Certified Registered Nurse Anesthetist (CRNA) scope of practice is covered in South Dakota Codified Law 36-9-3.1. CRNAs are encouraged to use the APRN Scope of Practice Decisioning Algorithm to guide decision-making on whether a specific task, intervention, or activity is in a CRNA's scope or practice.

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Telehealth Requirements

All health care providers are expected to adhere to requirements in SDCL 34-52 when treating patients in the state 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.

Collaboration Requirements

The CRNA shall collaborate with:

  • A physician, a dentist, a podiatrist, a certified nurse practitioner, a certified nurse midwife, or a physician assistant when providing anesthesia services.
  • Other health care providers when engaging in chronic pain practice.
  • According to SDCL 36-9-1 (7), collaboration is defined 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 34-20Bwithin the CRNA's role and focus area.  CRNAs who order CS drugs must meet requirements and be registered with the:

Nothing in SDCL 36-9-3.1 prohibits or changes the usual and customary practice of a CRNA, as of June 30, 2020, or the institutional and individual practitioners with whom they may practice; including the direct administration of CS by a CRNA, or the ordering of CS preoperatively, intraoperatively or postoperatively as a CRNA in accordance with chapter 34-20B or per institutional policy.

Applicable Rules:

  • ARSD 20:48:04:08 -- Defines prescribing, provision of drug samples, board authority to sanction CRNA for inappropriate prescribing.
  • ARSD 20:48:04:09 -- Provides guidelines for prescribing CS for treatment of chronic, non-cancer pain, lists documentation requirements, and state and federal registration requirements.

CDC 2022 Clinical Practice Guideline for Prescribing Opioids for Pain

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Pain Management & Radiography

CRNAs must complete education specific to pain management and fluoroscopy prior to performing pain management procedures or using fluoroscopy.  Education content must include:

  • Radiation physics, radiobiology, radiological safety, and radiation management, applicable to the use of fluoroscopy.
  • Physiology of pain, pain assessment, and treatment options, and demonstration of competence to perform a procedure(s).

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.

CRNAs who perform pain management procedures or use fluoroscopy in an institution or health care setting, such as a hospital or surgical center, that is licensed under SDCL chapter 34-12 and that 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.

CRNAs who are not practicing within a licensed facility or institution, must complete an educational program approved by the board and provide a completion certificate to the board. ****

Pre-approved Education Course Options:

  • Fluoroscopy Use:
    • AANA Fluoroscopy within Pain Management Series: Modules 1 through 5

Applicable Rules:

  • ARSD 20:48:04:10 - Clarifies that CRNAs may order, interpret and supervise radiographic procedures, including fluoroscopy, in accordance with .

    ARSD chapter 44:03

  • ARSD 20:48:04:11 -- Specifies pain procedures CRNAs may perform with required education.