Autonomous Practice by a Certified Registered Nurse Anesthetist:
HB 649 would expand the scope of practice for certified registered nurse anesthetists (CRNAs) in Florida, especially for those registered as autonomous advanced practice registered nurses under s. 464.0123. The bill revises multiple statutes to clarify that autonomous CRNAs may perform anesthesia-related functions without an established facility protocol, while still allowing facilities to require protocols for CRNAs not practicing autonomously. It also updates the autonomous practice statute to expressly include CRNAs among the APRNs who may practice under that section.
Under the bill, autonomous CRNAs could determine patient status related to anesthesia risk, select anesthesia type, order preanesthetic medication, administer and manage regional, spinal, general, inhalation, intravenous, and hypnosis-based anesthesia techniques, monitor patients, support life functions during anesthesia, respond to abnormal reactions and arrhythmias, manage postanesthesia recovery, and place certain venous and arterial lines. The bill also broadens autonomous APRN authority in health care facilities to admit, manage, and discharge patients, and to provide certain signatures and certifications otherwise required of physicians, with a specific exception for physician certification under the medical marijuana law.
HB 649 would amend sections 395.0191, 464.012, and 464.0123 of the Florida Statutes to create a clearer and broader autonomous practice pathway for certified registered nurse anesthetists. It would reduce the dependence of autonomous CRNAs on facility-approved protocols for anesthesia practice, while preserving protocol-based practice for non-autonomous CRNAs and maintaining limits tied to part I of chapter 464. The bill would also expand the practical authority of autonomous APRNs in facility settings and in executing legally required documentation, though it would not authorize physician certifications under s. 381.986.
The available record shows no committee transcript or vote tally, so there is no documented floor or committee debate to gauge support or opposition. Based on the bill’s content, it appears designed to advance APRN and CRNA autonomy and likely reflects support from nursing practice advocates, while also implicating concerns from physician or facility stakeholders about oversight, patient safety, and the role of medical direction. The bill ultimately died in the Senate Rules Committee, indicating it did not complete the legislative process.
The main point of contention is the shift from physician- or facility-directed anesthesia practice toward autonomous practice by CRNAs. Supporters would likely favor expanded access, efficiency, and professional autonomy for advanced practice nurses, especially in anesthesia services and facility-based care. Opponents or skeptics would likely focus on whether removing established protocols could affect patient safety, supervision, and institutional control over anesthesia services. Another likely issue is the bill’s broader authorization for autonomous APRNs to admit, manage, and discharge patients in facilities and to sign documents otherwise reserved to physicians, which could raise scope-of-practice and credentialing concerns.