Pennsylvania addresses RN conscious sedation through a Board of Nursing statement of policy. Subchapter D of 49 Pa. Code Chapter 21 is where the Board publishes its interpretations of “whether the execution of specific practices are within the scope of professional or practical nursing” (§ 21.401(a)), and § 21.413(d) is the one on conscious sedation. It defines the term, then says the registered nurse who is not a CRNA “may administer conscious sedation medications, under § 21.14, during minor therapeutic and diagnostic procedures, when the following conditions exist” (§ 21.413(d)) — eight conditions, among them a physician or CRNP physically in the room, ACLS certification and periodic competence evaluation. Everything below is quoted or paraphrased from Subchapter D, so you can check it against the source.
Pennsylvania at a glance
| Board | Pennsylvania State Board of Nursing (the text itself says only “the Board”) |
| Document | 49 Pa. Code Chapter 21, Subchapter D (Interpretations) — § 21.413, “Interpretations regarding the administration of drugs—statement of policy”, subsection (d) and its conditions (1)–(8). An HTML page on the Pennsylvania Code & Bulletin website; no page numbers. |
| Rule it is, and applies | Is 49 Pa. Code § 21.413(d), a statement of policy. Applies § 21.14, which § 21.413(a) describes as relating to “administration of drugs”. Authority: “amended under sections 8.2(c) and 8.3(b) of the Professional Nursing Law” (§ 21.413, Authority note). |
| Status | A statement of policy, in the document’s own words: the subchapter is titled “Interpretations”, and § 21.413 sits under the heading “STATEMENT OF POLICY”. Interpretations “do not constitute an exercise of delegated legislative power by the Board”, are “not intended to be legally enforceable against a licensed person by the Board”, and in adjudications “the Board may consider, but is not bound by, interpretations” (§ 21.401(c)). Within the eight conditions, mandatory verbs appear in two — “shall” in (5) and “may not” in (7); the rest are conditions that “exist” when the RN “may administer” (§ 21.413(d)). § 21.401(g) adds that a nurse “shall only undertake the practice if the nurse has the necessary preparation, experience and knowledge to properly execute the practice”. |
| Dates | Adopted February 20, 1987, effective February 21, 1987 (17 Pa.B. 811); amended in 1991, 1992, 1993 and 1998; last “amended March 31, 2023, effective April 1, 2023, 53 Pa.B. 1806” (§ 21.413, Source note). The history line does not say which amendment touched subsection (d). No review cycle is stated. |
| Who it covers | “The registered nurse who is not a certified registered nurse anesthetist” administering conscious sedation medications during minor therapeutic and diagnostic procedures (§ 21.413(d)). For applying nursing standards and qualifications in this Commonwealth, registered nurse includes a Pennsylvania licensee and “an individual who holds a privilege to practice as a registered nurse in this Commonwealth under the Nurse Licensure Compact Act” (§ 21.415(2)). |
| Who it does not cover | CRNAs — the subsection addresses only the RN who is not a CRNA. LPNs — not addressed: § 21.414, the LPN statement of policy, lists the practices interpreted as within LPN scope, and conscious sedation is not among them. Deeper levels of sedation and particular drugs — not addressed: the subsection defines only “conscious sedation” (the words moderate sedation do not appear anywhere in the subchapter) and leaves the medication list to written guidelines (§ 21.413(d)(2)). |
| Settings the document names | No practice-setting types are listed. The subsection names minor therapeutic and diagnostic procedures (§ 21.413(d)), “a particular setting” for medications (d)(2), “the room” where a physician or CRNP is present (d)(1), and the facility whose discharge criteria apply (d)(8). |
| Re-verification interval | Not stated. The only words on timing are “evaluation of competence on a periodic basis” (§ 21.413(d)(6)). |
| Where the record lives | Not stated. It makes a written order (d)(1), written guidelines on medications (d)(2) and on minimum patient monitoring (d)(3), and the facility’s discharge criteria (d)(8) conditions of the practice, but says nothing about where evidence of competence is kept. |
| CE hours | Not stated. No contact-hour count, named course or renewal-CE requirement appears in the subsection. The one credential it names is ACLS certification, for the RN in direct patient care (§ 21.413(d)(5)). |
What the Pennsylvania State Board of Nursing says
Subsection (d) first defines its term, for use in that subsection: conscious sedation is “a minimally depressed level of consciousness in which the patient retains the ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal commands” (§ 21.413(d)). The operative language is then the eight conditions under which the non-CRNA registered nurse may administer conscious sedation medications — paraphrased here with the document’s own fragments, in its order:
- The specific amount has been ordered in writing by a licensed physician or certified registered nurse practitioner, and one of those two — the condition names no other profession — “is physically present in the room during administration” (d)(1).
- “Written guidelines specifying the medications that the registered nurse may administer in a particular setting are available to the registered nurse” (d)(2).
- Electrocardiogram, blood pressure and oximetry equipment “are used for both monitoring and emergency resuscitation purposes pursuant to written guidelines which are provided for minimum patient monitoring”, and “Additional emergency resuscitation equipment is immediately available” (d)(3).
- The patient “has a patent intravenous access when the conscious sedation is administered intravenously” (d)(4).
- The RN in direct patient care “is certified in advanced cardiac life support (ACLS)”, and provisions are in place for back-up personnel expert in airway management, emergency intubation and advanced life support — who they are, and how near, is not stated (d)(5).
- The RN’s knowledge, skills, abilities and periodic competence evaluation — quoted below (d)(6).
- The RN managing the patient “may not have other responsibilities during the procedure” and may not leave the patient unattended (d)(7).
- The RN “monitors the patient until the patient is discharged” by a qualified professional under the facility’s criteria (d)(8).
“The registered nurse possesses the knowledge, skills and abilities related to the management of patients receiving conscious sedation with evaluation of competence on a periodic basis.”
Pennsylvania State Board of Nursing — 49 Pa. Code § 21.413(d)(6)
What a Pennsylvania facility should be able to show
Beyond the per-nurse ACLS card (d)(5), the conditions translate into three records a Pennsylvania facility should be able to produce:
- Written guidelines — specifying the medications the RN may administer in the setting (d)(2), and providing for minimum patient monitoring (d)(3).
- Per-nurse evidence of knowledge, skills and abilities in what condition (6) names — “arrhythmia detection, airway management and pharmacologic action of drugs administered”, including “emergency drugs” — for every non-CRNA RN who administers conscious sedation.
- Per-nurse periodic competence evaluation, on an interval your own policy names — condition (6) says only that it is periodic.
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 Pennsylvania facilities ask
Does Pennsylvania set a renewal interval for sedation competency?
No. Condition (6) asks for periodic evaluation of competence and stops there — no interval, no named evaluator, no form of record (§ 21.413(d)(6)). The interval you write into your guidelines is your own; a certificate with an expiry date makes it visible on the roster.
Does Pennsylvania require the CSRN™ course specifically?
No. Subsection (d) names no sedation course, and no state mandates this specific one. The only credential it names is ACLS (d)(5); for the rest it asks that the RN possess the knowledge, skills and abilities condition (6) lists, evaluated periodically, without saying how that is shown. CSRN™ is designed to serve as that evidence — a named credential, assessed competency and an employer-verifiable certificate ID.
Does a physician or CRNP have to be in the room?
Yes, as a condition of the interpretation: under (d)(1) the specific amount is ordered in writing by a licensed physician or CRNP, and a physician or CRNP is physically present in the room during administration. After administration the subsection names only the RN, who monitors until discharge by “a qualified professional authorized to discharge the patient” (d)(8); it does not say how long the physician or CRNP remains.
Compliance note (last reviewed September 2026): This page is educational information about 49 Pa. Code § 21.413(d), the Pennsylvania State Board of Nursing’s statement of policy on conscious sedation, not legal advice or a compliance determination. Every quotation was checked word-for-word against 49 Pa. Code Chapter 21, Subchapter D as published on the Pennsylvania Code & Bulletin website on 2026-09-01; citations refer to section, subsection and numbered condition. The section’s history line shows its last amendment effective April 1, 2023; confirm the current text and your own facility policy before relying on this summary. No state mandates this specific course.