Taking into account state hospital licensing laws or regulations, how many states don't require physician supervision or direction of CRNAs?

• A. 40
• B. 33
• C. 10
• D. 23

Answer: (D)

This item is testing state-by-state autonomy for CRNAs under hospital licensing rules. It asks how many states do not require physician supervision or direction of CRNAs, meaning CRNAs can practice anesthesia independently within their licensure and hospital policies. The number is 23 states. In these states, CRNAs can perform the full anesthesia process—assessment, planning, administration, monitoring, and emergence—without a required on-site physician supervisor for each case, though they still work under credentialing and facility policies. In other states, some form of physician supervision or direction is mandated, with the specifics varying by state and setting. Laws can change, so current practice may differ, but the stated count reflects the independent-practice states.