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, Pennsylvania in 1887. The most
famous nurse anesthetist of the nineteenth century, Alice Magaw, worked at
St. Mary's Hospital (1889) in Rochester, Minnesota. 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, DC. 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 27,000 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 by awarding 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, Illinois. The Association's federal affairs office is
maintained in Washington, DC.
References
Bankert, M., Watchful Care: A History of America's Nurse Anesthetists,
Continuum, New York, 1989.
Thatcher, V.S., History of Anesthesia with Emphasis on the Nurse
Specialist, JB Lippincott Company, Philadelphia, 1953.
