Position Statement

 

Other State Resources

Back to Top

Michigan


Source:
Michigan Public Health Code
Type of Guidance: Public Health Code Act 368 of 1978; Part 172 – Nursing(11/13)
Impact:RNs
Guidance*: Michigan does not have an official Scope of Practice for nurses. The general definition of the practice of nursing is found in the Michigan Public Health Code. No guidance is offered regarding the administration of moderate or deep sedation by Registered Nurses within the state of Michigan.

Read Michigan Public Health Code Act 368 of 1978; Part 172 – NURSING

Other State Resources

Back to Top

Minnesota


Source:
Minnesota Board of Nursing
Type of Guidance: Minnesota Board of Nursing Practice Statement(12/09)
Impact: RNs
Guidance*: Statement of Accountability for Administration of Medications
Classified as Anesthetics by the Registered Nurse
(12-2009)

  • It is within the scope of practice for the Registered Nurse to administer medications classified as anesthetics for the purpose of procedural sedation and analgesia as long as certain strict training and knowledge requirements are met.
  • A Registered Nurse may decline to administer medications classified as anesthetics or other medications if he/she perceives the administration would be unsafe under the circumstances.
  • The Institute for Safe Medication Practices has listed both propofol and ketamine as "High Alert" medications that “bear a heightened risk of causing significant patient harm when they are used in error.
  • Registered nurses who administer medications classified as anesthetics are accountable to:
    • Maintain safeguards for the appropriate management of controlled or abusable substances.
    • Comply with all applicable Federal and state laws and rules. Under Minnesota Rule 4675.0500, only an anesthesiologist or qualified physician and/or anesthetist shall administer anesthetics other than local infiltration anesthetic.

Read Statement of Accountability for Administration of Medications Classified as Anesthetics by the Registered Nurse

Source:State of Minnesota Office of the Revisor of Statutes
Type of Guidance:Minnesota Administrative Rules (01/00)
Impact:MDs, DOs, RNs, CRNAs
Guidance*: CHAPTER 4675.0500: Outpatient Surgical Centers - Medical Staff (January 21, 2000)
Preparation for and administration of anesthesia. Only an anesthesiologist or qualified physician and/or anesthetist shall administer anesthetics other than local infiltration anesthetics.

Read Minnesota Administrative Rules Chapter 4675.0500

Other State Resources

Back to Top

Missouri


Guidance*: No direct guidance is offered by the State Board of Nursing regarding the administration of moderate or deep sedation by Registered Nurses within the state of Missouri.

Source: Missouri Board of Nursing
Type of Guidance: Position Statements
Impact: RNs
Guidance*: Response to Sermchief V Gonzales Case (Revised 07-2011)

The Board takes the position that the dimensions of an individual nurse's practice should be based upon the nurse's education, knowledge, competence, interest and in consultation with nursing organizations. Practice decisions of the individual nurse shall be made in order to provide safe health services for the consumer. 
The legal limit of an individual nurse's practice is defined by the nurse's education, knowledge and competence. An individual who is licensed as a nurse may legally practice within his/her full range of nursing regardless of whether or not the individual uses other titles which are indicative of the individual's advanced education, knowledge or experience.

Read the Response to Sermchief V Gonzales Case

Source: Department of Health and Senior Services
Type of Guidance: Code of State Regulations: Division 30 Regulation and Licensure Rules: Chapter 30 (07-07)
Impact: MDs, DOs, RNs, CRNAs
Guidance*: 19 CSR 30-30.020 Administration Standards for Ambulatory Surgical Centers (7-31-07) – Page 6
(E) Anesthesia Services.

6. All anesthetics shall be administered by anesthesiologists, physicians with training or experience in the administration of anesthetics, certified registered nurse anesthetists or anesthesiologist assistants supervised by an anesthesiologist, except for local anesthetic agents which may be administered by the attending physician, dentist, or podiatrist.

Read 19 CSR 30-30.020(1)(E)6

Other State Resources

Back to Top

Nebraska



Source: Nebraska Board of Nursing
Type of Guidance: Advisory Opinion (02/2018)
Impact:
Guidance*: Nebraska Advisory Opinion on Procedural Sedation (2/2018)  -- (Replaces Sedation 7/2016)
Non-Anesthetic Agents.

  • It is within the scope of practice of an appropriately trained RN to administer non-anesthetic medications for moderate procedural sedation.
  • RN caring for the patient shall have no other responsibilities that would leave the patient unattended or compromise continuous patient monitoring.

Anesthetic Agents.
Advanced Cardiac Life Support (ACLS) certification alone does not ensure the RN ongoing expertise in airway management and emergency intubation. Personnel with expertise in airway management and emergency intubation must be readily available.

  • Propofol. An appropriately trained RN may only administer Propofol for moderate sedation under the following circumstances:
    • To intubated, ventilated patients in a critical care setting OR
    • When assisting an anesthesia provider who is intubating or otherwise managing the patient airway.
  • Other. Other medications labeled as anesthetics may be administered by the RN for moderate sedation provided the supervising non-anesthesiologist provider has:
    • Proper competence and credentialing in advanced airway management AND
    • Availability to abandon any procedure to rescue the patient from deep sedation or general anesthesia.
Read the Nebraska Board of Nursing Advisory Opinion on Procedural Sedation

Source: Health Care Financing Administration of the United States Department of Health and Human Services
Type of Guidance:Code of Federal Regulations - Title 42 – Public Health (10/01)
Impact: MDs, DOs, RNs, CRNAs
Guidance*: Chapter IV: PART 416.42—AMBULATORY SURGICAL SERVICES
Standard: Administration of Anesthesia (10-1-01) - Page 644

An Ambulatory Surgical Center as defined by the Nebraska Department of Health and Human Services complies with the following standard established by the US DHHS Health Care Financing Administration:

  • Anesthetics must be administered by only:
    • A qualified anesthesiologist; or
    • A physician qualified to administer anesthesia, a certified registered nurse anesthetist or an anesthesiologist’s assistant or a supervised trainee in an approved educational program.
  • In those cases in which a non-physician administers the anesthesia, the anesthetist must be under the supervision of the operating physician, and in the case of an anesthesiologist’s assistant, under the supervision of an anesthesiologist.
Read 42 CFR: Chapter IV - Part 416.42 (Page 644)

Other State Resources

Back to Top

North Dakota


Source:North Dakota Board of Nursing
Type of Guidance:Practice Statement (10/12)
Impact:RNs
Guidance*: Role of Registered Nurse (RN) in the Management of Patients Receiving Moderate Sedation/Analgesia for Therapeutic, Diagnostic, or Surgical Procedures (10-2012)

  • The non-anesthetist RN is allowed by state laws and institutional policy, procedures, and protocol to administer:
    • Minimal sedation in the form of nitrous oxide/oxygen-inhalation
    • Moderate sedation/analgesia medications
  • A licensed nurse who is not a Certified Registered Nurse Anesthetist may not administer general anesthesia or conscious/moderate sedation, if the drug manufacturer's general warning advises the drug should be administered and monitored by persons experienced in the use of general anesthesia who are not involved in the conduct of the surgical and/or diagnostic procedure.
  • The Registered Nurse must demonstrate requisite knowledge, skills, and training to manage the care of patients receiving sedation/analgesia and comply with the requirements of the institution or practice setting.
  • Registered nurses who are not qualified anesthesia providers may be authorized to manage and monitor minimum sedation in the form of nitrous oxide or moderate sedation/analgesia during therapeutic, diagnostic or surgical procedures if specified criteria are met.

Read the Board of Nursing Practice Statement on the Management of Patients Receiving Moderate Sedation/Analgesia for Therapeutic, Diagnostic, or Surgical Procedures 

Source: North Dakota Board of Nursing Guidance
Type of Guidance: Practice Guidance (05/2018)
Impact: 
Guidance*: North Dakota Board of Nursing Practice Guidance: Role of the Nurse in Sedation/Analgesia (05/2018)
The administration of anesthetic agents (e.g., Propofol, methohexital, ketamine, and etomidate) for analgesia/sedation is outside the scope of practice for nurses EXCEPT in the following situations:
• When assisting in the physical presence of a CRNA or anesthesiologist (the CRNA or anesthesiologist may direct the nurse to administer anesthetic agents in conjunction with the CRNA or anesthesiologist intubating or otherwise managing the client’s airway);
• When administering these medications to clients who are intubated and mechanically ventilated in critical care settings;
• When assisting the licensed practitioner during an intubation procedure in an emergency setting;
• When administering these medications for relief of refractory symptoms in intractable distress in the dying client

During routine diagnostic or therapeutic procedures, the safety of the client must be considered when assessing the need for staff appropriate to the procedure being performed. It would not be prudent to presume that the licensed practitioner will be able to abandon the procedure to assist in rescuing the client, if complications arise.

Read the Nursing Board of Nursing Practice Guidance: Role of the Nurse in Sedation/Analgesia

Other State Resources

Back to Top

 

Ohio


Source: 
State of Ohio Board of Nursing
Type of Guidance: Interpretive Guideline (03/2018)
Impact: RNs
Guidance*: The Registered Nurse's Care of Patients Receiving Intravenous Moderate Sedation for Medical and/or Surgical Procedures
(Reapproved 3-21-2018)

  • The registered nurse responsible for monitoring the patient during the procedure should not engage in other activities that would divert the nurse’s attention from the patient.
  • The registered nurse may execute the moderate sedation regimen with a valid authorized provider order.
  • The registered nurse may administer other sedating medications, those that are not classified as anesthetic agents.
  • A registered nurse should not engage in activities that are the practice of anesthesia care and/or the practice of medicine and surgery in Ohio, including:
    • Administer medications to induce deep sedation and/or anesthesia;
    • Independently select the medication or dosage to be administered during a procedure.

Read the State of Ohio Board of Nursing Guideline

Source: Ohio State Legislature
Type of Guidance: Ohio Revised Code (9/2013)
Impact: MDs, RNs, CRNAs
Guidance*: Ohio Revised Code Title 37, Chapter 37:Ambulatory surgical facilities. (09/2013)

  • Anesthesia is administered in the facility by an anesthesiologist or certified registered nurse anesthetist, and the facility functions separately from a hospital's inpatient surgical service and from the offices of private physicians, podiatrists, and dentists.
  • Anesthesia in this context is defined as total or partial loss of sensation, tactile sensibility, or protective reflexes, with or without the loss of consciousness.

Read ORC 3702.30

Source:Ohio State Medical Board
Type of Guidance: Ohio Administrative Code (05/31/2018)
Impact: MDs, RNs, CRNAs
Guidance* Chapter 4731-25 Office Based Surgery: Standards for surgery using moderate sedation/analgesia.(05-2018) Moderate sedation/analgesia may be administered in the office setting by only the following:

  • A physician who holds privileges to provide moderate sedation/analgesia from a local hospital with appropriate accreditation/licensing;
  • A certified registered nurse anesthetist (CRNA) who is acting under the supervision of and in the immediate presence of a physician or podiatric physician;
A registered nurse who is acting under the supervision and in the immediate presence of a physician or podiatric physician, provided that such registered nurse shall only administer specifically prescribed doses of drugs selected by the physician or podiatric physician who shall be continuously present in the anesthetizing location during the administration of those drugs

.

Read OAC 4731-25-03

Other State Resources

Back to Top


South Dakota

Source:South Dakota Board of Nursing
Type of Guidance: Board of Nursing Position Statement (11/2018)
Impact:RNs
Guidance*: The Role of the Registered Nurse in the Management of Patients Receiving Moderate Sedations – Position Statement (11-2018)
It is within the scope of practice for a registered nurse (RN) to manage the care of adult clients receiving IV moderate sedation, which may progress to deep sedation during therapeutic, diagnostic, or surgical procedures under the direct supervision of an anesthesia provider or physician, provided specified knowledge, training, and institutional requirements are met.


Read the Board of Nursing Position Statement   

Source:South Dakota Legislature
Type of Guidance:South Dakota Administrative Rules: Article 20:48:04 - Practice of Nursing (7/2014)
Impact:MDs, DOs, RNs
Guidance*:Article 20:48:04:01: Scope and standards of nursing practice -- Basic role (7-31-2014)
South Dakota Board of Nursing Declaratory Ruling 89-1

Although registered nurses, under the direction of a physician, may administer narcotics, analgesics, sedatives, and tranquilizing medications to patients, registered nurses may not administer any medication for the purpose of inducing general anesthesia. It is not within the authority of the board to determine how or for what purpose a specific drug with multiple uses is being administered at any given time. Institutional or agency protocol must address this.

Read SDAR 20:48:04:01

Source: South Dakota Legislature
Type of Guidance: South Dakota Codified Laws: Chapter 36; Title 9 - Nurses
Impact: RNs
Guidance*:36-9-3.2:   Settings in which anesthetic functions performed  
Any certified registered nurse anesthetist may perform the functions of nurse anesthesia only in the following settings:

  • A licensed health care agency either as an employee or as granted privileges by the agency, its medical staff and its governing body; or
  • The office of a physician licensed under chapter 36-4 (Professions and Occupations - Physicians and Surgeons)

Read SDCL 36-9-3.2  (No document date provided. Date Accessed: 01/22/2019) 

Other State Resources

Back to Top

Wisconsin

Source: Wisconsin Department of Safety and Professional Services
Type of Guidance: Position Statements Related to Nursing, Registered Nurses, and Advanced Practice Nurse Prescribers
Impact: RNs, APRN
Guidance*: AT THIS TIME THERE ARE NO BOARD OF NURSING POSITION STATEMENTS (01-2019)

 

See statement Issued by the Board of Nursing

 


Source:
Wisconsin Department of Health and Family Services (DHFS)
Type of Guidance:Wisconsin Administrative Code(02/17)
Impact:MDs, DOs, RNs, CRNAs
Guidance*: Chapter 124: Hospitals (2-2014)

124.20(3)(b)3:  If anesthetics are not administered by a qualified anesthesiologist, they shall be administered by a physician anesthetist, dental anesthetist, podiatrist or a registered nurse anesthetist, under supervision as defined by medical staff policy. The hospital, on recommendation of the medical staff, shall designate persons qualified to administer anesthetics and shall determine what each person is qualified to do.
Read DHS Chapter 124

Other State Resources

Back to Top 


*This page was last updated February 21, 2019. This page is for informational purposes only and nothing on this website constitutes legal advice. Please consult the Wisconsin State Board of Nursing or a legal professional before administering anesthetic or sedative products to determine proper conduct in your particular situation and to assess currentness of regulations.


Search