Position Statement on CRNA Supervision and Training of Anesthesiologist Assistants (AAs) and AA Students

Background

In 2025, the Virginia General Assembly enacted Senate Bill 882, establishing licensure for Anesthesiologist Assistants (AAs) under the authority of the Virginia Board of Medicine. The law (Code of Virginia § 54.1-2957.23) specifies that AAs must practice only under the supervision of a licensed anesthesiologist and directs the Board of Medicine to develop regulations governing licensure, standards of practice, and supervision.

As of November 2025, the Virginia Department of Health Professions and the Board of Medicine are still in the process of developing regulations to implement this new licensure category. Until those regulations are finalized, operational details, such as supervision ratios, practice settings, and participation in training programs, remain pending.

Certified Registered Nurse Anesthetists (CRNAs) are licensed as Advanced Practice Registered Nurses (APRNs) under the joint regulatory authority of the Virginia Board of Nursing and the Board of Medicine (18VAC90-30). Current Virginia law does not authorize CRNAs to supervise or precept AAs or AA students, and there is no statutory or regulatory authority permitting CRNAs to assume responsibility for the clinical supervision or education of AAs.

Other states have taken similar positions clarifying the appropriate supervision and training relationships for AAs:

  • Nebraska (2022) – The Board of Nursing formally adopted the AANA’s position statement that CRNAs should not supervise AAs or AA students.
  • Missouri (§ 334.402.6) – Explicitly excludes CRNAs from participating in the training of AAs.
  • Wisconsin (§ 448.22(8)) – Limits AA student supervision exclusively to anesthesiologists, anesthesiology fellows, residents (PGY-2+), or licensed AAs.

 

VANA’s Position

  1. Supervision
    • Virginia statute clearly restricts AA supervision to anesthesiologists.
    • CRNAs are not authorized to supervise AAs or AA students under current law or regulations.
    • VANA supports the forthcoming regulatory framework, maintaining this supervision structure to ensure clarity, patient safety, and professional integrity.
  2. Training
    The term training is not yet defined in Virginia’s AA licensure framework but may encompass a range of professional interactions:

    • Orientation activities (e.g., introducing facility procedures or demonstrating anesthesia equipment): May be appropriate as collegial exchanges between licensed professionals.
    • Task-specific instruction (e.g., demonstrating an isolated clinical technique or skill within the CRNA’s scope, examples include skills such as intubation or IV insertion): May be permissible if it does not substitute for anesthesiologist supervision.
    • Global training or educational oversight (e.g., managing an AA’s clinical progress or competency evaluation): Not appropriate for CRNAs and remains the legal and professional responsibility of the supervising anesthesiologist.
  3. Precepting AA Students
    • Precepting AA students constitutes supervision of an anesthesiologist’s supervisee.
    • This role is reserved for anesthesiologists and should not be assigned to CRNAs.
    • VANA urges the Board of Medicine to ensure that AA student supervision is explicitly defined in regulation to prevent scope conflicts.

 

Conclusion

CRNAs in Virginia are independently licensed, highly educated anesthesia professionals with distinct practice authority under the Board of Nursing and Board of Medicine. Their role does not include supervising or precepting Anesthesiologist Assistants or AA students.

While collegial collaboration and sharing of knowledge between anesthesia professionals are encouraged, CRNAs must not be placed in positions of formal supervision, precepting, or educational oversight of AAs or AA students.

VANA urges policymakers, health systems, and anesthesia departments to:

  • Uphold statutory supervision requirements that reserve AA oversight to anesthesiologists;
  • Ensure forthcoming regulations clearly delineate CRNA and AA roles; and
  • Protect patient safety and professional boundaries within Virginia’s anesthesia care team model.

 

Member Guidance

If you are a CRNA and are asked to supervise or train an AA or AA student:

  1. Clarify the request – Determine if the task involves orientation, skill demonstration, or formal supervision.
  2. Reference this VANA Position Statement – Politely note that Virginia law restricts AA supervision to anesthesiologists.
  3. Decline inappropriate assignments – Particularly those involving supervision or precepting duties.
  4. Escalate concerns – Raise the issue with your facility’s compliance office, medical staff leadership, or human resources.
  5. Contact VANA for support – VANA can provide documentation and advocacy to ensure compliance with Virginia law and protection of CRNA practice.

Fall 2025 VANA Newsletter, News