1. Introduction to Nurse AnesthesiaPutting the pieces together-Units 7 & 8- HistoryLynn L. Lebeck, CRNA, PhD

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. 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 Franks cases 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. 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. 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. 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. 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. 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 1999AANAs 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. 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. 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. 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. 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. 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. 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. 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. 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. AANA Headquarters& Executive Directors 1931-1937- University Hospitals ofCleveland 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. AANA Headquarters& Executive Directors 1951-1957 116 South Michigan AveChicago, Illinois Very small but all that could be afforded ata fashionable address 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. 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. AANA Headquarters& Executive Directors 1978-1992 216 Higgins Rd, ParkRidge, Illinois- first buildingpurchased by AANA 24. AANA Headquarters& Executive Directors 1976-77 Acting & 1979-1983 Nancy Fevold, CRNA- ExecutiveDirector AANA Education and ResearchFoundation formed 1st independentAANA annual meeting1976 25. AANA Headquarters& Executive Directors 1983-2001 John F. Garde, CRNA, MS,FAAN AANA subsidiaries Publication of WatchfulCare Opening of theWashington DC office 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. 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 ofUniversity of Cincinnati Past President of AANA 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. 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. 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. Agatha Hodgins Award For OutstandingAccomplishment Established in 1975 torecognize individualswhose dedication toexcellence has furtheredthe art and science ofnurse anesthesia 33. Agatha Hodgins Award Winnerswith 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 aCRNA who has made a significantcontribution to the education of nurseanesthetists 35. Helen Lamb Award Winners withMichigan connections 1981-John Garde 1985- Celestine Harrigan 1996- Helen Vos 2000- Agnes Hagan 2002- Karen Zaglanicnzy 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. 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 firstaccredited in 2007/08 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. 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. 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. 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. 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. 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 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.