1. Introduction to Nurse Anesthesia
Putting the pieces together-
Units 7 & 8- History
Lynn L. Lebeck, CRNA, PhD
2. A Brief Look at Nurse Anesthesia
History-Time Line
• 1861-1865
Catherine S. Lawrence and other nurses provided
anesthesia for surgeons operating on the wounded during
the Civil War
• 1877
Sister Mary Bernard, a Catholic nursing sister at St.
Vincent's Hospital in Erie, Pennsylvania, was the first nurse
known to have specialized in anesthesia
• 1893
Alice Magaw begins as nurse anesthetist for Dr. Mayo, who
would later bestow upon Magaw the title "Mother of
Anesthesia" for her mastery of open drop ether
3. A Brief Look at Nurse Anesthesia
History -Time Line
• 1899
Magaw published the first paper by a nurse anesthetist in
the Northwestern Lancet
• 1914-1917
Agatha Hodgins and many other nurse anesthetists in
volunteer American medical units provided anesthesia for
casualties during World War I
• 1917
In Frank v South, the Kentucky Court of Appeals ruled that
nurse anesthetist Margaret Hatfield was not engaged in the
practice of medicine when she administered anesthesia for
surgeon Louis Frank’s cases
4. A Brief Look at Nurse Anesthesia
History -Time Line
• 1931
Agatha Hodgins, together with 47 nurse anesthetists,
founded the National Association for Nurse Anesthetists
(NANA)
• 1934
In Chalmers-Francis v Nelson, the California Supreme Court
affirmed the Superior Court finding for nurse anesthetists
Dagmar Nelson in a ruling that confirmed the legality of
nurse anesthesia practice
• 1939
NANA became the American Association of Nurse
Anesthetists (AANA)
5. A Brief Look at Nurse
Anesthesia History –
Time Line
• 1941-1945
Second Lieutenant Mildred Clark, who would later become
the first nurse anesthetist to serve as Chief of the Army
Nurse Corps, and many other nurse anesthetists provide
anesthesia for the wounded in World War II
• 1945
AANA administered its first qualifying (certification)
examination
• 1952
AANA implemented its program for accrediting nurse
anesthesia schools
6. A Brief Look at Nurse Anesthesia
History -Time Line
• 1956
AANA members adopt the credential Certified Registered
Nurse Anesthetist (CRNA)
• 1969
AANA members approved a voluntary continuing education
for CRNAs
• 1974
Board of Directors adopts Standards for Nurse Anesthesia
Practice
• 1975
The Council of Certification of Nurse Anesthetists (CCNA),
the Council on Accreditation of Nurse Anesthesia
Educational Programs, and the Council for Public Interest
in Anesthesia were formed
7. A Brief Look at Nurse Anesthesia
History -Time Line
• 1977
AANA members approved mandatory continuing education
for CRNAs
• 1978
The Council on Recertification of Nurse Anesthetists was
established
• 1986
-- Congress passed legislation providing CRNAs direct
reimbursement under Medicare Part B
-- Board of Directors endorsed Harvard Patient Monitoring
Standards
8. A Brief Look at Nurse Anesthesia
History -Time Line
• 1989
-- Direct reimbursement for CRNAs under Medicare Part B
was implemented
-- Guidelines for Obstetrical Epidural Anesthesia Services
were implemented
• 1996
CCNA administered the certification examination for the
first time using computerized adaptive testing
• 1997
Guidelines for Office-Based Anesthesia for CRNAs were
implemented.
9. A Brief Look at Nurse Anesthesia
History -Time Line
• 1998
The U.S. Department of Health & Human Services' Health
Care Financing Administration (HCFA) published a
proposed rule to defer to the states on physician
supervision of CRNAs for Medicare cases
• 1999
AANA’s Standards for Office Based Practice for CRNAs
were adopted
• 2000
HCFA announced it would finalize the rule to defer to the
states on physician supervision of CRNAs for Medicare
cases
10. A Brief Look at Nurse Anesthesia
History -Time Line
• 2001
Bush administration first suspends and then
implements rule that does not defer to the
states on CRNA supervision but allows “opt
out” option by individual states
• 2002
As of November, 2002 six states have “opted
out” of the Bush supervision rules. Those
states are Iowa, Idaho, Minnesota, New
Hampshire, Nebraska, and New Mexico
11. A Brief Look at Nurse Anesthesia
History -Time Line
• 2004
Total of 12 states have “opted out” of Bush
supervision rules
• 2005
14 states have “opted out” of the Bush
supervision rules.
• 2007
Major General Gale Pollock, CRNA appointed
Interim Surgeon General of the Army
12. A Brief Look at Nurse Anesthesia
History -Time Line
• 2009
– California opts out- court challenges
upheld the op out
• 2010
– Colorado opts out- 16 states have opted
out of the supervision requirements
13. A Brief Look at Nurse Anesthesia
History- People
• Alice Magaw 1860-1928
– Early published nurse anesthetist
– Administered anesthesia for the Mayo brothers
– Observations in Anesthesia-a report on over 3000
anesthetics published in the Northwestern Lancet in 1899
– Updated this report several times
– A Review of Over Fourteen Thousand Surgical Anesthesias
published in 1906
– Known as the “Mother of Anesthesia”
14. A Brief Look at Nurse Anesthesia
History- 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. A Brief Look at Nurse Anesthesia
History - 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 of
Anesthesia 1929-1951
– Two terms as President of the AANA 1940-42
– Award for Outstanding Educator
16. A Brief Look at Nurse Anesthesia
History - 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. A Brief Look at Nurse Anesthesia
History- 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 US
Dept of Health, Education and Welfare for functions of
accreditation and certification
19. AANA Headquarters
& Executive Directors
• 1937- 1951 American Hospital
Association Building, Chicago, Illinois
– 1939- 1 desk- Anna Willenborg, CRNA
volunteer at first then full-time salaried
– 1946- had grown to a small suite, with an
Executive officer and Executive Secretary
20. AANA Headquarters
& Executive Directors
• 1951-1957 116 South Michigan Ave
Chicago, Illinois
– Very small but all that could be afforded at
a fashionable address
21. AANA Headquarters
& Executive Directors
• 1957-1971 Prudential Building
– Bernice Baum-Executive Director 1970-
1976
– Oversaw the formation of three councils
– Rebuffed challenges
to accreditation of
anesthesia programs
22. AANA Headquarters
& Executive Directors
• 1971-1978- Illinois Center 111 East
Wacker Dr
• 1977-78 J. Martin Stone, MHA
– Only non-CRNA to hold the position
– First male Executive Director
– Council on Recertification formed
23. AANA Headquarters
& Executive Directors
• 1978-1992 216 Higgins Rd, Park
Ridge, Illinois- first building
purchased by AANA
24. AANA Headquarters
& Executive Directors
• 1976-77 Acting & 1979-1983
• Nancy Fevold, CRNA- Executive
Director
• AANA Education and Research
Foundation formed
• 1st independent
AANA annual meeting
1976
25. AANA Headquarters
& Executive Directors
• 1983-2001 John F. Garde, CRNA, MS,
FAAN
– AANA subsidiaries
– Publication of Watchful
Care
– Opening of the
Washington DC office
26. AANA Headquarters
& Executive Directors
• 1992-present 222 South Prospect Dr,
Park Ridge, Illinois
– Members contributed $500,000 through
a fundraising drive chaired by Ruth M.
Wright, CRNA
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. AANA Headquarters
& Executive Directors
• 2009 to present
– Wanda O. Wilson,
CRNA, PhD
– Past director of
University of Cincinnati
– Past President of AANA
29. A Brief Look at Nurse Anesthesia
History-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. A Brief Look at Nurse Anesthesia
History-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 in
Marquette
31. Past Presidents of the AANA
from 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 Nurse
Anesthesia
32. Agatha Hodgins Award
• For Outstanding
Accomplishment
– Established in 1975 to
recognize individuals
whose dedication to
excellence has furthered
the art and science of
nurse anesthesia
33. Agatha Hodgins Award Winners
with Michigan Connections
• 1979- Helen Vos
• 1994- Jeff Beutler
• 2000- John Garde
• 2001- Christine Zambricki
• 2004- Ruth Wright
34. Helen Lamb Award
• Outstanding Educator Award
– Established in 1980 and presented to a
CRNA who has made a significant
contribution to the education of nurse
anesthetists
35. Helen Lamb Award Winners with
Michigan connections
• 1981-John Garde
• 1985- Celestine Harrigan
• 1996- Helen Vos
• 2000- Agnes Hagan
• 2002- Karen Zaglanicnzy
36. History of Nurse Anesthesia
Education
• 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. 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. 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 first
accredited in 2007/08
39. History of Practice Battles
• Historical Invisibility
– Physician Anesthesiologists refused to
recognized contributions of nurse
anesthetists
• A question of money
– Nurse anesthetists were taking money
out of the MDs pocket
40. History of Practice Battles
• Public relations campaigns
– Scare tactics directed at the public
– How to guides for getting rid of nurse
anesthetists
– Look magazine
• American College of Surgeons defended NAs
• Legal challenges
– Frank vs. South
– Dagmar Nelson
41. History of Practice Battles
• Control of Accreditation
– Lakeside School of Nursing- 1916
• Control of Education
– 1912- AAA resolution “no member shall
instruct an undergraduate nurse or orderly in
the art of anesthesia”
– 1947- ASA Bylaws- “Unethical”
42. History of Practice Battles
• Control of Accreditation
– Lakeside School of Nursing- 1916
• Control of Education
– 1912- AAA resolution “no member shall
instruct an undergraduate nurse or orderly in
the art of anesthesia”
– 1947- ASA Bylaws- “Unethical”
– 1975- Hearings before the US Office of
Education
43. History of Practice Battles
• Control of Certification
• Insurance issues
• Introduction of AAs
• Addition of “educational” membership
class within ASA
– CRNA must be “sponsored by 2 ASA
members” and subscribe to the ACT statement
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. History of Practice Battles- People
• Dr. Ralph Waters- Father of
Academic Anesthesia
– Economics of anesthesia
– Every physician should have a hobby-
anesthesia
– Tried to shame the Mayo Clinic for
having nurses give anesthesia and
claiming that a nurse makes a better
anesthetist than the average doctor.