Expanding Autonomy for APRNs and CRNAs in Washington, DC: A New Era in Advanced Practice Nursing
The recent legislative changes under the Health Occupations Revision General Amendment Act of 2024 mark a monumental shift for Advanced Practice Registered Nurses (APRNs) in Washington, DC. These amendments have broadened the scope of practice for APRNs, including Certified Registered Nurse Anesthetists (CRNAs), permitting a more independent practice. This article provides an in-depth look at the previous law, recent changes, and how these modifications empower APRNs to deliver enhanced, autonomous care to the DC community.
Section I: Previous Law and Requirements for APRNs
Under the old law, DC Code § 3-1201.02 provided a foundational definition of APRN practice, outlining the duties and standards for APRNs in Washington, DC. According to this law, APRNs were defined as registered nurses with advanced education and certification, empowered to perform advanced-level actions such as:
Advanced Assessment
Medical Diagnosis
Prescribing Medications
Administering and Dispensing Therapeutic Measures
Treating Alterations in Health Status
These advanced responsibilities allowed APRNs to contribute significantly to patient care. However, DC Code § 3-1206.03 required that APRNs carry out these actions in “collaboration” with a licensed healthcare provider. This mandate limited APRNs’ ability to practice independently, requiring them to form collaborative agreements with physicians, regardless of their training, expertise, and ability to provide safe, quality care autonomously.
Authorized Acts Under the Old Law
DC Code § 3-1206.04 granted APRNs a range of clinical and diagnostic responsibilities, including the ability to initiate drug therapies, order treatments, and make referrals. Additionally, APRNs could sign and certify documents traditionally requiring a physician’s signature, provided these tasks fell within their scope of practice. Yet, the collaboration mandate limited APRNs’ independence in exercising these skills.
Educational Standards
DC Municipal Regulations Title 17 Chapter 56 set stringent educational standards for APRNs, including coursework in advanced physiology, health assessment, and pharmacology. Each APRN was required to complete 500 hours of supervised direct care clinical training and hold a valid registered nursing license. Program coordinators were required to have a doctoral degree and at least two years of clinical experience as an APRN.
Certified Nurse Midwife (CNM) Scope of Practice
Under Title 17, Chapter 58, Sec. 5808, Certified Nurse Midwives were authorized to manage obstetric and gynecological care, perform minor surgical procedures, and provide family planning and primary healthcare. CNMs were also bound by collaboration requirements under DC law.
Section II: Legislative Changes Under HORA 2024 and Expanded Autonomy for APRNs
The HORA 2024 amendments have introduced groundbreaking changes for APRNs, beginning with the redefinition of APRN practice to include the term “independent.” By repealing DC Code § 3-1206.03, which mandated collaboration with licensed healthcare providers, HORA 2024 has allowed APRNs, including Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), and Certified Nurse Midwives (CNMs), to practice independently.
Expanded Scope for Nurse Practitioners and Clinical Nurse Specialists
HORA 2024 also broadens the responsibilities of Certified Nurse Practitioners and Clinical Nurse Specialists under new DC Code 3-1206.07a and DC Code 3-1206.07b, respectively. Certified Nurse Practitioners are now authorized to provide a full spectrum of healthcare services, including:
Ordering, performing, and interpreting diagnostic tests
Diagnosing and treating acute and chronic conditions
Prescribing medications and managing overall patient care
Providing counseling and patient education on preventive health
Similarly, Clinical Nurse Specialists can now independently manage patient care across specialized populations, settings, and health conditions, from pediatrics and geriatrics to critical care and oncology. Their role includes supporting continuous improvements in patient outcomes, mentoring, and creating therapeutic environments.
New Educational Requirements
The amendments in HORA 2024 underscore a commitment to high standards by requiring each APRN to possess a minimum of a master’s degree for certification. These updated qualifications reflect a continued dedication to advanced nursing education while enabling APRNs to provide high-quality, autonomous care.
Comparative Overview: Maryland and Virginia
In neighboring Maryland, Nurse Practitioners can practice independently, albeit with restrictions, and this independence does not extend to CRNAs, CNMs, or CNSs. In Virginia, Nurse Practitioners may practice independently after completing 9,000 hours of supervised practice (about five years), while other APRNs remain under physician collaboration requirements.
Section III: Enhanced Independence for Certified Registered Nurse Anesthetists (CRNAs)
Certified Registered Nurse Anesthetists (CRNAs) are among the APRNs who have benefited directly from the recent legislative amendments in Washington, DC. Through Bill B25-0545— the Health Occupations Revision General Amendment Act of 2024, CRNAs in DC are now authorized to practice independently without the need for a collaborating physician. This independence enables CRNAs to autonomously plan and deliver anesthesia, pain management, and other related services.
Previously, CRNAs were restricted by collaborative agreements despite their extensive training and national certification. The recent amendment recognizes the specialized expertise CRNAs bring to patient care and aligns DC with the national trend supporting CRNA autonomy. Today, 31 states, including Maryland, California, and Michigan, allow CRNAs to practice without collaboration requirements, underscoring a broader recognition of CRNAs’ capacity to deliver safe, effective care independently.
Conclusion: The Path Forward for APRNs and CRNAs in Washington, DC
The legislative changes under HORA 2024 represent a historic shift in Washington DC’s approach to healthcare delivery, granting APRNs and CRNAs the independence to exercise their full training and skills without collaborative restrictions. This new era of autonomy aligns with a national trend to enhance access to healthcare by leveraging the expertise of APRNs and CRNAs. By promoting this independence, DC is ensuring that highly trained professionals can provide vital healthcare services directly to the community, advancing patient outcomes and reducing barriers to accessible care.
For more details on the legislative amendments, the full text of the DC bill is available online.
