Photograph of nurse anesthetist providing open drop ether anesthesia to accident victim, circa 1900-1920.
The surgeon appears to be suturing the scalp. The right arm is already bandaged.
History of Nurse Anesthesia Practice
Nurses were the first professional group to provide anesthesia services in the United States. Established in the late 1800s, nurse anesthesia has since become recognized as the first clinical nursing specialty. The discipline of nurse anesthesia developed in response to requests of surgeons seeking a solution to the high morbidity and mortality attributed to anesthesia at that time. Surgeons saw nurses as a cadre of professionals who could give their undivided attention to patient care during surgical procedures. Serving as pioneers in anesthesia, nurse anesthetists became involved in the full range of specialty surgical procedures, as well as in the refinement of anesthesia techniques and equipment.
The earliest existing records documenting the anesthetic care of patients by nurses were those of Sister Mary Bernard, a Catholic nun who assumed her duties at St. Vincent's Hospital in Erie, Pa. in 1877. The most famous nurse anesthetist of the nineteenth century, Alice Magaw, worked at St. Mary's Hospital (1889), in Rochester, Minn. That hospital, established by the Sisters of St. Francis and operated by Dr. William Worrell Mayo, later became internationally recognized as the Mayo Clinic. Dr. Charles Mayo conferred upon Alice Magaw the title of "mother of anesthesia," for her many achievements in the field of anesthesiology, particularly her mastery of the open-drop inhalation technique of anesthesia utilizing ether and chloroform and her subsequent publishing of her findings.
Together, Dr. Mayo and Ms. Magaw were instrumental in establishing a showcase of professional excellence in anesthesia and surgery. Hundreds of physicians and nurses from the United States and throughout the world came to observe and learn their anesthesia techniques. Alice Magaw documented the anesthesia practice outcomes at St. Mary's Hospital and reported them in various medical journals between 1899 and 1906. In 1906, one article documented more than 14,000 anesthetics without a single complication attributable to anesthesia. (Surgery, Gynecology and Obstetrics, 3:795.)
In 1909, the first formal educational programs preparing nurse anesthetists were established. In 1914, Dr. George Crile and his nurse anesthetist, Agatha Hodgins, who became the founder of the American Association of Nurse Anesthetists (AANA), went to France with the American Ambulance group to assist in planning for the establishment of hospitals that would provide for the care of the sick and wounded members of the Allied Forces. While there, Hodgins taught both physicians and nurses from England and France how to administer anesthesia.
Since World War I, nurse anesthetists have been the principal anesthesia providers in combat areas of every war in which the United States has been engaged. During the Panama action, only nurse anesthetists were sent with the fighting forces. Nurse anesthetists have been held as prisoners of war, suffered combat wounds during wartime service, and have lost their lives serving their country. The names of two CRNAs killed in the Vietnam War are engraved on the Vietnam Memorial Wall in Washington, D.C. (1LT Jerome Olmsted, CRNA, and 1LT Kenneth Shoemaaker, CRNA). Military nurse anesthetists have been honored and decorated by the United States and foreign governments for outstanding achievements, dedication to duty, and competence in treating the seriously wounded.
Although nurse anesthesia educational programs existed prior to World War I, the war sharply increased the demand for nurse anesthetists and, consequently, the need for more educational programs. Nurse anesthetists were often appointed as directors of anesthesia services in both the public and private sectors. In academic health centers, they were frequently responsible for the education of other nurses, medical interns, and physicians. Among the notable early programs of nurse anesthesia were: Johns Hopkins Hospital in Baltimore, the University Hospital of the University of Michigan in Ann Arbor, Charity Hospital in New Orleans, Barnes Hospital in St. Louis, and Presbyterian Hospital in Chicago. In 1922, Alice Hunt, a nurse anesthetist at Peter Bent Brigham Hospital in Boston, was invited by Dr. Samuel Harvey, professor of surgery, to join the Yale Medical School faculty as an instructor of anesthesia with academic rank. She accepted that position, eventually retiring from that institution in 1948.
Founded in 1931, the AANA is the professional association representing more than 37,000 nurse anesthetists nationwide. The AANA promulgates education, and practice standards and guidelines, and affords consultation to both private and governmental entities regarding nurse anesthetists and their practice. The AANA Foundation supports the profession through award of education and research grants to students, faculty, and practicing CRNAs.
The AANA developed and implemented a certification program in 1945 and instituted mandatory recertification in 1978. It established a mechanism for accreditation of nurse anesthesia educational programs in 1952, which has been recognized by the U.S. Department of Education since 1955. In 1975, the AANA was a leader among professional organizations in the United States by forming autonomous multidisciplinary councils with public representation for performing the profession's certification, accreditation, and public interest functions. Today, the CRNA credential is well recognized as an indicator of quality and competence.
The national office of the American Association of Nurse Anesthetists is located in Park Ridge, Ill. The Association's federal government affairs office is maintained in Washington, D.C.
References
Bankert, M. Watchful Care: A History of America's Nurse Anesthetists. New York: Continuum. 1989.
Thatcher VS. History of Anesthesia with Emphasis on the Nurse Specialist. Philadelphia: JB Lippincott Company. 1953.
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