Registered Nurse (CSRN) Scope of Practice
Certified Sedation Registered Nurse (CSRN) Scope of Practice
Scope of Practice
Certification is a process by which a nongovernmental agency validates, based upon predetermined standards, an individual nurse’s qualification and knowledge for practice in a defined functional or clinical area of nursing.
Certified Sedation Registered Nurses (CSRNs) are registered nurses who become sedation certified by taking an advanced curriculum of study which focuses on the development of knowledge in the areas of patient assessment, pharmacology, airway, monitoring, equipment, emergencies, emergence, clinical judgment and critical thinking. It is within the scope of practice of a registered nurse to manage the care of patients receiving sedation during therapeutic, diagnostic, or surgical procedures under the guidance of a licensed independent provider (LIP) who is qualified by education, licensure and certification.
CSRNs are legally responsible for the sedation care they provide which is either determined by their state Board of Nursing (BON) policy and position statement on non-anesthetists RNs giving sedation. If no BON policy on non-anesthesia RNs giving and monitoring sedation then guidance should come from their facility sedation policy and their own job description. More information concerning CSRNs state policies in their states can be found at:
Responsibilities and Functions of a CSRN
The scope of practice of CSRNs includes, but is not limited to, the following:
1. Administration of moderate sedation medications by non-anesthetist RNs is allowed by state laws and institutional policy, procedures, and protocol.
2. A qualified anesthesia provider or attending physician selects and orders the medications to achieve moderate sedation.
3. ·Guidelines for patient monitoring, drug administration, and protocols for dealing with potential complications or emergency situations are available and have been developed in accordance with accepted standards of anesthesia practice.
4. The registered nurse managing the care of the patient receiving moderate sedation shall have no other responsibilities that would leave the patient unattended or compromise continuous monitoring.
5. The registered nurse managing the care of patients receiving moderate sedation is able to:
a. Demonstrate the acquired knowledge of anatomy, physiology, pharmacology, cardiac arrhythmia recognition and complications related to moderate sedation and medications.
b. Assess total patient care requirements during moderate sedation and recovery. Physiologic measurements should include, but not be limited to, respiratory rate, oxygen saturation, blood pressure, cardiac rate and rhythm, and patient’s level of consciousness.
c. Understand the principles of oxygen delivery, respiratory physiology, transport and uptake, and demonstrate the ability to use oxygen delivery devices.
d. Anticipate and recognize potential complications of moderate sedation in relation to the type of medication being administered.
e. Possess the requisite knowledge and skills to assess, diagnose and intervene in the event of complications or undesired outcomes and to institute nursing interventions in compliance with orders (including standing orders) or institutional protocols or guidelines.
f. Demonstrate skill in airway management resuscitation.
g. Demonstrate knowledge of the legal ramifications or administering moderate sedation and/or monitoring patients receiving moderate sedation, including the RN’s responsibility and liability in the event of an untoward reaction or life-threatening complication.
6. The institution or practice setting has in place an educational/competency validation mechanism that includes a process for evaluating and documenting the individuals’ demonstration of the knowledge, skills, and abilities related to the management of patients receiving moderate sedation. Evaluation and documentation of competence occurs on a periodic basis according to institutional policy.
Additional nurse sedation responsibilities which are within the expertise of the individual CSRN may include the following:
1. Administration/management: scheduling, material and supply management, development of policies and procedures, fiscal management, performance evaluations, preventative maintenance, billing, data management, and supervision of staff, students or ancillary personnel.
2. Quality assessment: data collection, reporting mechanism, trending, compliance, committee meetings, departmental review, problem-focused studies, problem solving, interventions, documents and process oversight.
3. Education: clinical and didactic teaching, BCLS/ACLS instruction, in-service commitment and facility continuing education.
4. Research: conducting and participating in departmental, hospital-wide, and university-sponsored research projects.
5. Committee appointments: assignment to committees, committee responsibilities, and coordination of committee activities.
6. Interdepartmental liaison: interface with other departments such as nursing, surgery, obstetrics, postsedation care units (PACU), outpatient surgery, admissions, administration, laboratory, pharmacy, etc.
7. Clinical/administrative oversight of other departments: respiratory therapy, PACU, operating room, surgical intensive care unit, pain clinic, etc.
The functions listed above are a summary of CSRN clinical practice and are not intended to be all-inclusive.
