North Dakota guides nurse sedation through Board-approved practice guidance rather than a task-specific rule — in the Board’s own words, “The law and rules are not prescriptive to specific tasks a nurse may or may not perform” (p. 2), and that guidance “does not carry the force and effect of the law/rules” (p. 1). The Board wrote it after receiving “several practice inquiries related to the role of the registered nurse (RN) in administration and monitoring of anesthetic agents for a variety of indications and dosages in various settings” (p. 1). Everything below is quoted or paraphrased from the Board’s five-page PDF, with page numbers.
North Dakota at a glance
| Board | North Dakota Board of Nursing |
| Document | Practice Guidance, “Role of the Nurse in Sedation/Analgesia” — North Dakota Board of Nursing PDF, 5 pages, updated 1/2026. Page numbers below refer to it. |
| Rule it applies | Issued under NDCC 43-12.1-08 (2)(p) (p. 1). Applies the Standards of Practice at NDAC 54-05-01-07, 54-05-02-04 (p. 1), 54-05-02-05 and 54-05-02-06 (p. 2); competence defined at NDAC 54-01-03-01(16) (p. 1). |
| Status | Advisory. “Board approved practice guidance does not carry the force and effect of the law/rules” (p. 1). The rules it applies are binding: “All licensed nurses practicing in North Dakota are required to know and comply with the NPA (law) and NDAC (rules)” (p. 2), and NDAC 54-05-02-06 “establishes the nurse’s duty to the client, which supersedes any licensed practitioner order or any facility policy” (p. 2). |
| Dates | Adopted 05/18 · Reviewed 1/2022 · Updated 1/2026 (p. 4). No review cadence is stated. |
| Who it covers | The document’s term nurse “refers to the RN and the APRN who is not a CRNA” (p. 2) — the nurse “administering and/or monitoring clients receiving sedation/analgesia” (p. 3). It “is NOT intended to apply to” “Deep sedation and general anesthesia” (p. 2). |
| Who it does not cover | Deep sedation and general anesthesia; the CRNA “functioning within his/her authorized scope of practice” (p. 2); “The nurse practicing in a critical care setting, where the client in question is intubated, receiving mechanical ventilatory support, and continuously monitored” (p. 2); nitrous oxide as a single sedative agent “which is not being administered concurrently with any other anesthetic agent or narcotic analgesic”, and monitoring maternal self-administration of nitrous oxide during labor (p. 2). LPNs are excluded outright — see below. |
| Settings the document names | It does not list the settings in which moderate sedation is given; it addresses “Employing institutions” (p. 3) and speaks of “various settings” (pp. 1 and 3). Named in passing: “a critical care setting” (p. 2), “an emergency or critical care setting” (p. 4), “during labor” (p. 2) and “routine diagnostic or therapeutic procedures” (p. 4). |
| Re-verification interval | None stated. The guidance asks for “ongoing competence” (p. 3) and points to AANA, ANA, AORN and AWHONN, which “have well-defined standards and recommendations for ongoing nursing education and competency assessment” (p. 2), and to the Board’s adopted Scope of Practice Decision-Making Framework (p. 2). |
| Where the record lives | In the employing institution’s policies and procedures, which “should include but not be limited to” “documentation/evidence of initial education and training and ongoing competence” (p. 3). Nothing else in the guidance says where, or for how long, training records are kept. |
| CE hours | None stated — no contact-hour count and no renewal-CE requirement. The guidance says “no continuing education program, including ACLS, will ensure that the nurse has the knowledge, skills, and abilities to rescue a client from deep sedation or general anesthesia” (p. 3). |
What the North Dakota Board of Nursing says
The guidance starts from the four-level continuum — minimal sedation, moderate sedation/analgesia, deep sedation/analgesia and general anesthesia (pp. 1–2). In its definition of moderate sedation “No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate” (p. 1), and “Reflex withdrawal from a painful stimulus is NOT considered a purposeful response” (p. 2). It addresses its operative list to employing institutions, which “should develop policies and procedures to guide the nurse in the administration of medications and client monitoring associated with sedation/analgesia” (p. 3).
The operative language is the list of things those policies and procedures “should include but not be limited to” (p. 3): a pre-sedation health assessment by the practitioner ordering the sedation; guidelines for client assessment, monitoring and drug administration with a plan for complications and emergencies; accessible emergency equipment and supplies; documentation and monitoring of the level of sedation and physiologic measurements; and the item this page is about:
“Documentation/evidence of initial education and training and ongoing competence of the nurse administering and/or monitoring clients receiving sedation/analgesia”
North Dakota Board of Nursing — Practice Guidance: Role of the Nurse in Sedation/Analgesia (PDF updated 1/2026, p. 3)
Two lines the guidance draws
LPNs
The guidance does not apply to “The practice of the licensed practical nurse (LPN), since the administration and monitoring of patients receiving sedation/analgesia is not within the scope of the LPN” (p. 2).
Propofol, ketamine and other anesthetic agents
At anesthetic agents the guidance draws a line: “It is the position of the Board that the administration of anesthetic agents (e.g., Propofol, methohexital, ketamine, and etomidate) for analgesia/sedation is outside the scope of practice for nurses EXCEPT in the following situations” (p. 4) — the four situations are listed under the questions below. During routine diagnostic or therapeutic procedures “It would not be prudent to presume that the licensed practitioner will be able to abandon the procedure to assist in rescuing the client, if complications arise” (p. 4), and the nurse’s duty to assure client safety “is an independent obligation under his/her professional licensure that supersedes any licensed practitioner order or facility policy” (p. 4) — which obliges the nurse “to decline orders to administer medications or doses of medications that have the potential to cause the client to reach a level of deep sedation or anesthesia outside the presence of a qualified licensed practitioner, CRNA or anesthesiologist” (p. 4).
What a North Dakota facility should be able to show
The policy list above translates into three records a North Dakota facility should be able to produce:
- Sedation policies and procedures covering the five items the guidance lists (p. 3).
- Per-nurse evidence of initial education and training for every RN and non-CRNA APRN who administers or monitors sedation/analgesia (p. 3).
- Per-nurse evidence of ongoing competence, on an interval your own policy names — the guidance sets none (p. 3).
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 North Dakota facilities ask
Does North Dakota set a renewal interval for sedation competency?
No. The guidance asks for documentation of “ongoing competence” (p. 3) and is silent on the interval; it points instead to the professional organizations’ “standards and recommendations for ongoing nursing education and competency assessment” (p. 2). The interval you write into your policy is your own; a certificate with an expiry date makes it visible on the roster.
Does North Dakota require the CSRN™ course specifically?
No. The guidance requires no named course, and no state mandates this specific one. It asks for “Documentation/evidence of initial education and training and ongoing competence” (p. 3) without defining what that evidence is. CSRN™ is designed to serve as that evidence — a named credential, assessed competency and an employer-verifiable certificate ID.
Can a North Dakota nurse give propofol for moderate sedation?
The Board’s position is that only in the four situations on p. 4 — assisting in the presence of a CRNA or anesthesiologist; an intubated and mechanically ventilated client in critical care; assisting a qualified licensed practitioner with an intubation or other procedure in an emergency or critical care setting; or relief of refractory symptoms in intractable distress in the dying client. Outside those, anesthetic agents are outside nurse scope (p. 4). The guidance also passes on the FDA product warning that “only persons trained to administer general anesthesia should administer Propofol for purposes of general anesthesia or for monitored anesthesia care/sedation” (p. 3), and notes that “there are no reversal agents for Propofol” (p. 3).
Compliance note (last reviewed September 2026): This page is educational information about the North Dakota Board of Nursing’s practice guidance Role of the Nurse in Sedation/Analgesia, not legal advice or a compliance determination. Every quotation was checked word-for-word against the Board’s PDF updated 1/2026 (adopted 05/18, reviewed 1/2022) on 2026-09-01; page numbers refer to that PDF. The guidance states no review cadence; confirm the current version on the Board’s site and your own facility policy before relying on this summary. No state mandates this specific course.