• Florida Republican lawmakers Rep. Mike Giallombardo and Sen. Blaise Ingoglia are proposing legislation that would allow Certified Registered Nurse Anesthetists (CRNAs) to practice independently, removing the current requirement for a written supervisory agreement with a physician. 
• The measures are driven by a belief that existing supervisory relationships, which often involve financial arrangements, do not significantly enhance patient care or safety in anesthesia administration.
• Data shows that Florida is losing a significant portion of nurse anesthesiology graduates to other states with less restrictive regulations.

A pair of Republican lawmakers, Rep. Mike Giallombardo and Sen. Blaise Ingoglia, are readying legislation aimed at granting Certified Registered Nurse Anesthetists (CRNAs) the authority to practice autonomously through the elimination of existing requirements that mandate written supervisory agreements with physicians.

The measures, if passed, would allow CRNAs to practice independently, eliminating the current requirement for a written supervision agreement with a physician or dentist. Under current Florida law, CRNAs are required to have written supervisory protocols, meaning that to practice, they need a formal agreement with a supervisor that oftentimes involves a financial component where CRNAs pay a percentage of their collections to the supervising physician.

Individuals looking to strip the supervision requirement note that many of the physicians or dentists who sign these supervisory protocols do not have specialized training in anesthesia. Thus, the supervision does not contribute to enhanced patient care or safety in anesthesia administration and largely serves as a statutory formality rather than a clinically significant supervisory relationship.

“Right now a lot of CRNAs provide this same service, yes, with paper supervision, but without any physical or real supervision. And everybody is just fine,” Giallombardo told The Capitolist. “If we can remove this paper supervision, I think we’d also see savings and healthcare costs in the anesthesia component [of healthcare].”

Bill proponents further assert that the supervisory requirements contribute to the shortage of CRNAs in Florida, as many choose to practice in states with less restrictive regulations. This shortage is particularly acute in rural areas and is leading to the closures of healthcare services like obstetrics departments in hospitals.

According to data aggregated by the American Association of Nurse Anesthesiology, the state of Florida loses 32.8 percent of nurse anesthesiology graduates to other states each year. A secondary subset of data shows that 84.5 percent of graduates leaving Florida relocate to one of the 43 states that do not hold supervision requirements in their nursing or medical laws.

Between 2018 and 2023, Florida State University experienced the highest rate of graduates relocating, with 65 percent of its students moving away. This was followed by Keiser University, where 55.9 percent of graduates left Florida, and Florida Gulf Coast University, with a 43.3 percent departure rate. The University of Miami saw 29.5 percent of its graduates leave the state. Meanwhile, Barry University and the University of North Florida had departure rates of 23.6 percent and 24.8 percent, respectively. Advent Health University reported that 22.8 percent of its graduates left Florida, while the University of South Florida had a slightly higher rate at 23.7 percent. Florida International University had the lowest rate, with 20.3 percent of its graduates moving out of state.

“I look at this as a health care workforce bill,” said Giallombardo. “I think it’s important to note that because we do have an increasing amount of CRNAs and anesthesiologists that leave the state, and partly because of this protocol … it’s going to be important for us to ensure that we have the health care workforce that we need.”

The House version of the bill, introduced by Giallombardo on Nov. 2, has been referred to the Healthcare Regulation Subcommittee, Health Care Appropriations Subcommittee, and Health & Human Services Committee. Ingoglia is expected to file the Senate companion bill later this month.

The legislation faces resistance from the Florida Medical Association and some anesthesiologists, citing patient safety concerns over the lack of physician oversight.