CRNA Practice

All Certified Registered Nurse Anesthetists (CRNA) must hold an active South Dakota nursing license to practice nursing.
CRNAs who are practicing in South Dakota, in-person or by telehealth, must follow South Dakota's practice laws as outlined in SDCL 36-9-3.1.
Nurses and employers are encouraged to use the Board's APRN Scope of Practice Decisioning Algorithm as a guide to making decisions on whether a specific task, intervention, or activity is in a CRNA's scope.

Telehealth

All health care providers, including nurses, are expected to adhere to the requirements in SDCL 34-52 when providing services to patients located in South Dakota through telehealth. SDCL 34-52 includes the definition of telehealth and the requirements for treatment of patients, provider-patient relationship and exceptions, consultation recommendations, examination, prescribing, informed consent, and medical records.

CRNAs are required to collaborate with a physician, dentist, podiatrist, certified nurse practitioner, certified nurse midwife, or a physician assistant when providing anesthesia services; or other health care providers when engaging in chronic pain practice.
Collaboration is defined in SDCL 36-9-1 (7), as "the act of communicating pertinent information or consulting with a licensed physician or other licensed health care provider with each provider contributing the provider's respective expertise to optimize the overall care delivered to the patient.”

Upon licensure a CRNA may prescribe, procure, furnish, and administer over-the-counter, legend, and controlled substance (CS) drugs (schedules II-IV as listed in SDCL 34-20B) within the CRNA's role and focus area.
CRNAs who order CS drugs must meet requirements and be registered with the Federal DEA, South Dakota Controlled Substance Registration, and the South Dakota Prescription Drug Monitoring Program (PDMP).
Nothing in SDCL 36-9-3.1 prohibits the practice of a CRNA to administer CS drugs or to order CS preoperatively, intraoperatively or postoperatively in accordance with chapter 34-20B or per institutional policy.
Review South Dakota specific information in ARSD 20:48:04:08 on requirements for prescribing, provision of drug samples, and the board's authority to sanction a CRNA for inappropriate prescribing.
Review ARSD 20:48:04:09 on the guidelines for prescribing CS for treatment of chronic, non-cancer pain, lists documentation requirements, and state and federal registration requirements.
Review more information on prescribing opioids in the CDC's document, 2022 Clinical Practice Guideline for Prescribing Opioids for Pain, and the Agency for Healthcare Research and Quality's (AHRQ) Toolkit for Primary Care Providers who Manage Patients Taking Opioids.

Prior to a CRNA performing pain management procedures or using fluoroscopy, as allowed in ARSD 20:48:04:11, a CRNA, who:
- Is not practicing in a licensed facility or institution, must complete a board-approved educational program specific to pain management and fluoroscopy and send the completion certificate to the board. The education content must include radiation physics, radiobiology, radiological safety, and radiation management, applicable to the use of fluoroscopy; and physiology of pain, pain assessment, and treatment options, and demonstration of competence to perform a procedure(s).
- Performs pain management procedures or uses fluoroscopy in an institution or health care setting, such as a hospital or surgical center, licensed under SDCL chapter 34-12, and who has met radiological requirements in ARSD 44:75 and 44:76, must meet the institution's requirements prior to using fluoroscopy or performing pain management procedures.
Pain management procedures may include use of medications, regional anesthetic techniques, therapeutic injections, sympathetic blocks, and other pain relief modalities performed or administered in compliance with accepted standards of practice.

Approved advanced pain management courses include those offered by Maverick Medical Education, Texas Christian University, and the University of South Florida.
Email the Board to request additional information or the approval of a different course.

South Dakota specific laws and rules relating to ordering, interpreting and supervising radiographic procedures, including fluoroscopy, are located in ARSD chapter 44:03 and ARSD 20:48:04:10.
ARSD 20:48:04:11 -- Specifies pain procedures CRNAs may perform with required education.