HB 2335

                                                PRINTER'S NO.   3109
                THE GENERAL ASSEMBLY OF PENNSYLVANIA
                    HOUSE BILL
                    No. 2335
                                          Session of
                                            2026
INTRODUCED BY BOROWSKI, RYNCAVAGE, GUENST, HOWARD, PROKOPIAK,
   ABNEY, MALAGARI, McNEILL, KUZMA, CIRESI, WAXMAN, CERRATO,
   CEPEDA-FREYTIZ, FLICK, FRITZ, HAMM, TOMLINSON, ROWE, WATRO,
   MAYES, KUTZ, GREEN, REICHARD, ARMANINI, STENDER, KOZAK,
   KEPHART, McANDREW AND GIRAL, MARCH 30, 2026
REFERRED TO COMMITTEE ON PROFESSIONAL LICENSURE, MARCH 30, 2026
                               AN ACT
1 Amending the act of May 22, 1951 (P.L.317, No.69), entitled "An
2    act relating to the practice of professional nursing;
3    providing for the licensing of nurses and for the revocation
4    and suspension of such licenses, subject to appeal, and for
5    their reinstatement; providing for the renewal of such
6    licenses; regulating nursing in general; prescribing
7    penalties and repealing certain laws," further providing for
8    definitions and for scope of practice for certified
9    registered nurse anesthetists.
10    The General Assembly of the Commonwealth of Pennsylvania
11 hereby enacts as follows:
12    Section 1.    Sections 2(1) and (17) and 8.9 of the act of May
13 22, 1951 (P.L.317, No.69), known as The Professional Nursing
14 Law, are amended to read:
15    Section 2.    Definitions.--When used in this act, the
16 following words and phrases shall have the following meanings
17 unless the context provides otherwise:
18    (1)   The "Practice of Professional Nursing" means diagnosing
19 and treating human responses to actual or potential health
20 problems through such services as casefinding, health teaching,
1 health counseling, and provision of care supportive to or
2 restorative of life and well-being, and executing medical
3 regimens as prescribed by a licensed physician or dentist. The
4 foregoing shall not be deemed to include acts of medical
5 diagnosis or prescription of medical therapeutic or corrective
6 measures, except as performed by a certified registered nurse
7 practitioner or certified registered nurse anesthetist acting in
8 accordance with rules and regulations promulgated by the Board.
9    * * *
10    [(17)    "Overall direction" means oversight of anesthesia
11 services and medical management of patient care by a qualified
12 individual who is present and available onsite, but not
13 necessarily present in the same procedure room as a certified
14 registered nurse anesthetist performing anesthesia services for
15 the duration of the services provided.]
16    Section 8.9.    Scope of Practice for Certified Registered
17 Nurse Anesthetists.--(a)    A certified registered nurse
18 anesthetist shall have the authority to perform anesthesia
19 services in cooperation with a physician, podiatrist or dentist
20 involved in a procedure for which anesthesia care is being
21 [provided if the anesthesia services are performed under the
22 overall direction of any of the following:
23    (1)     A physician licensed by the State Board of Medicine or
24 the State Board of Osteopathic Medicine who has completed an
25 accredited residency training program in anesthesiology.
26    (2)     A physician licensed by the State Board of Medicine or
27 the State Board of Osteopathic Medicine who is performing the
28 procedure for which the certified registered nurse anesthetist
29 is performing anesthesia services.
30    (3)     A podiatrist licensed by the State Board of Podiatry who
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1 is performing the procedure for which the certified registered
2 nurse anesthetist is performing anesthesia services.
3    (4)   A dentist licensed by the State Board of Dentistry and
4 permitted by the act of May 1, 1933 (P.L.216, No.76), known as
5 "The Dental Law," or the State Board of Dentistry to administer,
6 supervise or direct the administration of anesthesia.] provided.
7    (a.1)   Anesthesia services include the authority to
8 prescribe, dispense and administer prescription drugs, including
9 prescriptions for controlled substances listed in Schedules II,
10 III, IV and V under 21 U.S.C. § 812 (relating to schedules of
11 controlled substances); to order and evaluate laboratory and
12 diagnostic test results and perform point-of-care testing that
13 the certified registered nurse anesthetist is qualified to
14 perform; and to order and evaluate radiographic imaging studies
15 that the certified registered nurse anesthetist is qualified to
16 order and interpret. A certified registered nurse anesthetist
17 may prescribe prescription drugs for a supply of not more than
18 ten (10) days with no refills and only for an individual for
19 whom the certified registered nurse anesthetist has, at the time
20 of the prescription, established a client or patient record.
21    (a.2)   Nothing in this section requires a certified
22 registered nurse anesthetist to obtain prescriptive authority
23 from a physician, podiatrist or dentist to select, order and
24 administer controlled substances in connection with the
25 procedure for which anesthesia care is being provided.
26    (a.3)   A certified registered nurse anesthetist may perform
27 the following services and procedures:
28    (1)   be responsible for performing and documenting total
29 anesthesia care of a patient, including, but not limited to,
30 preanesthetic preparation and evaluation, requesting
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1 consultations and diagnostic studies, obtaining informed consent
2 for anesthesia and selection and administration of anesthetic
3 agents or other agents administered in the management of
4 anesthetic care, anesthesia induction, maintenance, emergence
5 and post anesthesia care;
6    (2)    develop and implement an anesthetic care plan;
7    (3)    select and initiate the planned anesthesia technique
8 which may include general, regional and local anesthesia and
9 sedation;
10    (4)    select, apply or insert appropriate noninvasive and
11 invasive monitoring modalities for collecting and interpreting
12 patient physiological data;
13    (5)    support life functions during the perioperative period;
14    (6)    select, obtain and administer the anesthetics, adjuvant
15 drugs, accessory drugs and fluids necessary to manage the
16 anesthetic to maintain the patient's physiologic homeostasis,
17 and to correct abnormal responses to the anesthesia or surgery;
18    (7)    recognize and be able to take appropriate action for
19 untoward patient responses during anesthesia;
20    (8)    observe and manage the patient's emergence from
21 anesthesia by selecting, obtaining, ordering or administering
22 medications, fluids or ventilatory support in order to maintain
23 homeostasis;
24    (9)    discharge patients from a postanesthesia care area;
25    (10)     participate in the life support of the patient,
26 including, but not limited to, perianesthetic and clinical
27 support functions;
28    (11)     implement acute and chronic pain management modalities;
29    (12)     respond to emergency situations by providing airway
30 management, administration of emergency fluids or drugs, or
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1 using basic or advanced cardiac life support techniques;
2    (13)    supervise anesthesia care being provided by nurse
3 trainees enrolled in a course approved by the Council on
4 Accreditation of Nurse Anesthesia Educational Programs; and
5    (14)    direct administration of anesthesia by a graduate of an
6 approved anesthesia program until the announcement of results of
7 the first examination given for certification for which the
8 graduate is eligible.
9    (b)    Nothing in this section shall be construed to:
10    [(1)    prohibit a certified registered nurse anesthetist who
11 would otherwise require direction from providing brief periods
12 of care in the event of an emergency that temporarily prevents
13 or interferes with overall direction;]
14    (2)    restrict the authority of a health care facility to
15 provide for additional oversight requirements for a certified
16 registered nurse anesthetist practicing within the facility; or
17    (3)    limit or prohibit a certified registered nurse
18 anesthetist from engaging in those activities which normally
19 constitute the practice of professional nursing as defined in
20 section 2.
21    (c)    For purposes of this section, a licensed physician,
22 licensed podiatrist or licensed dentist is not liable for any
23 act or omission of a certified registered nurse anesthetist who
24 orders or administers anesthetics.
25    (d)    As used in this section, the following words and phrases
26 shall have the meanings given to them in this subsection unless
27 the context clearly indicates otherwise:
28    "Cooperation" means a process in which the certified
29 registered nurse anesthetist and the physician, dentist or
30 podiatrist work together with each contributing an area of
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1 expertise, at their individual and respective levels of
2 education and training.
3    Section 2.   This act shall take effect in 60 days.
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