Massachusetts speaks to the registered nurse’s role in sedation through an advisory ruling of its Board of Registration in Nursing. Advisory Ruling 9101 gives its purpose as “To guide the practice of the Registered Nurse (RN) whose clinical responsibilities include the administration and management of medications intended to produce a depressed level of consciousness” (Purpose:). Everything below is quoted or faithfully paraphrased from the Board’s own file, a Word document with no page numbers, so citations name its section headings; the Advisory’s two subheadings are shortened to Mild to Moderate Sedation and Deep Sedation.
Massachusetts at a glance
| Board | Massachusetts Board of Registration in Nursing |
| Document | Advisory Ruling 9101, “Administration of Medications for Sedation/Analgesia” — an Advisory Ruling on Nursing Practice, published as a Word (.doc) file carrying no printed edition number. |
| Rule it is / rules it cites | Advisory Ruling Number 9101. It cites M.G.L. c. 13, §§ 13, 14, 14A, 15 and 15D, G.L. c. 112, §§ 74 through 81C and M.G.L. c.30A, § 8; the one regulation it points at is 244 CMR 9.03(6) (Authority:). |
| Status | Advisory ruling, made under M.G.L. c.30A, § 8. Whether it carries the force of law is not stated in its text. The Authority section records that 244 CMR 9.03(6) “requires all nurses to comply with any other law and regulation related to licensure and practice”. Inside the ruling the Board’s own verbs are obligatory — the nurse “must acquire and maintain” (Advisory:), the nurse in the management role “must ensure” (Advisory: Mild to Moderate Sedation). |
| Dates | Issued 9/21/91; revised 9/26/96, 11/10/99, 6/10/09, 9/11/13 and 6/14/17. No effective date, expiry date or review cycle is stated. |
| Who it covers | The registered nurse. The ruling’s scope line is “Scope of Practice: Registered Nurse”, and it speaks separately to “the nurse in the management role” (Advisory: Mild to Moderate Sedation). |
| Who it does not cover | Not stated. The ruling names no excluded licence category and no exemption for any nurse, patient or procedure; the LPN, the APRN and the nurse anaesthetist are absent from its text. Nothing on this row should be read as the Board permitting or barring anyone it does not name. |
| Settings the document names | Not stated. No practice setting appears — no hospital, endoscopy suite, emergency department, office or ambulatory centre. The ruling works through the employer’s “organizational policies” instead. |
| Re-verification interval | Not stated — the ruling sets no interval and names no frequency for reassessment (Advisory: Mild to Moderate Sedation). |
| Where the record lives | Not stated as a place. What the ruling locates with the employer is the protocol, not the record: policies must include protocols for “assessing and documenting the education and validation” of RN initial and continued competency (Advisory: Mild to Moderate Sedation). It names no file, registry or form. |
| CE hours | Not stated. No contact-hour count appears, and the ruling sets no continuing-education hours condition; what it asks for is documented education and validation of competency, initial and continued, with no quantity attached. |
What the Massachusetts Board of Registration in Nursing says
Two sentences open the Advisory: “The RN licensed by the Board will engage in the practice of nursing in accordance with accepted professional standards.” and “The nurse must acquire and maintain necessary knowledge, skills, and abilities before assuming duties and responsibilities for administering sedation/analgesia medication as described herein.” (Advisory:). The ruling then splits into a mild-to-moderate part and a deep-sedation part. Under the first, “The duly educated and qualified RN may receive, accept, and transcribe orders from duly authorized prescribers for medications that may produce minimal to moderate sedation/analgesia” (Advisory: Mild to Moderate Sedation).
First it describes the nurse: “Professional standards recognize the RN as responsible and accountable for possessing the knowledge, skills and abilities to perform the activity safely, effectively and competently including, but not limited to:”
- “patient selection and screening”;
- “pharmacological selection, properties and mechanism of physiological response”;
- “competent and safe administration of the medication by the specified route”;
- “ability to anticipate, recognize and facilitate corrective action for potential complications of the medications being administrated (e.g., but not limited to, hypoventilation, hypoxia, hypotension)” — “administrated” is the Board’s spelling; and
- “ability to recognize and appropriately react to emergency situations”.
Second, “the nurse in the management role” must ensure that organizational policies include five things — again “not limited to” these:
- “listing specific medications to be used for sedation/analgesia, their purpose, goals, techniques, desired outcomes, and the recommended dose per kilogram of body weight that may be safely administered by a RN”, “taking into account the patient’s age and co-morbidities”;
- “nursing care responsibilities, including, but not limited to patient assessment, monitoring, medication administration, potential complications, and documentation criteria”;
- “emergency protocols including, but not limited to, immediate, on site availability of resuscitative equipment, medications and personnel”;
- “protocols for assessing and documenting the education and validation for RN initial and continued competency”; and
- “protocols for provision of clear, complete and culturally appropriate informed consent”.
The fourth is the only place the ruling asks for a nurse’s competency to be documented:
“The nurse in the management role must ensure that organizational policies include, but are not limited to:” … “protocols for assessing and documenting the education and validation for RN initial and continued competency”
Advisory Ruling 9101 (Advisory: Mild to Moderate Sedation)
The ruling’s separate part for deep sedation
A second headed part covers medications “capable of producing deep sedation”. An RN may administer them to an intubated patient as ordered by a duly authorized prescriber. For a non-intubated patient the ruling adds conditions that organizational policies must require: that “the registered nurse whose sole responsibility is to manage the patient’s airway does so in the presence of a provider trained in anesthesia and proficient in airway management and advanced life support”, and that uninterrupted monitoring of patient consciousness be provided by “an individual with no other significant responsibilities that compromise or compete with his/her ability to continually monitor the patient” (Advisory: Deep Sedation). The CSRN™ course is a moderate-sedation course and is not offered as evidence of competency for deep sedation.
What a Massachusetts facility should be able to show
Three records follow from what that part asks organizational policies to contain:
- A sedation policy carrying all five items the ruling lists above.
- Per-RN evidence of initial education and validation for every registered nurse who administers or manages medications intended for minimal to moderate sedation/analgesia — the first half of the competency protocol the ruling asks to be documented.
- Per-RN evidence of continued competency, on an interval your own policy names, because Advisory Ruling 9101 names none.
The CSRN™ course — 10 CE contact hours developed and delivered by Capt. M. Ron Eslinger, CRNA, with module exams, case studies and a certificate ID your credentialing office can verify — is built to be records 2 and 3 on that list. Facility seats and roster tracking →
Questions Massachusetts facilities ask
How often does Massachusetts want sedation competency reassessed?
The ruling does not say. It asks that organizational policies contain protocols for assessing and documenting RN initial and continued competency (Advisory: Mild to Moderate Sedation), and is silent on how often the continued half is repeated — no interval, no expiry, no renewal language anywhere in the document. That interval is yours to set and to defend.
Does Massachusetts require the CSRN™ course specifically?
No. Advisory Ruling 9101 requires no particular course and names no certification, and no state mandates this specific course. What it asks for is documented education and validation of competency, initial and continued, without defining what that evidence looks like (Advisory: Mild to Moderate Sedation). CSRN™ is designed to serve as that evidence.
Does the ruling say which drugs an RN may give for moderate sedation?
No. No agent is named anywhere in Advisory Ruling 9101: propofol, ketamine, midazolam and etomidate do not appear in it. The ruling instead requires the employer’s policy to list the specific medications, their purpose, goals, techniques and desired outcomes, and a safe per-kilogram dose for an RN to give, taking the patient’s age and co-morbidities into account (Advisory: Mild to Moderate Sedation). Anything more specific has to come from your own policy and your prescribers.
Compliance note (last reviewed September 2026): This page is educational information about Massachusetts Board of Registration in Nursing Advisory Ruling 9101, not legal advice or a compliance determination. Every quotation was checked word-for-word on 2026-09-02 against the Board’s own AR 9101 Word file, downloaded that day from mass.gov; the file has no page numbers, so citations name its section headings. An advisory ruling can be revised — this one has been five times — so confirm the current version on the Board’s advisory-rulings page, the rules that apply to your setting, and your own facility policy before relying on this summary. No state mandates this specific course.