Virginia’s Board of Nursing addresses RN sedation in a two-page guidance document. Guidance Document 90-63 defines four levels of sedation — “minimal (anxiolysis); moderate (conscious sedation); deep sedation; and general anesthesia” (p. 1) — says that “Registered nurses may administer mild to moderate sedation under certain conditions according to a prescriber’s order” (p. 1), lists seven competencies that “should be demonstrated” (p. 2) in order to administer sedation, and names the monitoring standards the nurse should understand. Everything below is quoted or paraphrased from the Board’s PDF, with page numbers, so you can check it against the source.
Virginia at a glance
| Board | Virginia Board of Nursing |
| Document | Guidance Document 90-63, “Registered Nurses and Procedural Sedation” — Virginia Board of Nursing PDF, two pages, revised May 18, 2021 and effective July 8, 2021 (header, pp. 1–2). |
| Rule it applies or is | Not stated — the document cites no statute or regulation; its header labels it a “Guidance document” (pp. 1–2). Its only references are the American Society of Anesthesiologists’ sedation continuum (p. 1, footnote) for its four level definitions and, as its stated “Document source” (p. 2), research and a presentation on “RN Administered Sedation” (p. 2) “taken from a literature review, information from other states, and key reference articles” (p. 2). |
| Status | A guidance document — both pages are headed “Guidance document: 90-63” (pp. 1–2). It does not describe its own legal status. Its verbs draw the line instead: its three operative “must” sentences are all on the first page (p. 1), while the competencies and training on the second page are written as “should”: “certain competencies should be demonstrated” (p. 2). |
| Dates | “Revised: May 18, 2021” (pp. 1–2) · “Effective: July 8, 2021” (pp. 1–2). Adoption date and review cycle: not stated. |
| Who it covers | Registered nurses: “Registered nurses may administer mild to moderate sedation under certain conditions according to a prescriber’s order” (p. 1); the training sentence addresses “the registered nurse administering medications for procedural sedation” (p. 2). |
| Who it does not cover | Not stated. The document names no excluded role: it never mentions licensed practical nurses or unlicensed staff, and the only advanced-practice role it names is the certified registered nurse anesthetist — as a director of deep sedation or anesthesia (p. 1), not as an administering nurse. |
| Settings the document names | Not stated. No hospital, surgery center, office or unit is named; the document speaks of “procedural sedation” (p. 2). |
| Re-verification interval | Not stated. “In order to administer sedation, certain competencies should be demonstrated” (p. 2) — with no interval, renewal or re-demonstration requirement anywhere in the document. |
| Where the record lives | Not stated for training or competency: the document names no policy, file or office that holds the evidence. The only documentation it addresses is the patient’s sedation record — the “standards of monitoring and documentation” (p. 2) it lists. |
| CE hours | Not stated. No contact-hour count or continuing-education requirement appears; the guidance describes training content, not hours (p. 2). |
What the Virginia Board of Nursing says
The first page frames the role — mild to moderate sedation, on a prescriber’s order, with the prescriber present (p. 1). The guidance does not enumerate the “certain conditions” (p. 1) under which registered nurses may administer it; what it supplies is that presence requirement and the second page’s competencies, training and monitoring standards. The operative language sits under “Education and Training” (p. 2): “In order to administer sedation, certain competencies should be demonstrated” (p. 2), followed by seven of them:
- “Knowledge of the purpose, actions and side effects of sedating medications” (p. 2)
- “Knowledge of the respiratory system and oxygen delivery” (p. 2)
- “Demonstrated airway management competency” (p. 2)
- “Understanding of cardiovascular system, medication pharmacology and antidotes, dysrhythmia recognition and sedation complications” (p. 2)
- “Ability to initiate emergency rescue procedures and resuscitation” (p. 2)
- “Identification and differentiation of levels of sedation and common patient assessment risk scales” (p. 2)
- “Competency in pre, intra and post procedural nursing care from initial assessment to discharge” (p. 2)
The sentence that follows the list is the document’s most operative line on training, and the one this page is about:
“Training for the registered nurse administering medications for procedural sedation should include advanced training in airway management, treatment of cardio-respiratory complications, and advanced pharmacology training in the medications utilized.”
Virginia Board of Nursing — Guidance Document 90-63, p. 2
Under “Monitoring and documentation” (p. 2) the registered nurse is expected to “understand standards of monitoring and documentation” (p. 2) covering four items: “Pre-sedation assessment – airway, NPO status, pregnancy, medical history, medication history, allergies, previous complications with sedation and history and physical” (p. 2); “Collaboration with physician to develop sedation plan” (p. 2); “Continuous monitoring to include heart rate, respiration, blood pressure, EKG, oxygenation via pulse oximetry and level of sedation” (p. 2); and “Continuous monitoring into the recovery phase as the patient returns to baseline until discharge” (p. 2). A note on wording: in the published PDF the sentence that introduces this list carries a visible revision mark — “must” struck through with “should” written beside it, and “to include” struck through with “including” beside it — so, as revised, it is a “should” sentence like the rest of the second page.
What a Virginia facility should be able to show
The guidance’s own lists translate into three records a Virginia facility should be able to produce:
- A sedation record for every case that shows the four standards the guidance lists (p. 2) — the pre-sedation assessment, the sedation plan developed with the physician, continuous monitoring, and monitoring through recovery to discharge — with the prescriber credentialed and privileged for sedation present (p. 1).
- Per-nurse evidence of training in the three areas the guidance names — advanced airway management, treatment of cardio-respiratory complications, and advanced pharmacology in the medications used (p. 2).
- Per-nurse evidence that the seven competencies were demonstrated (p. 2) — from drug knowledge and airway management to rescue and pre-, intra- and post-procedural care — on an interval your own policy names, because the guidance 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 Virginia facilities ask
Does Virginia set a renewal interval for sedation competency?
Not in this guidance. Guidance Document 90-63 says “certain competencies should be demonstrated” (p. 2) and names no interval, no renewal and no re-demonstration; it is equally silent on who assesses the competencies and where the evidence is kept. The interval you write into your policy is your own; a certificate with an expiry date makes it visible on the roster.
Does Virginia require the CSRN™ course specifically?
No. The guidance names no course, no provider and no contact-hour count, and no state mandates this specific one. It names no certification either — no ACLS or PALS; the nearest it comes is the competency of initiating emergency rescue procedures and resuscitation (p. 2) — and no drug: it speaks of sedating medications, of pharmacology and antidotes and of the medications utilized (p. 2), never a named agent. What it describes is training content and seven competencies that “should be demonstrated” (p. 2). CSRN™ is designed to serve as that evidence — a named credential, assessed competency and an employer-verifiable certificate ID.
Can a Virginia RN administer sedation without the prescriber present?
Not under this guidance. “Administration must be in the presence of a prescriber appropriately credentialed and privileged for sedation” (p. 1) — one of the document’s three “must” sentences, all on the first page. The other two: the registered nurse “must be prepared to handle a deeper level of sedation” (p. 1), and where deep sedation or anesthesia is the goal, “there must be a qualified physician or certified registered nurse anesthetist directing the administration” (p. 1). The education, training and monitoring sections on the second page are written with “should” (p. 2).
Compliance note (last reviewed September 2026): This page is educational information about Virginia Board of Nursing Guidance Document 90-63, not legal advice or a compliance determination. Every quotation was checked word-for-word against the Board’s PDF of the guidance document (revised May 18, 2021; effective July 8, 2021) on 2026-09-01; page numbers refer to that PDF. Confirm the current version with the Board and your own facility policy before relying on this summary. No state mandates this specific course.