Wisconsin CRNAs just got independent practice. On paper.

The Anesthesia Brief  ·  Issue #11

If you're thinking it, we're talking about it.

By Marc Smith, DNP, CRNA & Shantall Ruiz Cummins, DNP, CRNA

Six things worth knowing today. Let's get into it.

Wisconsin CRNAs just got independent practice. On paper.

If you contract in Wisconsin, the collaborative agreement your license has required for as long as you've practiced there is no longer the law. Act 17, the APRN Modernization Act, took effect September 1. Once you have 3,840 hours and 24 months of practice in your role alongside a physician, you can practice as a CRNA outside any collaborative relationship, and existing advanced practice nurse prescriber certificates convert to the new APRN license.

Nothing changed in the room. CRNAs have delivered safe anesthesia care in Wisconsin under collaborative agreements for decades. What changed is who has to sign off on paper, and it took more than one veto and years of CRNAs refusing to drop it before Governor Evers signed this version in August 2025.

A state law is the ceiling. Your facility's bylaws and anesthesia policy decide whether you actually practice to it, and that paperwork can take months to catch up to a new law. Wisconsin CRNAs, this month is when you check yours and push for the update.

Our take is at the bottom of this issue ↓

Wisconsin CRNAs, put the question to your facility in writing

If you work in Wisconsin, pull your facility's medical staff bylaws and anesthesia policy this week, find the line that references your collaborative agreement, and ask the medical staff office in writing when it will be updated to match Act 17. While you wait, start documenting your 3,840 hours on the Board's forms so you're ready the day they say yes. Everywhere else, check whether your state still requires a collaborative agreement or physician supervision for CRNAs, then ask your state association what bill they're carrying next session.

Quiet statehouses, one federal bill to read

The statehouses were quiet on CRNA scope this week. The bill to watch is federal. The Medicare Access to Rural Anesthesiology Act, HB9642, would open Medicare's rural anesthesia pass-through, the program that lets small rural hospitals use Part A dollars to keep anesthesia on staff, to physician anesthesiologists. Today that money can only pay CRNAs and anesthesiologist assistants. The ASA is backing the bill, it cleared the House Ways and Means Committee unanimously in July, and it has not moved since. Why it matters, that rural pass-through money is a fixed pot. If physician anesthesiologists become eligible for it too, it's the same dollars split more ways at small rural hospitals that currently staff with CRNAs alone. If your paycheck comes from one of those hospitals, this is the one to read.

→ Full scope tracker + your state

The epi locals are back on the list

Bupivacaine with epinephrine and lidocaine with epinephrine are both back on the FDA shortage list as of September 9, along with midazolam and atropine, and etomidate now shows an unavailable presentation on a demand increase. If your blocks run on the epi-containing locals, confirm with pharmacy this week which concentrations you're actually stocked on and pick your substitute and dose before the block day, not during it.

→ Full shortage list

The algorithm that reads a face to predict a hard airway

Here's the line that should stop you, an algorithm can now flag a hard airway from a photo of your patient's face or a recording of their voice, and it's already beating the bedside tests you run today, though still not perfectly. That's the headline finding of a new narrative review in the British Journal of Anaesthesia (Sorbello et al., Feb 2026) rounding up where AI in airway management actually stands. Videolaryngoscopy software is catching up too, reading anatomy and verifying tube placement on the screen in real time. The furthest-out piece, early AI-guided robotic intubation systems already matching expert performance, so far only in the lab.

The authors' own caution matters as much as the promise, the deskilling risk, black-box algorithms nobody can fully audit, and a validation bar none of this has cleared yet. None of it replaces judgment in the room. Call it a preview, not a verdict.

→ Tech watch

On Wisconsin's independent practice law

We've watched this play out in other states, and the pattern is always the same. The law changes on a Tuesday and nothing in the building changes for a year, because the bylaws still say "collaborating physician" and nobody in administration has a reason to reopen them. The CRNAs who actually practice to the new law are the ones who take it up with administration and don't let it drop.

So our take is, Wisconsin CRNAs, this is your year to be annoying. Log the hours, file the forms, and put the question in writing at every facility you contract with. And for those of us in states that still haven't moved, this is the proof that a veto is a delay, not an ending. Wisconsin's CRNAs got told no more than once and kept coming back.

- Marc & Shantall

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Legislative data, LegiScan & OpenStates (CC BY 4.0). Drug shortage data, openFDA. Federal regulatory data, FederalRegister.gov (public domain). Compensation, Marit Health, BLS, AANA.

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