Taken from the WIKI article manintained by CRNAs



Nurse anesthetists have been providing anesthesia care in the United States for over 125 years. Nurse anesthetists were the first "nursing specialty group" in the United States.

The first nurse to provide anesthesia was Catherine S. Lawrence, and probably along with other nurses, administered anesthesia for Civil War surgeons circa 1861 to 1865.[17] The first "official" nurse anesthetist is recognized as Sister Mary Bernard, a Catholic nun who practiced in 1877 at St. Vincent's Hospital in Erie, Pennsylvania.[18] There is evidence that up to 50 or more other Sisters were called to practice anesthesia in various midwest Catholic and Protestant hospitals throughout the last two decades of the 19th century. By the early 1900s, the influence of nurse anesthetisa had moved east.[18] The first school of nurse anesthesia was formed in 1909 at St. Vincent Hospital, Portland, Oregon. Established by Agnes McGee, the course was 6 months long, and included courses on anatomy and physiology, pharmacology, and administration of common anesthetic agents.[18] Following this many schools formed. Between 1912 and 1920, approximately 19 schools opened. All consisted of post-graduate anesthesia training for nurses, and were about 6 months in length. These included programs at Mayo Clinic, Johns Hopkins Hospital, Barnes Hospital, New York Post-Graduate Hospital, Presbyterian Hospital in Chicago, Charity Hospital in New Orleans, Grace Hospital in Detroit, among others.[18] In contrast, nearly 20 years later, only seven physician anesthesia residencies existed.[19]

Since physician residences in anesthesia did not exist very early on, doctors attended these programs to learn anesthesia. For example, in 1915, chief nurse anesthetist Agatha Hodgins established the Lakeside Hospital School of Anesthesia in Cleveland, Ohio. This program was open to graduate nurses, physicians, and dentists. The training was 6 months, and the tuition was $50.00. A diploma was awarded on completion. In its first year, it graduated 6 physicians, 2 dentists, and 11 nurses.[18] Later, in 1918, it established a system of clinical affiliations with other Cleveland hospitals.[18] Ms. Hodgins was originally appointed as anesthetist in 1908 by Dr. George W. Crile. Under Dr. Crile's direction, she became an expert in the administration of anesthesia, and had administered 575 anesthetics by 1909.[18]

Some nurse anesthetists were appointed to medical school faculties to train the medical students in anesthesia. For example, Agnes McGee also taught 3rd year medical school students at the University of Oregon.[18] Nurse anesthetist Alice Hunt was appointed instructor in anesthesia with university rank at the Yale University School of Medicine in 1922. She held this position for 26 years.[18] In addition, she authored the 1949 book Anesthesia, Principles and Practice. This is most likely the first nurse anesthesia textbook.

Early nurse anesthetists were also involved in publications. For example, in 1906, nurse anesthetist Alice Magaw (1860-1928) published a report on the use of ether anesthesia by drop method 14,000 times without a fatality (Surg., Gynec. & Obst. 3:795, 1906). She had many other publications, beginning in 1899, with some published and many ignored because of her status as a nurse. Ms. Magaw was the anesthetist at St. Mary’s Hospital in Rochester for the famous Drs. William J. Mayo and Charles H. Mayo.[18] This became the famed Mayo Clinic in Rochester, Minnesota. She is often referred to as "the Mother of Anesthesia." She set up a showcase for surgery and anesthesia and attracted students from across the United States and the world. Recently, the city of Corunna, Michigan, discovered that Alice Magaw and family are interred in Corunna's Pine Tree Cemetery.






















All Images: AANA Archives, 222 S. Prospect Avenue, Park Ridge, IL 60068




After much growth, the nurse anesthesia specialty was formally organized on June 17, 1931, when the National Association of Nurse Anesthetist (AANA) held their first meeting.[18] It was Agatha Hodgins who organized the event, inviting members from the Alumnae Association of the Lakeside School of Anesthesia and also nurse anesthetists from across the United States. As a new organization, it had two main objectives: establish a national qualifying exam, and establish an accreditation program for nurse anesthesia schools.[18] The first national certification exam was held on June 4, 1945, with 92 candidates sitting for the exam. After many years of preparation, on January 19, 1952, a program for the accreditation of nurse anesthesia schools when into effect.[18] This has been recognized by the U.S. Department of Education since 1955.[19]


Legal Challenges

In the United States, there have been three challenges brought against nurse anesthetists for illegally practicing medicine (Hodgins and Crile, 1919; Frank v. South, 1917; and Chalmers-Francis v. Nelson, 1936).[20][19] All occurred before 1940 and all were found in favor of the nursing profession. Prior to World War II, the delivery of anesthesia was mainly a nursing function. In 1942, there were seventeen nurse anesthetists for every one anesthesiologist.[19] The numbers of physicians in this specialty did not greatly expand until the late 1960s. Therefore, it was legally established that when a nurse delivers anesthesia, it is the practice of nursing. When a physician delivers anesthesia, it is the practice of medicine. When a dentist delivers anesthesia, it is the practice of dentistry. There are great overlaps of tasks and knowledge in the health care professions. Administration of anesthesia and its related tasks by one provider does not necessarily contravene the practice of other health care providers.[21][22] For example, endotracheal intubation (placing a breathing tube into the windpipe) is performed by physicians, nurse anesthetists, respiratory therapists, paramedics, and dental (oral) surgeons. In the United States, nurse anesthetists practice under the state's nursing practice act (not medical practice acts), which outlines the scope of practice for anesthesia nursing.



Military Service

In the United States military, CRNAs provide a critical peacetime and wartime skill. During peacetime, they provide the majority of anesthesia services for retired service members, active duty military, and their dependents. CRNAs function as the only licensed independent anesthesia practitioners at many military treatment facilities, including Navy ships at sea. They are also the leading provider of anesthesia for the Veterans Administration and Public Health medical facilities.

CRNAs have made a significant contribution in the provision of anesthesia services in every U.S. war during the 20th century. During World War I, America's nurse anesthetists played a vital role in the care of combat troops in France. From 1914 to 1915, two years prior to America entering the war, Dr. George Crile and nurse anesthetists Agatha Hodgins and Mabel Littleton served in the Lakeside Unit at the American Ambulance at Neuilly, France.[18] They even helped train the French and British nurses and physicians in anesthesia care. After the war, France continued to use nurse anesthetists, however, Britain adopted a physician only policy that continues today. In 1917, with American participation in the war, for the first time the U.S. Military started training nurse anesthetists for service. The Army and Navy sent nurses to various hospitals (e.g. Mayo clinic in Rochester, Lakeside hospital in Cleveland) for anesthesia training and then overseas service.[20][18] Nurse anesthetist Sophie Gran Winton served at an army hospital in Chateau-Thierry, France, and earned the French Croix de Guerre medal, along with other awards, for her anesthesia service.[20] Anne Penland was the first nurse anesthetist on the British Front, and was blinded in one eye from a shrapnel wound.[20][18] American nurse anesthetists also served in World War II and Korea, receiving numerous citations and awards.[20] They are represented by such heroes Second Lieutenant Mildred Irene Clark, who provided anesthesia in the heat of battle for casualties from the Japanese bombing of Pearl Harbor.[23] During the Vietnam war, nurse anesthetists served as both CRNAs and flight nurses, and outnumbered physician anesthesiologist by 3:1.[20] CRNAs have been casualties of war (Lieutenants Kenneth R. Shoemaker, Jr. and Jerome E. Olmsted, Qui Nhon, Vietnam) and prisoners of war (Annie Mealer, 3 year imprisonment by Japanese in the Philippines, 1945).[20] For Operation Iraqi Freedom and Operation Enduring Freedom, CRNAs comprise the largest group of anesthesia providers at forward positioned medical treatment facilities.[24] In addition, they play a key role in the continuing education and training of Department of Defense nurses and technicians in the care of wartime trauma patients.



References
  1. ^ Horton, B. (2007). "Upgrading Nurse Anesthesia Education Requirements (1933-2006) - Part 2: Curriculum, Faculty and Students." AANA Journal Vol. 75, No. 4.
  2. ^ American Association of Nurse Anesthetists (2007). A Brief Look at Nurse Anesthesia History Retrieved May 23, 2007, from http://www.aana.com/brieflookhistory.aspx
  3. ^ American Association of Nurse Anesthetists (2005). Education of Nurse Anesthetists in the United States - At a Glance. Retrieved May 23, 2007, from http://www.aana.com/educuscrnas.aspx
  4. ^ American Association of Nurse Anesthetists (2007). Council on Certification of Nurse Anesthetists Candidate Handbook – 2007.
  5. ^ American Association of Colleges of Nursing (2004). AACN Position Statement on the Practice Doctorate in Nursing October 2004. Retrieved May 23, 2007, from http://www.aacn.nche.edu/DNP/pdf/DNP.pdf
  6. ^ American Association of Nurse Anesthetists (2006). The Doctorate in Nursing Practice (DNP) Background, Current Status and Future Activities. Retrieved May 23, 2007 from http://www.aana.com/dnpbackground.aspx
  7. ^ American Association of Nurse Anesthetists (2007). Certified Registered Nurse Anesthetists at a Glance. Retrieved May 23, 2007 from http://www.aana.com/ataglance.aspx
  8. ^ U.S. Department of Health and Human Services (2001). Physician Supervision of Certified Registered Nurse Anesthetists. Retrieved May 23, 2007 from http://www.cms.hhs.gov/apps/media/pr...sp?Counter=391
  9. ^ American Association of Nurse Anesthetists (2002). AANA Fact Sheet Final Supervision Rule -- Frequently Asked Questions, Centers for Medicare & Medicaid Services (CMS)Conditions of Participation for Hospitals, Ambulatory Surgical Centers (ASCs), and Critical Access Hospitals (CAHs): Anesthesia Services (Part A Payment), November 21. Retrieved May 23, 2007 from http://www.aana.com/finalsupervisionfaqs.aspx
  10. ^ U.S. Department of Health and Human Services (2001). States Allowed To Set Standards For Anesthesia. Retrieved May 23, 2007 from http://www.cms.hhs.gov/apps/media/pr...sp?Counter=319
  11. ^ American Association of Nurse Anesthetists (2005). Gov. Doyle Removes Physician Supervision for Wisconsin CRNAs. Retrieved May 23, 2007 from http://www.aana.com/wis_optout.aspx
  12. ^ American Association of Nurse Anesthetists (2007). Scope and Standards for Nurse Anesthesia Practice. Retrieved May 24, 2007 from http://www.aana.com/scope.aspx
  13. ^ American Association of Nurse Anesthetists (2007). Guidelines for Clinical Privileges. Retrieved May 24, 2007 from http://www.aana.com/clinicalprivileges.aspx
  14. ^ International Federation of Nurse Anesthetists (2007). About IFNA... Retrieved May 23, 2007, from http://ifna-int.org/ifna/page.php?16
  15. ^ McAuliffe, M.S., Henry B. (2002). Nurse Anesthesia Worldwide: Practice, Education, and Regulation. Retrieved May 23, 2007, from http://ifna-int.org/ifna/e107_files/...s/Practice.pdf
  16. ^ AMGA Medical Group Compensation and Financial Survey (2006). 2006 AMGA MID-LEVEL COMPENSATION. Retrieved May 23, 2007 from http://www.cejkasearch.com/compensat...ion_survey.htm
  17. ^ American Association of Nurse Anesthetists (2007). AANA History: Hand in Hand with Nurse Anesthesia. Retrieved May 26, 2007 from http://www.aana.com/75th/timeline1844.aspx
  18. ^ Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company.
  19. ^ Garde, J.F. (1996) The Nurse Anesthesia Profession, A Past, Present, and Future Perscpective. Nursing Clinics of North America, Vol 31, Number 3.
  20. ^ Bankert, M. (1989) Watchful Care; A History of America's Nurse Anesthetists. New York: The Continuum Publishing Company.
  21. ^ Blumenreich, G.A. JD (1999). Legal Briefs, Anesthesia -- It's Finally the Practice of Medicine. Retrieved May 25, 2007 from http://www.aana.com/Resources.aspx?u...nuID=6&id=2352
  22. ^ Blumenreich, G.A. JD (1990). Legal Briefs, The Administration of Anesthesia and the Practice of Medicine. Retrieved May 25, 2007 from http://www.aana.com/lb_june90.aspx
  23. ^ Fessler D.B. (1996) No Time for Fear, Voices of American Military Nurses in World War II. East Lansing, Mich: Michigan State University Press.
  24. ^ American Association of Nurse Anesthetists (2004). Certified Registered Nurse Anesthetists Play Pivotal Role in U.S. Efforts to Combat Worldwide Terrorism. Retrieved May 23, 2007 from http://www.aana.com/pr011304.aspx