Nebraska addresses RN sedation in a Board of Nursing advisory opinion. Sedation and Analgesia (adopted 8/2021, revised 7/2022) sets out level by level what is “within the scope of practice of the Registered Nurse (RN)” (p. 1), limits LPNs to minimal sedation, and lists ten things “Employers/Facilities shall develop and maintain” (p. 2) in writing — among them “Education/training and competency assessment requirements for nurses” (p. 3).
Nebraska at a glance
| Board | Nebraska Board of Nursing (Nebraska DHHS) |
| Document | Advisory Opinion, “Sedation and Analgesia” — adopted 8/2021, revised 7/2022 (p. 1). An eight-page PDF: the opinion on pp. 1–5, references on pp. 6–8. |
| Rule it applies | None of its own — it is an advisory opinion, not a rule. It cites the Nurse Practice Act, §38-2209, for the supervising “physician or other licensed practitioner” (pp. 1–2); §38-2311, on the direction of LPNs (p. 2); and the Dentistry Practice Act, §38-1137, on dentists’ sedation permits (p. 2). |
| Status | Advisory in form — headed “Advisory Opinion” (p. 1), and it does not say whether it carries the force of law. Its own wording is mandatory in places: “Employers/Facilities shall develop and maintain written policies/procedures/protocols/order sets/records” (p. 2). The Act sections it cites are statute (Ne. Rev. Stat.), not opinion. |
| Dates | Adopted 8/2021 · revised 7/2022 · template revised 08/2016 · the “Reaffirmed” line is blank (p. 1). Replaces the Board’s earlier procedural-sedation opinion. No effective date and no review cycle are stated. |
| Who it covers | Registered nurses: “It is within the scope of practice of the Registered Nurse (RN) to administer medications and monitor the patient for sedation and analgesia” (p. 1) — minimal sedation (anxiolysis), dissociative sedation, moderate sedation “under direct, in-person supervision of a physician or other licensed practitioner” (p. 1), “Deep sedation in acute care settings” (p. 2) in two situations only, and palliative or end-of-life sedation (p. 2). It also speaks to LPNs, supervising practitioners and employers/facilities (pp. 2–3). Nurse practitioners appear only as supervisors; the opinion does not address APRNs administering sedation. |
| Who it does not cover | Two topics the opinion says it “does not include” (p. 1): “Nurse-led initiation of nitrous oxide in maternity care” for patient self-administration, and intravenous ketamine “for other than procedural or other acute analgesia indications” (p. 1). CRNA practice itself is not addressed; CRNAs appear only in a line saying they “do not supervise RNs” for sedation and analgesia (p. 2). |
| Settings the document names | It does not list procedure areas. It names “acute care settings” for the two deep-sedation situations (p. 2); “licensed health care facilities with credentialing/privileging requirements” as the only settings where nurse practitioners and physician assistants may supervise the RN (p. 2); and it asks facilities to set which levels of sedation RNs may assist with by the patient’s location in the facility (p. 3). |
| Re-verification interval | Not stated. The opinion makes “Education/training and competency assessment requirements for nurses” (p. 3) something the employer writes into its own policies, and names no interval, renewal cycle or expiry. |
| Where the record lives | With the employer — the written “policies/procedures/protocols/order sets/records” (p. 2) it is to develop and maintain, including the “Education/training and competency assessment requirements for nurses” (p. 3). |
| CE hours | Not stated. No contact-hour count, named course or continuing-education requirement appears in the opinion. The only certifications named are ACLS and, for palliative sedation, BLS (p. 2) — with the caution that ACLS certification “does not ensure the RN ongoing expertise in airway management and emergency intubation” (p. 5). |
What the Nebraska Board of Nursing says
The operative language is the requirements list — ten things the opinion says employers and facilities “shall develop and maintain” (p. 2) in writing (pp. 2–3): prescriber credentialing/privileging; documentation of ACLS certification for nurses administering moderate and deep sedation, BLS for palliative sedation; education/training and competency assessment requirements for nurses; the levels of sedation RNs may assist with based on the patient’s location in the facility; approved medications, including age/weight dosages; medication orders with initial dose, titration parameters and maximum dose; emergency equipment, medications and supplies; monitoring guidelines and equipment; documentation and monitoring of sedation level and physiologic measurements; and venous access requirements. The third item is the one this page is about:
“Employers/Facilities shall develop and maintain written policies/procedures/protocols/order sets/records including, but not limited to:” … “3. Education/training and competency assessment requirements for nurses;”
Nebraska Board of Nursing — Sedation and Analgesia, Requirements, pp. 2–3
Three lines the opinion draws
LPNs, and who may supervise the RN
LPNs “are directed in practice by a RN or licensed practitioner” (p. 2), and for sedation their “Scope of practice is limited to the administration and monitoring of medications for minimal sedation (anxiolysis)” (p. 2); they may practice “in support roles in RN-led nursing care teams” for patients requiring sedation or analgesia when the RN has primary responsibility (p. 2). CRNAs “do not supervise RNs” for sedation and analgesia, and “Supervising dentists are required to have permits for sedation, but not inhalation analgesia” (p. 2). Absent anyone credentialed or privileged to perform rapid sequence intubation, the practitioner performing the procedure and supervising the RN “must have competence and credentialing in advanced airway management, including emergency intubation AND the availability to abandon the procedure to rescue the patient from unintended deep sedation or general anesthesia” (p. 3).
Deep sedation, general anesthesia and the duty to refuse
“The administration of medications and primary responsibility for monitoring the patient during intended procedural deep sedation or general anesthesia are not within RN scope of practice” (p. 4). The only deep sedation it places within RN scope is in acute care settings where the patient “is intubated and mechanically ventilated” or the nurse “is assisting a qualified health care professional with Rapid Sequence Intubation (RSI)” under direct, in-person supervision (p. 2). Registered nurses “are responsible and accountable for refusing to administer and/or refusing to continue to administer medications in amounts that may induce or maintain unintended levels of sedation” (p. 4).
Anesthetic agents and nitrous oxide
“Using anesthetic agents for the purposes of moderate sedation presents serious risks to the patient, including loss of protective reflexes and airway, no matter who is administering the drug”, and “Personnel with expertise in airway management and emergency intubation must be readily available” (p. 5). For nitrous oxide, “Concurrent administration of any other sedative, anesthetic or narcotic analgesic with nitrous oxide is outside the scope of practice of the RN” (p. 4).
What a Nebraska facility should be able to show
The requirements list translates into three records:
- The written sedation policy set — the “written policies/procedures/protocols/order sets/records” (p. 2) covering all ten listed items (pp. 2–3), including item 2’s ACLS documentation — BLS for palliative sedation (p. 2).
- Per-nurse evidence of education and training against the “Education/training and competency assessment requirements for nurses” (p. 3) that your own policy sets — the opinion names no sedation course and no hour count.
- Per-nurse evidence of competency assessment under the same item, on an interval your own policy names — the opinion sets 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 Nebraska facilities ask
Does Nebraska set a renewal interval for sedation competency?
Not in this opinion. It leaves “Education/training and competency assessment requirements for nurses” (p. 3) to the employer’s own policies and is silent on the interval — no renewal cycle, expiry or re-verification period appears in it.
Does Nebraska require the CSRN™ course specifically?
No. The opinion names no particular course, and no state mandates this specific one. It asks employers to set “Education/training and competency assessment requirements for nurses” (p. 3). CSRN™ is designed to serve as that education-and-competency evidence.
Can a Nebraska RN give propofol for moderate sedation?
Only in the three circumstances the opinion lists, none of which is procedural moderate sedation. “An appropriately trained RN may only administer Propofol for sedation under the following circumstances” (p. 5): to intubated, mechanically ventilated patients; when assisting a qualified health care professional during RSI; or as palliative sedation for end-of-life care (p. 5). Ketamine and etomidate are treated differently — they “may be administered by the RN for moderate sedation” (p. 5).
Compliance note (last reviewed September 2026): This page is educational information about the Nebraska Board of Nursing’s advisory opinion Sedation and Analgesia, not legal advice or a compliance determination. Every quotation was checked word-for-word against the Board’s PDF (adopted 8/2021, revised 7/2022) on 2026-09-01; page numbers refer to that PDF. The opinion states no review cycle; confirm the current version on the Board’s advisory-opinions page and your own facility policy before relying on this summary. No state mandates this specific course.