Introduction to Nurse AnesthesiaPutting the pieces together-Units 7 & 8- HistoryLynn L. Lebeck, CRNA, PhD
A Brief Look at Nurse AnesthesiaHistory-Time Line• 1861-1865Catherine S. Lawrence and other nurses providedanesthesia for ...
A Brief Look at Nurse AnesthesiaHistory -Time Line• 1899Magaw published the first paper by a nurse anesthetist inthe North...
A Brief Look at Nurse AnesthesiaHistory -Time Line• 1931Agatha Hodgins, together with 47 nurse anesthetists,founded the Na...
A Brief Look at NurseAnesthesia History –Time Line• 1941-1945Second Lieutenant Mildred Clark, who would later becomethe fi...
A Brief Look at Nurse AnesthesiaHistory -Time Line• 1956AANA members adopt the credential Certified RegisteredNurse Anesth...
A Brief Look at Nurse AnesthesiaHistory -Time Line• 1977AANA members approved mandatory continuing educationfor CRNAs• 197...
A Brief Look at Nurse AnesthesiaHistory -Time Line• 1989-- Direct reimbursement for CRNAs under Medicare Part Bwas impleme...
A Brief Look at Nurse AnesthesiaHistory -Time Line• 1998The U.S. Department of Health & Human Services HealthCare Financin...
A Brief Look at Nurse AnesthesiaHistory -Time Line• 2001Bush administration first suspends and thenimplements rule that do...
A Brief Look at Nurse AnesthesiaHistory -Time Line• 2004Total of 12 states have “opted out” of Bushsupervision rules• 2005...
A Brief Look at Nurse AnesthesiaHistory -Time Line• 2009– California opts out- court challengesupheld the op out• 2010– Co...
A Brief Look at Nurse AnesthesiaHistory- People• Alice Magaw 1860-1928– Early published nurse anesthetist– Administered an...
A Brief Look at Nurse AnesthesiaHistory- People• Agatha Hodgins 1877-1945– Early nurse anesthetist– Co founded the Lakesid...
A Brief Look at Nurse AnesthesiaHistory - People• Helen Lamb 1900-1979– Chairman of the Education Committee 1931-1939– Cur...
A Brief Look at Nurse AnesthesiaHistory - People• Gertrude Fife– First Secretary of NANA– Coordinated the first annual mee...
A Brief Look at Nurse AnesthesiaHistory- People• Florence McQuillen– Mayo Clinic 1927– First Executive Director of the AAN...
AANA Headquarters& Executive Directors• 1931-1937- University Hospitals ofCleveland
AANA Headquarters& Executive Directors• 1937- 1951 American HospitalAssociation Building, Chicago, Illinois– 1939- 1 desk-...
AANA Headquarters& Executive Directors• 1951-1957 116 South Michigan AveChicago, Illinois– Very small but all that could b...
AANA Headquarters& Executive Directors• 1957-1971 Prudential Building– Bernice Baum-Executive Director 1970-1976– Oversaw ...
AANA Headquarters& Executive Directors• 1971-1978- Illinois Center 111 EastWacker Dr• 1977-78 J. Martin Stone, MHA– Only n...
AANA Headquarters& Executive Directors• 1978-1992 216 Higgins Rd, ParkRidge, Illinois- first buildingpurchased by AANA
AANA Headquarters& Executive Directors• 1976-77 Acting & 1979-1983• Nancy Fevold, CRNA- ExecutiveDirector• AANA Education ...
AANA Headquarters& Executive Directors• 1983-2001 John F. Garde, CRNA, MS,FAAN– AANA subsidiaries– Publication of Watchful...
AANA Headquarters& Executive Directors• 1992-present 222 South Prospect Dr,Park Ridge, Illinois– Members contributed $500,...
AANA Headquarters& Executive Directors• 2001-2009– Jeff Beutler, CRNA, MS• Education– BSN- Ferris State– BS Anesthesia– MS...
AANA Headquarters& Executive Directors• 2009 to present– Wanda O. Wilson,CRNA, PhD– Past director ofUniversity of Cincinna...
A Brief Look at Nurse AnesthesiaHistory-Firsts• First Annual Meeting-1933• First Educational Standards- 1933• First Certif...
A Brief Look at Nurse AnesthesiaHistory-Michigan• Michigan Association of Nurse Anesthetists (MANA)founded– November 11, 1...
Past Presidents of the AANAfrom Michigan– Helen Vos 1965-66• Director of Hurley Program– John F. Garde 1972-73• Director o...
Agatha Hodgins Award• For OutstandingAccomplishment– Established in 1975 torecognize individualswhose dedication toexcelle...
Agatha Hodgins Award Winnerswith Michigan Connections• 1979- Helen Vos• 1994- Jeff Beutler• 2000- John Garde• 2001- Christ...
Helen Lamb Award• Outstanding Educator Award– Established in 1980 and presented to aCRNA who has made a significantcontrib...
Helen Lamb Award Winners withMichigan connections• 1981-John Garde• 1985- Celestine Harrigan• 1996- Helen Vos• 2000- Agnes...
History of Nurse AnesthesiaEducation• Initial– On the Job Training– Salesmen– Hospital training courses• Early Program- pr...
Nurse Anesthesia Education• 1950s– Certificate programs– 12 months– Accreditation process in place• 1960s– 18 months• 1970...
Nurse Anesthesia Education• 1990s-– 24 months and longer– 64% were at the Master level by 1990– Mandate to all be graduate...
History of Practice Battles• Historical Invisibility– Physician Anesthesiologists refused torecognized contributions of nu...
History of Practice Battles• Public relations campaigns– Scare tactics directed at the public– How to guides for getting r...
History of Practice Battles• Control of Accreditation– Lakeside School of Nursing- 1916• Control of Education– 1912- AAA r...
History of Practice Battles• Control of Accreditation– Lakeside School of Nursing- 1916• Control of Education– 1912- AAA r...
History of Practice Battles• Control of Certification• Insurance issues• Introduction of AAs• Addition of “educational” me...
History of Practice Battles- People• Dr. Francis McMechan– Background in newspapers, theater– Crippled by arthritis in 191...
History of Practice Battles- People• Dr. Ralph Waters- Father ofAcademic Anesthesia– Economics of anesthesia– Every physic...
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Intro to na unit 7 & 8 2012 narrated compressed

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Intro to na unit 7 & 8 2012 narrated compressed

  1. 1. Introduction to Nurse AnesthesiaPutting the pieces together-Units 7 & 8- HistoryLynn L. Lebeck, CRNA, PhD
  2. 2. A Brief Look at Nurse AnesthesiaHistory-Time Line• 1861-1865Catherine S. Lawrence and other nurses providedanesthesia for surgeons operating on the wounded duringthe Civil War• 1877Sister Mary Bernard, a Catholic nursing sister at St.Vincents Hospital in Erie, Pennsylvania, was the first nurseknown to have specialized in anesthesia• 1893Alice Magaw begins as nurse anesthetist for Dr. Mayo, whowould later bestow upon Magaw the title "Mother ofAnesthesia" for her mastery of open drop ether
  3. 3. A Brief Look at Nurse AnesthesiaHistory -Time Line• 1899Magaw published the first paper by a nurse anesthetist inthe Northwestern Lancet• 1914-1917Agatha Hodgins and many other nurse anesthetists involunteer American medical units provided anesthesia forcasualties during World War I• 1917In Frank v South, the Kentucky Court of Appeals ruled thatnurse anesthetist Margaret Hatfield was not engaged in thepractice of medicine when she administered anesthesia forsurgeon Louis Frank’s cases
  4. 4. A Brief Look at Nurse AnesthesiaHistory -Time Line• 1931Agatha Hodgins, together with 47 nurse anesthetists,founded the National Association for Nurse Anesthetists(NANA)• 1934In Chalmers-Francis v Nelson, the California Supreme Courtaffirmed the Superior Court finding for nurse anesthetistsDagmar Nelson in a ruling that confirmed the legality ofnurse anesthesia practice• 1939NANA became the American Association of NurseAnesthetists (AANA)
  5. 5. A Brief Look at NurseAnesthesia History –Time Line• 1941-1945Second Lieutenant Mildred Clark, who would later becomethe first nurse anesthetist to serve as Chief of the ArmyNurse Corps, and many other nurse anesthetists provideanesthesia for the wounded in World War II• 1945AANA administered its first qualifying (certification)examination• 1952AANA implemented its program for accrediting nurseanesthesia schools
  6. 6. A Brief Look at Nurse AnesthesiaHistory -Time Line• 1956AANA members adopt the credential Certified RegisteredNurse Anesthetist (CRNA)• 1969AANA members approved a voluntary continuing educationfor CRNAs• 1974Board of Directors adopts Standards for Nurse AnesthesiaPractice• 1975The Council of Certification of Nurse Anesthetists (CCNA),the Council on Accreditation of Nurse AnesthesiaEducational Programs, and the Council for Public Interestin Anesthesia were formed
  7. 7. A Brief Look at Nurse AnesthesiaHistory -Time Line• 1977AANA members approved mandatory continuing educationfor CRNAs• 1978The Council on Recertification of Nurse Anesthetists wasestablished• 1986-- Congress passed legislation providing CRNAs directreimbursement under Medicare Part B-- Board of Directors endorsed Harvard Patient MonitoringStandards
  8. 8. A Brief Look at Nurse AnesthesiaHistory -Time Line• 1989-- Direct reimbursement for CRNAs under Medicare Part Bwas implemented-- Guidelines for Obstetrical Epidural Anesthesia Serviceswere implemented• 1996CCNA administered the certification examination for thefirst time using computerized adaptive testing• 1997Guidelines for Office-Based Anesthesia for CRNAs wereimplemented.
  9. 9. A Brief Look at Nurse AnesthesiaHistory -Time Line• 1998The U.S. Department of Health & Human Services HealthCare Financing Administration (HCFA) published aproposed rule to defer to the states on physiciansupervision of CRNAs for Medicare cases• 1999AANA’s Standards for Office Based Practice for CRNAswere adopted• 2000HCFA announced it would finalize the rule to defer to thestates on physician supervision of CRNAs for Medicarecases
  10. 10. A Brief Look at Nurse AnesthesiaHistory -Time Line• 2001Bush administration first suspends and thenimplements rule that does not defer to thestates on CRNA supervision but allows “optout” option by individual states• 2002As of November, 2002 six states have “optedout” of the Bush supervision rules. Thosestates are Iowa, Idaho, Minnesota, NewHampshire, Nebraska, and New Mexico
  11. 11. A Brief Look at Nurse AnesthesiaHistory -Time Line• 2004Total of 12 states have “opted out” of Bushsupervision rules• 200514 states have “opted out” of the Bushsupervision rules.• 2007Major General Gale Pollock, CRNA appointedInterim Surgeon General of the Army
  12. 12. A Brief Look at Nurse AnesthesiaHistory -Time Line• 2009– California opts out- court challengesupheld the op out• 2010– Colorado opts out- 16 states have optedout of the supervision requirements
  13. 13. A Brief Look at Nurse AnesthesiaHistory- People• Alice Magaw 1860-1928– Early published nurse anesthetist– Administered anesthesia for the Mayo brothers– Observations in Anesthesia-a report on over 3000anesthetics published in the Northwestern Lancet in 1899– Updated this report several times– A Review of Over Fourteen Thousand Surgical Anesthesiaspublished in 1906– Known as the “Mother of Anesthesia”
  14. 14. A Brief Look at Nurse AnesthesiaHistory- People• Agatha Hodgins 1877-1945– Early nurse anesthetist– Co founded the Lakeside School of Anesthesia– Organized the NANA (later know as the AANA)– First President of NANA– Award for Outstanding Accomplishment
  15. 15. A Brief Look at Nurse AnesthesiaHistory - People• Helen Lamb 1900-1979– Chairman of the Education Committee 1931-1939– Curriculum standards and Certification Exam– Cofounder and director of the Barnes Hospital School ofAnesthesia 1929-1951– Two terms as President of the AANA 1940-42– Award for Outstanding Educator
  16. 16. A Brief Look at Nurse AnesthesiaHistory - People• Gertrude Fife– First Secretary of NANA– Coordinated the first annual meeting 1933– Second President of the AANA– First Editor of the AANA Bulletin 1933-1945– Treasurer of the AANA 1935-1950
  17. 17. A Brief Look at Nurse AnesthesiaHistory- People• Florence McQuillen– Mayo Clinic 1927– First Executive Director of the AANA 1948-1970– Known as a very direct person– Gained recognition for the AANA from the AHA and the USDept of Health, Education and Welfare for functions ofaccreditation and certification
  18. 18. AANA Headquarters& Executive Directors• 1931-1937- University Hospitals ofCleveland
  19. 19. AANA Headquarters& Executive Directors• 1937- 1951 American HospitalAssociation Building, Chicago, Illinois– 1939- 1 desk- Anna Willenborg, CRNAvolunteer at first then full-time salaried– 1946- had grown to a small suite, with anExecutive officer and Executive Secretary
  20. 20. AANA Headquarters& Executive Directors• 1951-1957 116 South Michigan AveChicago, Illinois– Very small but all that could be afforded ata fashionable address
  21. 21. AANA Headquarters& Executive Directors• 1957-1971 Prudential Building– Bernice Baum-Executive Director 1970-1976– Oversaw the formation of three councils– Rebuffed challengesto accreditation ofanesthesia programs
  22. 22. AANA Headquarters& Executive Directors• 1971-1978- Illinois Center 111 EastWacker Dr• 1977-78 J. Martin Stone, MHA– Only non-CRNA to hold the position– First male Executive Director– Council on Recertification formed
  23. 23. AANA Headquarters& Executive Directors• 1978-1992 216 Higgins Rd, ParkRidge, Illinois- first buildingpurchased by AANA
  24. 24. AANA Headquarters& Executive Directors• 1976-77 Acting & 1979-1983• Nancy Fevold, CRNA- ExecutiveDirector• AANA Education and ResearchFoundation formed• 1st independentAANA annual meeting1976
  25. 25. AANA Headquarters& Executive Directors• 1983-2001 John F. Garde, CRNA, MS,FAAN– AANA subsidiaries– Publication of WatchfulCare– Opening of theWashington DC office
  26. 26. AANA Headquarters& Executive Directors• 1992-present 222 South Prospect Dr,Park Ridge, Illinois– Members contributed $500,000 througha fundraising drive chaired by Ruth M.Wright, CRNA
  27. 27. AANA Headquarters& Executive Directors• 2001-2009– Jeff Beutler, CRNA, MS• Education– BSN- Ferris State– BS Anesthesia– MS Anesthesia• Wayne State• Practiced in Grand Rapids-10 years
  28. 28. AANA Headquarters& Executive Directors• 2009 to present– Wanda O. Wilson,CRNA, PhD– Past director ofUniversity of Cincinnati– Past President of AANA
  29. 29. A Brief Look at Nurse AnesthesiaHistory-Firsts• First Annual Meeting-1933• First Educational Standards- 1933• First Certification Examination-1945• First Males allowed to join-1947• First Accreditation of Schools-1952• First use of “CRNA” credential-1957• First all-male class at Walter Reed-1961
  30. 30. A Brief Look at Nurse AnesthesiaHistory-Michigan• Michigan Association of Nurse Anesthetists (MANA)founded– November 11, 1937– 28 members of NANA met at the Stadler Hotel in Detroit– Gertrude Fife, past NANA president present– Ester Meil, CRNA first MANA president– Affiliated with NANA December 29, 1937– First State Mtg June, 1938 at Hotel Northland inMarquette
  31. 31. Past Presidents of the AANAfrom Michigan– Helen Vos 1965-66• Director of Hurley Program– John F. Garde 1972-73• Director of Wayne State Program– Christine S. Zambricki 1995-96• Director of Mercy Graduate Program• Founding Director of Oakland University-Beaumont Graduate Program of NurseAnesthesia
  32. 32. Agatha Hodgins Award• For OutstandingAccomplishment– Established in 1975 torecognize individualswhose dedication toexcellence has furtheredthe art and science ofnurse anesthesia
  33. 33. Agatha Hodgins Award Winnerswith Michigan Connections• 1979- Helen Vos• 1994- Jeff Beutler• 2000- John Garde• 2001- Christine Zambricki• 2004- Ruth Wright
  34. 34. Helen Lamb Award• Outstanding Educator Award– Established in 1980 and presented to aCRNA who has made a significantcontribution to the education of nurseanesthetists
  35. 35. Helen Lamb Award Winners withMichigan connections• 1981-John Garde• 1985- Celestine Harrigan• 1996- Helen Vos• 2000- Agnes Hagan• 2002- Karen Zaglanicnzy
  36. 36. History of Nurse AnesthesiaEducation• Initial– On the Job Training– Salesmen– Hospital training courses• Early Program- pre WWI– 3 months long• Early Standards- 1930s– Length- 6 months required, 12 preferred– Cases- 250• Specific requirements– Granted certificates
  37. 37. Nurse Anesthesia Education• 1950s– Certificate programs– 12 months– Accreditation process in place• 1960s– 18 months• 1970s-1980s– 24 months– Moved into academic settings• Bachelors degrees
  38. 38. Nurse Anesthesia Education• 1990s-– 24 months and longer– 64% were at the Master level by 1990– Mandate to all be graduate level by 1998• 2000s-– Clinical Doctorate program firstaccredited in 2007/08
  39. 39. History of Practice Battles• Historical Invisibility– Physician Anesthesiologists refused torecognized contributions of nurseanesthetists• A question of money– Nurse anesthetists were taking moneyout of the MDs pocket
  40. 40. History of Practice Battles• Public relations campaigns– Scare tactics directed at the public– How to guides for getting rid of nurseanesthetists– Look magazine• American College of Surgeons defended NAs• Legal challenges– Frank vs. South– Dagmar Nelson
  41. 41. History of Practice Battles• Control of Accreditation– Lakeside School of Nursing- 1916• Control of Education– 1912- AAA resolution “no member shallinstruct an undergraduate nurse or orderly inthe art of anesthesia”– 1947- ASA Bylaws- “Unethical”
  42. 42. History of Practice Battles• Control of Accreditation– Lakeside School of Nursing- 1916• Control of Education– 1912- AAA resolution “no member shallinstruct an undergraduate nurse or orderly inthe art of anesthesia”– 1947- ASA Bylaws- “Unethical”– 1975- Hearings before the US Office ofEducation
  43. 43. History of Practice Battles• Control of Certification• Insurance issues• Introduction of AAs• Addition of “educational” membershipclass within ASA– CRNA must be “sponsored by 2 ASAmembers” and subscribe to the ACT statement
  44. 44. History of Practice Battles- People• Dr. Francis McMechan– Background in newspapers, theater– Crippled by arthritis in 1911– Life-long crusade• Organizing MDs• Legal Challenges• Legislative bills• Publishing• Speeches
  45. 45. History of Practice Battles- People• Dr. Ralph Waters- Father ofAcademic Anesthesia– Economics of anesthesia– Every physician should have a hobby-anesthesia– Tried to shame the Mayo Clinic forhaving nurses give anesthesia andclaiming that a nurse makes a betteranesthetist than the average doctor.
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