Certified registered nurse anesthetist: Difference between revisions

Nurse Anesthetist
	Nurse-Anesthetist administers a local anesthetic
Occupation
Activity sectors	Anesthesia, health care
Description
Competencies	Administration of anesthetics, opioids, and the elimination of pain
Education required	Doctor of Nursing Practice; Master of Science in Nursing;
Fields of; employment	Hospital; Outpatient Surgery Centers; Ambulatory Surgery Centers;

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Certified Registered Nurse Anesthetist (CRNA), is an advanced practiced registered nurse with a doctorate or masters specializing in the administration of anesthesia.^[1] In the United States, CRNA's are recognized by the Joint Commission as licensed independent practitioners, with the ability to administer anesthesia independently of anesthesiologists and liability separate from any supervising physician.^[2]^[3]^[4] Scope of practice limitations and physician oversight requirements vary between healthcare facility and state, with 17 states and Guam granting complete autonomy as of 2016.^[5]

CRNA's account for approximately half of the anesthesia providers in the United States and are the main providers of anesthesia in rural America, administering approximately 43 million anesthetics to patients each year.^[6] Historically, nurse anesthetists have been providing anesthesia care to patients since the American Civil War more than 150 years ago. The CRNA credential came into existence in 1956 and approximately 40% of nurse anesthetists are male.^[7]

In the United States

History

Among the first American nurses to provide anesthesics was Catherine S. Lawrence during the American Civil War (1861–1865).^[8] The first "official" nurse anesthetist was Sister Mary Bernard, a Catholic nun who practiced in 1877 at St. Vincent's Hospital in Erie, Pennsylvania.^[9] There is evidence that up to 50 or more other Catholic sisters were called to practice anesthesia in various midwest Catholic and Protestant hospitals throughout the last two decades of the 19th century.^[10]^[11] The first school of nurse anesthesia was formed in 1909 at St. Vincent Hospital, Portland, Oregon. Established by Agnes McGee, the course was seven months long, and included courses on anatomy and physiology, pharmacology, and administration of the few common anesthetic agents available at the time.^[12] Within the next decade, approximately 19 schools opened. All consisted of post-graduate anesthesia training for nurses and were about six months in length. These included programs at Mayo Clinic, Johns Hopkins Hospital, Barnes Hospital, New York Post-Graduate Hospital, Charity Hospital in New Orleans, Grace Hospital in Detroit, among others.^[13] During those early days of administering anesthetics, knowledge and available anesthetic options were extremely limited and programs provided what little education they could for all levels of health providers. For example, in 1915, chief nurse anesthetist Agatha Hodgins established the Lakeside Hospital School of Anesthesia in Cleveland, Ohio. This program was open to nurses, physicians, and dentists. The training was only six months and the tuition was $50. In its first year, it graduated six physicians, eleven nurses, and two dentists.^[14]

Several notable nurse anesthetist from the early 20th century are revered by their modern counterparts. Agnes McGee taught at the Oregon Health Science Center.^[12] Alice Hunt was appointed instructor in anesthesia with university rank at the Yale University School of Medicine beginning in 1922 and continuing for 26 years.^[15] She authored the 1949 book Anesthesia, Principles and Practice, likely the first nurse anesthesia textbook.

Beginning in 1899, nurse anesthetist Alice Magaw (1860–1928) authored several papers, her most notable, published in 1906, reported on the use of ether anesthesia by drop method 14,000 times without a fatality (Surg., Gynec. & Obst. 3:795, 1906). ^[16] Ms. Magaw was the anesthetist at St. Mary's Hospital in Rochester for the famous brothers, Dr. William James Mayo and Dr. Charles Horace Mayo.^[17] which became the Mayo Clinic in Rochester, Minnesota. Ms. Magaw set up a showcase for surgery and anesthesia that has attracted many students and visitors.^[18]

The didactic curricula of nurse-anesthesia programs is governed by the COA standards. Accredited programs provide supervised experiences for students with patients of all ages who require medical, surgical, obstetrical, dental, and pediatric interventions.^[19] Programs require study in methods of scientific inquiry and statistics, as well as active participation in a student-generated and faculty-sponsored research project. Among the oldest schools in the U.S., Ravenswood Hospital in Chicago, opened in 1925 by Mae Cameron, which in 2001 became the NorthShore University HealthSystem School of Nurse Anesthesia, was the first school to be accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs in 1952.^[20]^[21]

History of education

CRNAs in the United States receive Master's or Doctoral degrees in nurse anesthesia. The nursing Council on Accreditation develops requirements for degree programs. In 1981, the Council on Accreditation developed guidelines for master's degrees. In 1982, it was the official position of the AANA board of directors that registered nurses applying for a school of anesthesia shall be, at minimum, baccalaureate prepared and then complete a master's level anesthesia program.^[22] As early as 1978, the Kaiser Permanente California State University program had evolved to a master's level program. All programs were required to transition to a master's degree beginning in 1990 and complete the process by 1998.^[23] Currently, the American Association of Colleges of Nursing has endorsed a position statement that will move the current entry level of training and education of nurse anesthetists in the United States to the Doctor of Nursing Practice (DNP) or Doctor of Nurse Anesthesia Practice (DNAP).^[24] This move will affect all advance practice nurses, with a mandatory implementation by the year 2015.^[25] In August 2007, the AANA announced its support of this advanced clinical degree as an entry level for practice of all nurse anesthetists with a target compliance date of 2025. In accordance with traditional grandfathering rules, all those in current practice will not be affected and neither will the training provided to those now receiving the DNP or DNAP designation.^[24] Currently, more than 50% of the 120 nurse anesthesia programs have already transitioned to the DNP or DNAP entry level format.^{[citation needed]}

Certification

Board certification and recertification process is governed by the National Board on Certification and Recertification of Nurse Anesthetists (NBCRNA). The NBCRNA exists as an autonomous not-for-profit incorporated organization. CRNAs also have continuing education requirements and recertification check-ins every two years thereafter, plus any additional requirements of the state in which they practice. The new recertification pathway focuses on: maintenance of certification, life long learning, and continued competence. The Continued Professional Certification (CPC) Program consists of 8-year periods, and each period comprises two four-year cycles.^[26]

Legal challenges

It has been established that, under US law, anesthesia is both the practice of medicine and nursing. Frank v. South,^[27] Chalmers-Francis v. Nelson^[28] and other court decisions determined that anesthesia was the practice of Nursing as well as Medicine.^[29] As such, the practice of anesthesia in the US may be delivered by either a nurse anesthetist or physician anesthesiologist. The decisions have not been challenged since the Dagmar Nelson case.^[30] In addition to legal decisions, individual hospital and surgical facility policies also regulate the granting of anesthesia clinical privileges and are often based on contractual agreements with provider groups.

All challenges to the CRNA scope of practice occurred before 1940 and all were found in favor of the nursing profession, relying on the premise that the surgeon in charge of the operating room was the person practicing medicine. In the United States, nurse anesthetists practice under the state's nursing practice act (not medical practice acts), which outlines the scope of practice for anesthesia nursing.

Scope of practice

The degree of independence or supervision by a licensed provider (physician, dentist, or podiatrist) varies with state law.^[31] Some states use the term collaboration to define a relationship where the supervising physician and the CRNA. Other states require the consent or order of a physician or other qualified licensed provider to administer the anesthetic.^[32]

The licensed CRNA is legally authorized to deliver care under the particular Nurse Practice Act of each state. Scope of CRNA practice is commonly further defined by the practice location's clinical privilege and credentialing process, anesthesia department policies, or practitioner agreements. Clinical privileges are based on the scope and complexity of the expected clinical practice, CRNA qualifications, and CRNA experience. This allows the CRNA to provide core services and activities under defined conditions with or without supervision.^[33]

In 2001, the Centers for Medicare and Medicaid Services (CMS) published a rule in the Federal Register that allows a state to be exempt from Medicare's physician supervision requirement for nurse anesthetists after appropriate approval by the state governor.^[34] To date, 17 states have opted out of the federal requirement, instituting their own individual requirements instead.^[35]

Armed forces

Nurse anesthetists serve in the United States armed forces. In some military treatment facilities, nurse anesthetists function as the only licensed independent anesthesia practitioners, including U.S. Navy ships at sea. They also provide anesthesia for the Veterans Administration and Public Health Service medical facilities.

During World War I, America's nurse anesthetists cared for troops in France. From 1914 to 1915, three years prior to America entering the war, Dr. George Crile and nurse anesthetists Agatha Hodgins and Mabel Littleton served in the Lakeside Unit at the American Ambulance at Neuilly-sur-Seine in France.^[36]^[37] In addition, they helped train the French and British nurses and physicians in anesthesia care. In 1917, the American participation in the war resulted in the U.S. military training nurse anesthetists for service. The Army and Navy sent nurses anesthesia trainees to various hospitals, including the Mayo Clinic at Rochester and the Lakeside Hospital in Cleveland before overseas service.^[38]

Among notable nurse anesthetists are Sophie Gran Winton. She served with the Red Cross at an army hospital in Château-Thierry, France, and earned the French Croix de Guerre in addition to other service awards.^[39] In addition, Anne Penland was the first nurse anesthetist to serve on the British Front and was decorated by the British government.^[40]

American nurse anesthetists also served in World War II and Korea.^[41] Second Lieutenant Mildred Irene Clark provided anesthesia for casualties from the Japanese attack on Pearl Harbor.^[42] During the Vietnam War, nurse anesthetists served as both CRNAs and flight nurses, and also developed new field equipment.^[43] Nurse anesthetists have been casualties of war. Lieutenants Kenneth R. Shoemaker, Jr. and Jerome E. Olmsted, were killed in an air evac mission en route to Qui Nhon, Vietnam.^[44]

At least one nurse anesthetist was a prisoner of war. Army Nurse anesthetist Annie Mealer endured a three-year imprisonment by the Japanese in the Philippines, and was released in 1945.^[45] During the Iraq War, nurse anesthetists provide care at forward positioned medical treatment facilities.^[46] In addition, they play a role in the continuing education and training of Department of Defense nurses and technicians in the care of wartime trauma patients.

References

^ "Certified Registered Nurse Anesthetists (CRNAs) - Department of Anesthesiology". anesthesiology.weill.cornell.edu.
^ "Archived copy" (PDF). Archived from the original (PDF) on 2018-08-04. Retrieved 2018-08-03. {{cite web}}: Unknown parameter |dead-url= ignored (|url-status= suggested) (help)CS1 maint: archived copy as title (link)
^ "Archived copy" (PDF). Archived from the original (PDF) on 2018-08-04. Retrieved 2018-08-03. {{cite web}}: Unknown parameter |dead-url= ignored (|url-status= suggested) (help)CS1 maint: archived copy as title (link)
^ "Archived copy" (PDF). Archived from the original (PDF) on 2018-08-04. Retrieved 2018-08-03. {{cite web}}: Unknown parameter |dead-url= ignored (|url-status= suggested) (help)CS1 maint: archived copy as title (link)
^ "Archived copy" (PDF). Archived from the original (PDF) on 2018-08-04. Retrieved 2018-08-03. {{cite web}}: Unknown parameter |dead-url= ignored (|url-status= suggested) (help)CS1 maint: archived copy as title (link)
^ Daughettry, Lindsay (2010). "Is There a Shortage of Anesthesia Providers in the United States?". Rand Health. Retrieved September 30, 2018.
^ "CRNA Fact Sheet". www.aana.com.
^ American Association of Nurse Anaesthetists (2007). AANA History: Hand in Hand with Nurse Anesthesia. Retrieved May 26, 2007 from http://www.aana.com/75th/timeline1844.aspx
^ Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 54.
^ Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 54-67.
^ Bankert, M. (1989) Watchful Care; A History of America's Nurse Anesthetists. New York: The Continuum Publishing Company. p. 25-26.
^ ^a ^b Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 95.
^ Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 90-109.
^ Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 105.
^ Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 101-102.
^ Bankert, M. (1990). "A Living Heritage." CRNA Forum. Vol. 6 No. 1, p. 5-9.
^ Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 60.
^ Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 62.
^ American Association of Nurse Anesthetists (2017). Education of Nurse Anesthetists in the United States - At a Glance. Retrieved February 5, 2018, from https://www.aana.com/membership/become-a-crna/education-of-nurse-anesthetists-in-the-u.s
^ "Nurse Anesthetist School & Programs - NorthShore". www.northshore.org.
^ "Archived copy". Archived from the original on 2016-05-31. Retrieved 2016-05-01. {{cite web}}: Unknown parameter |dead-url= ignored (|url-status= suggested) (help)CS1 maint: archived copy as title (link)
^ Horton, B. (2007). "Upgrading Nurse Anesthesia Education Requirements (1933-2006) - Part 2: Curriculum, Faculty and Students." AANA Journal, Vol. 75, No. 4, p. 247-251.
^ American Association of Nurse Anesthetists (2007). A Brief Look at Nurse Anesthesia History Retrieved May 23, 2007, from http://www.aana.com/brieflookhistory.aspx
^ ^a ^b American Association of Colleges of Nursing (2004). AACN Position Statement on the Practice Doctorate in Nursing October 2004. Retrieved May 23, 2007, from http://www.aacn.nche.edu/DNP/pdf/DNP.pdf
^ American Association of Nurse Anesthetists (2006). The Doctorate in Nursing Practice (DNP) Background, Current Status and Future Activities. Retrieved May 23, 2007 from http://www.aana.com/professionaldevelopment.aspx?ucNavMenu_TSMenuTargetID=131&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1742
^ "http://www.nbcrna.com/CPC-Recert/Pages/default.aspx". www.nbcrna.com. Retrieved 2017-05-05. {{cite web}}: External link in |title= (help)
^ 175 Ky 416, 194 SW 375 (1917)
^ 6 Cal 2d 402 (1936)
^ "The Practice of Anesthesia (Position Statement)". American Association of Nurse Anesthetists. Retrieved 17 January 2016.
^ "The administration of anesthesia and the practice of medicine". AANA. 2006-02-01. Archived from the original on 2007-10-21. Retrieved 2007-02-10. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
^ U.S. Department of Health and Human Services (2001). Physician Supervision of Certified Registered Nurse Anesthetists. Retrieved May 23, 2007 from http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=391
^ American Association of Nurse Anesthetists (2002). AANA Fact Sheet Final Supervision Rule -- Frequently Asked Questions, Centers for Medicare & Medicaid Services (CMS)Conditions of Participation for Hospitals, Ambulatory Surgical Centers (ASCs), and Critical Access Hospitals (CAHs): Anesthesia Services (Part A Payment), November 21. Retrieved May 23, 2007 from http://www.aana.com/finalsupervisionfaqs.aspx
^ American Association of Nurse Anesthetists (2007). Guidelines for Clinical Privileges. Retrieved May 24, 2007 from http://www.aana.com/clinicalprivileges.aspx
^ U.S. Department of Health and Human Services (2001). States Allowed To Set Standards For Anesthesia. Retrieved May 23, 2007 from http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=319
^ American Association of Nurse Anesthetists (2009). Fact Sheet Concerning State Opt-Outs And November 13, 2001 CMS Rule. Retrieved July 27, 2009 from http://www.aana.com/Advocacy.aspx?ucNavMenu_TSMenuTargetID=49&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=2573
^ Milestones in Anesthesia (1993) Nurse Anesthetists: The Dawn of a Specialty, Part II. Vol. 3, No. 2, p. 10-11.
^ Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 97.
^ Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 96-99.
^ Bankert, M. (1990). "A Living Heritage." CRNA Forum. Vol. 6 No. 1, p. 9-10.
^ Bankert, M. (1990). A Living Heritage. CRNA Forum. Vol. 6 No. 1, p. 13.
^ Bankert, M. (1989) Watchful Care; A History of America's Nurse Anesthetists. New York: The Continuum Publishing Company, p. 107-123, 137-139.
^ American Association of Nurse Anesthetists (2000). "Pearl Harbor, the Korean Conflict, and COL Mildred Irene Clark." Retrieved December 28, 2009 from http://www.aana.com/resources.aspx?ucNavMenu_TSMenuTargetID=164&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1810
^ Bankert, M. (1989) Watchful Care; A History of America's Nurse Anesthetists. New York: The Continuum Publishing Company, p. 144-148.
^ Bankert, M. (1989) Watchful Care; A History of America's Nurse Anesthetists. New York: The Continuum Publishing Company, p. 148.
^ Bankert, M. (1989) Watchful Care; A History of America's Nurse Anesthetists. New York: The Continuum Publishing Company, p. 119-142.
^ American Association of Nurse Anesthetists (2004). Certified Registered Nurse Anesthetists Play Pivotal Role in U.S. Efforts to Combat Worldwide Terrorism. Retrieved May 23, 2007 from http://www.aana.com/pr011304.aspx

Sources

Hodgins, Agatha. "The American Journal of Nursing." American Journal of Nursing. Vol. 30.No. 7 (1930): 863-867. Print. JSTOR 3410499
American Association of Nurse Anesthetists Archives. 222 South Prospect, Park Ridge, Illinois, 60068-4001
Certified Registered Nurse Anesthetists (CRNAs) at a Glance fact sheet. AANA, August 2011.
Quality of Care in Anesthesia. AANA, 2009.
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, 1953
Advancing the Art and Science of Anesthesia for 75 Years: A Pictorial History of the American Association of Nurse Anesthetists. Park Ridge, AANA, 2006.
“Certified Registered Nurse Anesthetists Fact Sheet.” AANA | American Association of Nurse Anesthetists, 26 Aug. 2016, www.aana.com/patients/certified-registered-nurse-anesthetists-fact-sheet.
“Certified Registered Nurse Anesthetists Fact Sheet.” S.C.A.N.A, AANA Public Relations Department , 2 Nov. 2017, www.sccrna.org/certified-registered-nurse-anesthetists-fact-sheet/.
“MoANA | Missouri Association of Nurse Anesthetists | CRNA.” MOANA - Missouri Association of Nurse Anesthetists, 17 Nov. 1970, www.moana.org/.
“Nurse Anesthetist.” ExploreHealthCareers.org, Liaison International, 2018, explorehealthcareers.org/career/nursing/nurse-anesthetist/.
Sines, Vonday J. “CRNA - Certified Registered Nurse Anesthetist Jobs, Requirements, and Salary.” Nurse.org, 29 Oct. 2015, nurse.org/articles/crna-certified-registered-nurse-anesthetist-jobs/.

External links

[1] "Certified Registered Nurse Anesthetists (CRNAs) - Department of Anesthesiology". anesthesiology.weill.cornell.edu.

[2] "Archived copy" (PDF). Archived from the original (PDF) on 2018-08-04. Retrieved 2018-08-03. {{cite web}}: Unknown parameter |dead-url= ignored (|url-status= suggested) (help)CS1 maint: archived copy as title (link)

[3] "Archived copy" (PDF). Archived from the original (PDF) on 2018-08-04. Retrieved 2018-08-03. {{cite web}}: Unknown parameter |dead-url= ignored (|url-status= suggested) (help)CS1 maint: archived copy as title (link)

[4] "Archived copy" (PDF). Archived from the original (PDF) on 2018-08-04. Retrieved 2018-08-03. {{cite web}}: Unknown parameter |dead-url= ignored (|url-status= suggested) (help)CS1 maint: archived copy as title (link)

[5] "Archived copy" (PDF). Archived from the original (PDF) on 2018-08-04. Retrieved 2018-08-03. {{cite web}}: Unknown parameter |dead-url= ignored (|url-status= suggested) (help)CS1 maint: archived copy as title (link)

[6] Daughettry, Lindsay (2010). "Is There a Shortage of Anesthesia Providers in the United States?". Rand Health. Retrieved September 30, 2018.

[7] "CRNA Fact Sheet". www.aana.com.

[timeline-8] American Association of Nurse Anaesthetists (2007). AANA History: Hand in Hand with Nurse Anesthesia. Retrieved May 26, 2007 from http://www.aana.com/75th/timeline1844.aspx

[ThatcherBernard-9] Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 54.

[Thatchersisters-10] Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 54-67.

[bankertsysters-11] Bankert, M. (1989) Watchful Care; A History of America's Nurse Anesthetists. New York: The Continuum Publishing Company. p. 25-26.

[Thatcherfirstschool-12] Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 95.

[Thatcherschools-13] Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 90-109.

[Thatcheraffiliations-14] Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 105.

[Thatcherhunt-15] Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 101-102.

[LivingHeritage-16] Bankert, M. (1990). "A Living Heritage." CRNA Forum. Vol. 6 No. 1, p. 5-9.

[Thatchermagaw-17] Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 60.

[Thatchershowcase-18] Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 62.

[Eduataglance-19] American Association of Nurse Anesthetists (2017). Education of Nurse Anesthetists in the United States - At a Glance. Retrieved February 5, 2018, from https://www.aana.com/membership/become-a-crna/education-of-nurse-anesthetists-in-the-u.s

[20] "Nurse Anesthetist School & Programs - NorthShore". www.northshore.org.

[21] "Archived copy". Archived from the original on 2016-05-31. Retrieved 2016-05-01. {{cite web}}: Unknown parameter |dead-url= ignored (|url-status= suggested) (help)CS1 maint: archived copy as title (link)

[Upgrading-22] Horton, B. (2007). "Upgrading Nurse Anesthesia Education Requirements (1933-2006) - Part 2: Curriculum, Faculty and Students." AANA Journal, Vol. 75, No. 4, p. 247-251.

[Briefhistory-23] American Association of Nurse Anesthetists (2007). A Brief Look at Nurse Anesthesia History Retrieved May 23, 2007, from http://www.aana.com/brieflookhistory.aspx

[AACN-24] American Association of Colleges of Nursing (2004). AACN Position Statement on the Practice Doctorate in Nursing October 2004. Retrieved May 23, 2007, from http://www.aacn.nche.edu/DNP/pdf/DNP.pdf

[AANADNP-25] American Association of Nurse Anesthetists (2006). The Doctorate in Nursing Practice (DNP) Background, Current Status and Future Activities. Retrieved May 23, 2007 from http://www.aana.com/professionaldevelopment.aspx?ucNavMenu_TSMenuTargetID=131&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1742

[26] "http://www.nbcrna.com/CPC-Recert/Pages/default.aspx". www.nbcrna.com. Retrieved 2017-05-05. {{cite web}}: External link in |title= (help)

[27] 175 Ky 416, 194 SW 375 (1917)

[28] 6 Cal 2d 402 (1936)

[29] "The Practice of Anesthesia (Position Statement)". American Association of Nurse Anesthetists. Retrieved 17 January 2016.

[AANAref2-30] "The administration of anesthesia and the practice of medicine". AANA. 2006-02-01. Archived from the original on 2007-10-21. Retrieved 2007-02-10. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)

[cmssupervision-31] U.S. Department of Health and Human Services (2001). Physician Supervision of Certified Registered Nurse Anesthetists. Retrieved May 23, 2007 from http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=391

[MDAsuper-32] American Association of Nurse Anesthetists (2002). AANA Fact Sheet Final Supervision Rule -- Frequently Asked Questions, Centers for Medicare & Medicaid Services (CMS)Conditions of Participation for Hospitals, Ambulatory Surgical Centers (ASCs), and Critical Access Hospitals (CAHs): Anesthesia Services (Part A Payment), November 21. Retrieved May 23, 2007 from http://www.aana.com/finalsupervisionfaqs.aspx

[CRNAprivileges-33] American Association of Nurse Anesthetists (2007). Guidelines for Clinical Privileges. Retrieved May 24, 2007 from http://www.aana.com/clinicalprivileges.aspx

[cmsoptout-34] U.S. Department of Health and Human Services (2001). States Allowed To Set Standards For Anesthesia. Retrieved May 23, 2007 from http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=319

[Optout15states-35] American Association of Nurse Anesthetists (2009). Fact Sheet Concerning State Opt-Outs And November 13, 2001 CMS Rule. Retrieved July 27, 2009 from http://www.aana.com/Advocacy.aspx?ucNavMenu_TSMenuTargetID=49&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=2573

[lakesideunit-36] Milestones in Anesthesia (1993) Nurse Anesthetists: The Dawn of a Specialty, Part II. Vol. 3, No. 2, p. 10-11.

[Thatcherlikesideunit-37] Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 97.

[Thatcher1917-38] Thatcher, V.S. (1953) History of Anesthesia, With Emphasis on the Nurse Specialist. Philadelphia: J.B. Lippincott Company, p. 96-99.

[Winton-39] Bankert, M. (1990). "A Living Heritage." CRNA Forum. Vol. 6 No. 1, p. 9-10.

[Penland-40] Bankert, M. (1990). A Living Heritage. CRNA Forum. Vol. 6 No. 1, p. 13.

[ww2korea-41] Bankert, M. (1989) Watchful Care; A History of America's Nurse Anesthetists. New York: The Continuum Publishing Company, p. 107-123, 137-139.

[clark-42] American Association of Nurse Anesthetists (2000). "Pearl Harbor, the Korean Conflict, and COL Mildred Irene Clark." Retrieved December 28, 2009 from http://www.aana.com/resources.aspx?ucNavMenu_TSMenuTargetID=164&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1810

[vietnam-43] Bankert, M. (1989) Watchful Care; A History of America's Nurse Anesthetists. New York: The Continuum Publishing Company, p. 144-148.

[kia-44] Bankert, M. (1989) Watchful Care; A History of America's Nurse Anesthetists. New York: The Continuum Publishing Company, p. 148.

[pow-45] Bankert, M. (1989) Watchful Care; A History of America's Nurse Anesthetists. New York: The Continuum Publishing Company, p. 119-142.

[crnawar-46] American Association of Nurse Anesthetists (2004). Certified Registered Nurse Anesthetists Play Pivotal Role in U.S. Efforts to Combat Worldwide Terrorism. Retrieved May 23, 2007 from http://www.aana.com/pr011304.aspx

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+{{Infobox Occupation
-#REDIRECT [[Nurse anesthetist]]
+| name= Nurse Anesthetist
+| image= [[File:US Navy 030425-N-2382W-004 Lt. Bob Hawkins, Nurse-Anesthetist administers a local anesthetic to an injured Marine prior to surgery aboard USS Kearsarge (LHD 3).jpg|250px]]
+| caption= Nurse-Anesthetist  administers a local anesthetic
+<!------------Details------------------->
+| activity_sector= [[Anesthesia]], [[health care]]
+| competencies= Administration of [[anesthesia|anesthetics]], [[Opioid|opioids]], and the elimination of [[pain]]
+| formation=
+*[[Doctor of Nursing Practice]]
+*[[Master of Science in Nursing]]
+| employment_field= *[[Hospital]]
+*[[Outpatient surgery|Outpatient Surgery Centers]]
+*[[Ambulatory care|Ambulatory Surgery Centers]]
+| related_occupation=
+}}
+'''Certified Registered Nurse Anesthetist''' (CRNA), is an [[Advanced practice registered nurse|advanced practiced registered nurse]] with a [[Doctorate|doctorate]] or [[Master's degree|masters]] specializing in the administration of [[Anesthesia|anesthesia]].<ref>{{cite web|url=https://anesthesiology.weill.cornell.edu/our-people/crnas|title=Certified Registered Nurse Anesthetists (CRNAs) - Department of Anesthesiology|website=anesthesiology.weill.cornell.edu}}</ref> In the United States, CRNA's are recognized by the [[Joint Commission]] as licensed independent practitioners, with the ability to administer anesthesia independently of [[Anesthesiologist|anesthesiologists]] and [[Legal liability|liability]] separate from any supervising physician.<ref>{{Cite web |url=https://www.jointcommission.org/assets/1/6/CAH_Deeming_Prepub_June2014.pdf |title=Archived copy |access-date=2018-08-03 |archive-url=https://web.archive.org/web/20180804014008/https://www.jointcommission.org/assets/1/6/CAH_Deeming_Prepub_June2014.pdf |archive-date=2018-08-04 |dead-url=yes |df= }}</ref><ref>{{Cite web |url=https://www.aana.com/docs/default-source/practice-aana-com-web-documents-(all)/sl-surgeon%27s-responsibility-for-crnas.pdf?sfvrsn=fe0749b1_2 |title=Archived copy |access-date=2018-08-03 |archive-url=https://web.archive.org/web/20180804014527/https://www.aana.com/docs/default-source/practice-aana-com-web-documents-(all)/sl-surgeon%27s-responsibility-for-crnas.pdf?sfvrsn=fe0749b1_2 |archive-date=2018-08-04 |dead-url=yes |df= }}</ref><ref>{{Cite web |url=https://www.aana.com/docs/default-source/practice-aana-com-web-documents-(all)/scope-of-nurse-anesthesia-practice.pdf?sfvrsn=250049b1_2 |title=Archived copy |access-date=2018-08-03 |archive-url=https://web.archive.org/web/20180804014731/https://www.aana.com/docs/default-source/practice-aana-com-web-documents-(all)/scope-of-nurse-anesthesia-practice.pdf?sfvrsn=250049b1_2 |archive-date=2018-08-04 |dead-url=yes |df= }}</ref> [[Scope of practice]] limitations and physician oversight requirements vary between healthcare facility and state, with 17 states and [[Guam]] granting complete autonomy as of 2016.<ref>{{Cite web |url=https://www.aana.com/docs/default-source/sga-aana-com-web-documents-(all)/801-fact-sheet-concerning-state-opt-outs-pdf.pdf?sfvrsn=450743b1_6 |title=Archived copy |access-date=2018-08-03 |archive-url=https://web.archive.org/web/20180804014531/https://www.aana.com/docs/default-source/sga-aana-com-web-documents-(all)/801-fact-sheet-concerning-state-opt-outs-pdf.pdf?sfvrsn=450743b1_6 |archive-date=2018-08-04 |dead-url=yes |df= }}</ref>
+CRNA's account for approximately half of the anesthesia providers in the United States and are the main providers of anesthesia in [[Rural areas in the United States|rural America]], administering approximately 43 million anesthetics to patients each year.<ref>{{cite journal |last=Daughettry |first=Lindsay |date=2010|title= Is There a Shortage of Anesthesia Providers in the United States?|url=https://www.rand.org/pubs/research_briefs/RB9541.html|journal= Rand Health|access-date= September 30, 2018}}</ref> Historically, nurse anesthetists have been providing anesthesia care to patients since the [[American Civil War]] more than 150 years ago. The CRNA credential came into existence in 1956 and approximately 40% of nurse anesthetists are male.<ref>{{cite web|url=https://www.aana.com/membership/become-a-crna/crna-fact-sheet|title=CRNA Fact Sheet|website=www.aana.com}}</ref>
+==In the United States==
+===History===
+Among the first American nurses to provide anesthesics was Catherine S. Lawrence during the [[American Civil War]] (1861–1865).<ref name="timeline">American Association of Nurse Anaesthetists (2007). ''AANA History: Hand in Hand with Nurse Anesthesia.'' Retrieved May 26, 2007 from http://www.aana.com/75th/timeline1844.aspx</ref> The first "official" nurse anesthetist was Sister Mary Bernard, a Catholic nun who practiced in 1877 at St. Vincent's Hospital in [[Erie, Pennsylvania]].<ref name="ThatcherBernard">Thatcher, V.S. (1953) ''History of Anesthesia, With Emphasis on the Nurse Specialist.'' Philadelphia: J.B. Lippincott Company, p. 54.</ref> There is evidence that up to 50 or more other Catholic sisters were called to practice anesthesia in various midwest Catholic and Protestant hospitals throughout the last two decades of the 19th century.<ref name="Thatchersisters">Thatcher, V.S. (1953) ''History of Anesthesia, With Emphasis on the Nurse Specialist.'' Philadelphia: J.B. Lippincott Company, p. 54-67.</ref><ref name="bankertsysters">Bankert, M. (1989) ''Watchful Care; A History of America's Nurse Anesthetists.'' New York: The Continuum Publishing Company. p. 25-26.</ref>
+The first school of nurse anesthesia was formed in 1909 at St. Vincent Hospital, [[Portland, Oregon]]. Established by Agnes McGee, the course was seven months long, and included courses on [[anatomy]] and [[physiology]], [[pharmacology]], and administration of the few common anesthetic agents available at the time.<ref name="Thatcherfirstschool">Thatcher, V.S. (1953) ''History of Anesthesia, With Emphasis on the Nurse Specialist.'' Philadelphia: J.B. Lippincott Company, p. 95.</ref> Within the next decade, approximately 19 schools opened. All consisted of post-graduate anesthesia training for nurses and were about six months in length. These included programs at [[Mayo Clinic]], [[Johns Hopkins Hospital]], [[Barnes–Jewish Hospital|Barnes Hospital]], New York Post-Graduate Hospital, [[Charity Hospital (New Orleans)|Charity Hospital]] in New Orleans, [[Sinai-Grace Hospital|Grace Hospital]] in Detroit, among others.<ref name="Thatcherschools">Thatcher, V.S. (1953) ''History of Anesthesia, With Emphasis on the Nurse Specialist.'' Philadelphia: J.B. Lippincott Company, p. 90-109.</ref> During those early days of administering anesthetics, knowledge and available anesthetic options were extremely limited and programs provided what little education they could for all levels of health providers. For example, in 1915, chief nurse anesthetist Agatha Hodgins established the Lakeside Hospital School of Anesthesia in [[Cleveland, Ohio]]. This program was open to nurses, [[physician]]s, and [[dentist]]s. The training was only six months and the tuition was $50. In its first year, it graduated six physicians, eleven nurses, and two dentists.<ref name="Thatcheraffiliations">Thatcher, V.S. (1953) ''History of Anesthesia, With Emphasis on the Nurse Specialist.'' Philadelphia: J.B. Lippincott Company, p. 105.</ref>
+Several notable nurse anesthetist from the early 20th century are revered by their modern counterparts. Agnes McGee taught at the Oregon Health Science Center.<ref name="Thatcherfirstschool"/> Alice Hunt was appointed instructor in anesthesia with university rank at the [[Yale University School of Medicine]] beginning in 1922 and continuing for 26 years.<ref name="Thatcherhunt">Thatcher, V.S. (1953) ''History of Anesthesia, With Emphasis on the Nurse Specialist.'' Philadelphia: J.B. Lippincott Company, p. 101-102.</ref> She authored the 1949 book ''Anesthesia, Principles and Practice,'' likely the first nurse anesthesia textbook.
+Beginning in 1899, nurse anesthetist [[Alice Magaw]] (1860–1928) authored several papers, her most notable, published in 1906, reported on the use of ether anesthesia by drop method 14,000 times without a fatality ''(Surg., Gynec. & Obst. 3:795, 1906).'' <ref name="LivingHeritage">Bankert, M. (1990). "A Living Heritage." CRNA Forum. Vol. 6 No. 1, p. 5-9.</ref> Ms. Magaw was the anesthetist at St. Mary's Hospital in Rochester for the famous brothers, Dr. [[William James Mayo]] and Dr. [[Charles Horace Mayo]].<ref name="Thatchermagaw">Thatcher, V.S. (1953) ''History of Anesthesia, With Emphasis on the Nurse Specialist.'' Philadelphia: J.B. Lippincott Company, p. 60.</ref> which became the [[Mayo Clinic]] in [[Rochester, Minnesota]]. Ms. Magaw set up a showcase for surgery and anesthesia that has attracted many students and visitors.<ref name="Thatchershowcase">Thatcher, V.S. (1953) ''History of Anesthesia, With Emphasis on the Nurse Specialist.'' Philadelphia: J.B. Lippincott Company, p. 62.</ref>
+The didactic curricula of nurse-anesthesia programs is governed by the COA standards. Accredited programs provide supervised experiences for students with patients of all ages who require medical, surgical, obstetrical, dental, and pediatric interventions.<ref name="Eduataglance">American Association of Nurse Anesthetists (2017). ''Education of Nurse Anesthetists in the United States - At a Glance.'' Retrieved February 5, 2018, from https://www.aana.com/membership/become-a-crna/education-of-nurse-anesthetists-in-the-u.s</ref> Programs require study in methods of scientific inquiry and statistics, as well as active participation in a student-generated and faculty-sponsored research project. Among the oldest schools in the U.S., Ravenswood Hospital in Chicago, opened in 1925 by Mae Cameron, which in 2001 became the NorthShore University HealthSystem School of Nurse Anesthesia, was the first school to be accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs in 1952.<ref>{{cite web|url=http://www.northshore.org/academics/academic-programs/other-programs/school-of-nurse-anesthesia/|title=Nurse Anesthetist School & Programs - NorthShore|author=|date=|website=www.northshore.org}}</ref><ref>{{Cite web |url=http://home.coa.us.com/accreditation/Pages/Accreditation-Policies,-Procedures-and-Standards.aspx |title=Archived copy |access-date=2016-05-01 |archive-url=https://web.archive.org/web/20160531233106/http://home.coa.us.com/accreditation/Pages/Accreditation-Policies,-Procedures-and-Standards.aspx |archive-date=2016-05-31 |dead-url=yes |df= }}</ref>
+===History of education===
+CRNAs in the United States receive Master's or Doctoral degrees in nurse anesthesia. The nursing Council on Accreditation develops requirements for [[Academic degree|degree]] programs. In 1981, the Council on Accreditation developed guidelines for [[master's degree]]s. In 1982, it was the official position of the AANA board of directors that registered nurses applying for a school of anesthesia shall be, at minimum, baccalaureate prepared and then complete a master's level anesthesia program.<ref name="Upgrading">Horton, B. (2007). "Upgrading Nurse Anesthesia Education Requirements (1933-2006) - Part 2: Curriculum, Faculty and Students." AANA Journal, Vol. 75, No. 4, p. 247-251.</ref> As early as 1978, the Kaiser Permanente California State University program had evolved to a master's level program. All programs were required to transition to a [[master's degree]] beginning in 1990 and complete the process by 1998.<ref name="Briefhistory">American Association of Nurse Anesthetists (2007). ''A Brief Look at Nurse Anesthesia History'' Retrieved May 23, 2007, from http://www.aana.com/brieflookhistory.aspx</ref> Currently, the American Association of Colleges of Nursing has endorsed a position statement that will move the current entry level of training and education of nurse anesthetists in the United States to the Doctor of Nursing Practice (DNP) or Doctor of Nurse Anesthesia Practice (DNAP).<ref name="AACN">American Association of Colleges of Nursing (2004). ''AACN Position Statement on the Practice Doctorate in Nursing October 2004.'' Retrieved May 23, 2007, from http://www.aacn.nche.edu/DNP/pdf/DNP.pdf</ref> This move will affect all [[Advanced Practice Registered Nurses (APRN)|advance practice nurses]], with a mandatory implementation by the year 2015.<ref name="AANADNP">American Association of Nurse Anesthetists (2006). ''The Doctorate in Nursing Practice (DNP) Background, Current Status and Future Activities.'' Retrieved May 23, 2007 from
+http://www.aana.com/professionaldevelopment.aspx?ucNavMenu_TSMenuTargetID=131&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1742</ref> In August 2007, the AANA announced its support of this advanced clinical degree as an entry level for practice of all nurse anesthetists with a target compliance date of 2025. In accordance with traditional grandfathering rules, all those in current practice will not be affected and neither will the training provided to those now receiving the DNP or DNAP designation.<ref name="AACN"/> Currently, more than 50% of the 120 nurse anesthesia programs have already transitioned to the DNP or DNAP entry level format.{{citation needed | date=February 2018}}
+===Certification===
+Board certification and recertification process is governed by the National Board on Certification and Recertification of Nurse Anesthetists (NBCRNA). The NBCRNA exists as an autonomous not-for-profit incorporated organization. CRNAs also have [[continuing education]] requirements and recertification check-ins every two years thereafter, plus any additional requirements of the state in which they practice. The new recertification pathway focuses on: maintenance of certification, life long learning, and continued competence. The Continued Professional Certification (CPC) Program consists of 8-year periods, and each period comprises two four-year cycles.<ref>{{cite web|url=http://www.nbcrna.com/CPC-Recert/Pages/default.aspx|title=http://www.nbcrna.com/CPC-Recert/Pages/default.aspx|website=www.nbcrna.com|language=en-us|access-date=2017-05-05}}</ref>
+===Legal challenges===
+It has been established that, under [[Law of the United States|US law]], anesthesia is both the practice of medicine and nursing. ''Frank v. South'',<ref>175 Ky 416, 194 SW 375 (1917)</ref> ''Chalmers-Francis v. Nelson''<ref>6 Cal 2d 402 (1936)</ref> and other court decisions determined that anesthesia was the practice of Nursing as well as Medicine.<ref>{{cite web |url=http://www.aana.com/resources2/professionalpractice/Pages/The-Practice-of-Anesthesia.aspx |title=The Practice of Anesthesia (Position Statement) |publisher=American Association of Nurse Anesthetists |accessdate=17 January 2016}}</ref> As such, the practice of anesthesia in the US may be delivered by either a nurse anesthetist or physician anesthesiologist.  The decisions have not been challenged since the Dagmar Nelson case.<ref name=AANAref2>{{cite web|date=2006-02-01 |title=The administration of anesthesia and the practice of medicine |url=http://www.aana.com/Resources.aspx?ucNavMenu_TSMenuTargetID=54&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=2465 |publisher=AANA |accessdate=2007-02-10 |deadurl=yes |archiveurl=https://web.archive.org/web/20071021193909/http://www.aana.com/Resources.aspx?ucNavMenu_TSMenuTargetID=54&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=2465 |archivedate=2007-10-21 }}</ref> In addition to legal decisions, individual hospital and surgical facility policies also regulate the granting of anesthesia clinical privileges and are often based on contractual agreements with provider groups.
+All challenges to the CRNA scope of practice occurred before 1940 and all were found in favor of the nursing profession, relying on the premise that the surgeon in charge of the operating room was the person practicing medicine. In the United States, nurse anesthetists practice under the state's nursing practice act (not medical practice acts), which outlines the scope of practice for anesthesia nursing.
+===Scope of practice===
+The degree of independence or supervision by a licensed provider (physician, dentist, or podiatrist) varies with state law.<ref name="cmssupervision">U.S. Department of Health and Human Services (2001). ''Physician Supervision of Certified Registered Nurse Anesthetists.'' Retrieved May 23, 2007 from http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=391</ref> Some states use the term collaboration to define a relationship where the supervising physician and the CRNA. Other states require the consent or order of a physician or other qualified licensed provider to administer the anesthetic.<ref name="MDAsuper">American Association of Nurse Anesthetists (2002). ''AANA Fact Sheet Final Supervision Rule -- Frequently Asked Questions, Centers for Medicare & Medicaid Services (CMS)Conditions of Participation for Hospitals, Ambulatory Surgical Centers (ASCs), and Critical Access Hospitals (CAHs): Anesthesia Services (Part A Payment), November 21.'' Retrieved May 23, 2007 from http://www.aana.com/finalsupervisionfaqs.aspx</ref>
+The licensed CRNA is legally authorized to deliver care under the particular Nurse Practice Act of each state. [[Scope of practice|Scope of CRNA practice]] is commonly further defined by the practice location's clinical privilege and credentialing process, anesthesia department policies, or practitioner agreements. Clinical privileges are based on the scope and complexity of the expected clinical practice, CRNA qualifications, and CRNA experience. This allows the CRNA to provide core services and activities under defined conditions with or without supervision.<ref name="CRNAprivileges">American Association of Nurse Anesthetists (2007). ''Guidelines for Clinical Privileges.'' Retrieved May 24, 2007 from http://www.aana.com/clinicalprivileges.aspx</ref>
+In 2001, the [[Centers for Medicare and Medicaid Services]] (CMS) published a rule in the [[Federal Register]] that allows a state to be exempt from Medicare's physician supervision requirement for nurse anesthetists after appropriate approval by the [[Governor (United States)|state governor]].<ref name="cmsoptout">U.S. Department of Health and Human Services (2001). ''States Allowed To Set Standards For Anesthesia.'' Retrieved May 23, 2007 from http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=319</ref> To date, 17 states have opted out of the federal requirement, instituting their own individual requirements instead.<ref name="Optout15states">American Association of Nurse Anesthetists (2009). ''Fact Sheet Concerning State Opt-Outs
+And November 13, 2001 CMS Rule.'' Retrieved July 27, 2009 from http://www.aana.com/Advocacy.aspx?ucNavMenu_TSMenuTargetID=49&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=2573</ref>
+===Armed forces===
+Nurse anesthetists serve in the [[United States armed forces]]. In some military treatment facilities, nurse anesthetists function as the only licensed independent anesthesia practitioners, including [[United States Navy|U.S. Navy]] ships at sea. They also provide anesthesia for the [[United States Department of Veterans Affairs|Veterans Administration]] and [[United States Public Health Service|Public Health Service]] medical facilities.
+During [[World War I]], America's nurse anesthetists cared for troops in [[France]]. From 1914 to 1915, three years prior to America entering the war, Dr. George Crile and nurse anesthetists Agatha Hodgins and Mabel Littleton served in the Lakeside Unit at the American Ambulance at [[Neuilly-sur-Seine]] in France.<ref name="lakesideunit">Milestones in Anesthesia (1993) Nurse Anesthetists: The Dawn of a Specialty, Part II. Vol. 3, No. 2, p. 10-11.</ref><ref name="Thatcherlikesideunit">Thatcher, V.S. (1953) ''History of Anesthesia, With Emphasis on the Nurse Specialist.'' Philadelphia: J.B. Lippincott Company, p. 97.</ref> In addition, they helped train the French and British nurses and physicians in anesthesia care. In 1917, the American participation in the war resulted in the U.S. military training nurse anesthetists for service. The Army and Navy sent nurses anesthesia trainees to various hospitals, including the Mayo Clinic at Rochester and the Lakeside Hospital in Cleveland before overseas service.<ref name="Thatcher1917">Thatcher, V.S. (1953) ''History of Anesthesia, With Emphasis on the Nurse Specialist.'' Philadelphia: J.B. Lippincott Company, p. 96-99.</ref>
+Among notable nurse anesthetists are Sophie Gran Winton. She served with the [[Red Cross]] at an army hospital in [[Château-Thierry]], France, and earned the [[Croix de guerre 1914–1918 (France)|French Croix de Guerre]] in addition to other service awards.<ref name="Winton">Bankert, M. (1990). "A Living Heritage." CRNA Forum. Vol. 6 No. 1, p. 9-10.</ref> In addition, Anne Penland was the first nurse anesthetist to serve on the British Front and was decorated by the British government.<ref name="Penland">Bankert, M. (1990). ''A Living Heritage.'' CRNA Forum. Vol. 6 No. 1, p. 13.</ref>
+American nurse anesthetists also served in [[World War II]] and [[Korean War|Korea]].<ref name="ww2korea">Bankert, M. (1989) ''Watchful Care; A History of America's Nurse Anesthetists.'' New York: The Continuum Publishing Company, p. 107-123, 137-139.</ref> [[Second Lieutenant]] Mildred Irene Clark provided anesthesia for casualties from the Japanese [[attack on Pearl Harbor]].<ref name="clark">American Association of Nurse Anesthetists (2000). "Pearl Harbor, the Korean Conflict, and COL Mildred Irene Clark." Retrieved December 28, 2009 from http://www.aana.com/resources.aspx?ucNavMenu_TSMenuTargetID=164&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1810</ref> During the [[Vietnam War]], nurse anesthetists served as both CRNAs and [[flight nurse]]s, and also developed new field equipment.<ref name="vietnam">Bankert, M. (1989) ''Watchful Care; A History of America's Nurse Anesthetists.'' New York: The Continuum Publishing Company, p. 144-148.</ref> Nurse anesthetists have been casualties of war. Lieutenants Kenneth R. Shoemaker, Jr. and Jerome E. Olmsted, were killed in an air evac mission en route to Qui Nhon, Vietnam.<ref name="kia">Bankert, M. (1989) ''Watchful Care; A History of America's Nurse Anesthetists.'' New York: The Continuum Publishing Company, p. 148.</ref>
+At least one nurse anesthetist was a [[prisoner of war]]. [[United States Army|Army]] Nurse anesthetist Annie Mealer endured a three-year imprisonment by the Japanese in the [[Philippines]], and was released in 1945.<ref name="pow">Bankert, M. (1989) ''Watchful Care; A History of America's Nurse Anesthetists.'' New York: The Continuum Publishing Company, p. 119-142.</ref> During the [[Iraq War]], nurse anesthetists provide care at forward positioned medical treatment facilities.<ref name="crnawar">American Association of Nurse Anesthetists (2004). ''Certified Registered Nurse Anesthetists Play Pivotal Role in U.S. Efforts to Combat Worldwide Terrorism.'' Retrieved May 23, 2007 from http://www.aana.com/pr011304.aspx</ref> In addition, they play a role in the continuing education and training of Department of Defense nurses and technicians in the care of wartime trauma patients.
+==References==
+{{reflist}}
+===Sources===
+*  Hodgins, Agatha. "The American Journal of Nursing." American Journal of Nursing. Vol. 30.No. 7 (1930): 863-867. Print. {{jstor|3410499}}
+*  American Association of Nurse Anesthetists Archives. 222 South Prospect, Park Ridge, Illinois, 60068-4001
+*  Certified Registered Nurse Anesthetists (CRNAs) at a Glance fact sheet. AANA, August 2011.
+*  Quality of Care in Anesthesia. AANA, 2009.
+*  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, 1953
+*  Advancing the Art and Science of Anesthesia for 75 Years: A Pictorial History of the American Association of Nurse Anesthetists. Park Ridge, AANA, 2006.
+*  “Certified Registered Nurse Anesthetists Fact Sheet.” ''AANA | American Association of Nurse Anesthetists'', 26 Aug. 2016, [http://www.aana.com/patients/certified-registered-nurse-anesthetists-fact-sheet www.aana.com/patients/certified-registered-nurse-anesthetists-fact-sheet].
+*  “Certified Registered Nurse Anesthetists Fact Sheet.” ''S.C.A.N.A'', AANA Public Relations Department , 2 Nov. 2017, [http://www.sccrna.org/certified-registered-nurse-anesthetists-fact-sheet/ www.sccrna.org/certified-registered-nurse-anesthetists-fact-sheet/].
+*“MoANA | Missouri Association of Nurse Anesthetists | CRNA.” ''MOANA - Missouri Association of Nurse Anesthetists'', 17 Nov. 1970, [http://www.moana.org/ www.moana.org/].
+*“Nurse Anesthetist.” ''ExploreHealthCareers.org'', Liaison International, 2018, explorehealthcareers.org/career/nursing/nurse-anesthetist/.
+*Sines, Vonday J. “CRNA - Certified Registered Nurse Anesthetist Jobs, Requirements, and Salary.” ''Nurse.org'', 29 Oct. 2015, nurse.org/articles/crna-certified-registered-nurse-anesthetist-jobs/.
+==External links==
+* [http://www.aana.com/ American Association of Nurse Anesthetists]
+* [http://www.ifna-int.org  The International Federation of Nurse Anesthetists (IFNA)]
+{{Nursing|state=show}}
+{{Anesthesia|state=show}}
+{{Portal bar|Nursing}}
+{{DEFAULTSORT:Nurse Anesthetist}}
+[[Category:Anesthesia]]
+[[Category:Nursing credentials and certifications]]
+[[Category:Advanced practice registered nursing]]
+[[Category:Nursing specialties]]

v t e Anesthesia and anesthesiology
Types	General Sedation Procedural sedation and analgesia Twilight anesthesia Local Continuous wound infiltration Topical Neuraxial blockade Combined spinal and epidural anaesthesia Epidural anesthesia Spinal anaesthesia Nerve block Brachial plexus block Fascia iliaca block Femoral nerve block Inferior alveolar nerve block Intercostal nerve block Interpleural block Intravenous regional anesthesia Occipital nerve block Paracervical block Pudendal nerve block Retrobulbar block Sciatic nerve block Transverse abdominis plane block Total intravenous anaesthesia
Pharmacologic agents	Anticholinergics Antiemetics Butyrophenones Benzodiazepines General anesthetics Inhalational anesthetics Local anesthetics Neuromuscular-blocking drugs Opioids Sedatives
Techniques	Airway management Anesthesia provision in the US Bronchoscopy Dogliotti's principle Intravenous therapy Laryngoscopy Tracheal intubation Rapid sequence induction
Scientific principles	Blood–gas partition coefficient Concentration effect Fink effect Minimum alveolar concentration Second gas effect
Measurements	ASA physical status classification system Baricity Bispectral index Body mass index Capnography Entropy monitoring Fick principle Goldman index Guedel's classification Intraoperative neurophysiological monitoring Mallampati score Neuromuscular monitoring Pain scale Thyromental distance
Instruments	Anaesthetic machine Anesthetic vaporizer Arterial catheter Bronchial blocker Double-lumen endobronchial tube Gas cylinder Laryngeal mask airway Laryngeal tube Magill forceps Relative analgesia machine Tracheal tube
Complications	Allergic reactions Anesthesia awareness Drug-induced amnesia Effects of early-life exposures to anesthesia on the brain Emergence delirium Local anesthetic toxicity Malignant hyperthermia Perioperative mortality Postanesthetic shivering Postoperative nausea and vomiting Postoperative residual curarization
Subspecialties	Cardiothoracic Critical emergency medicine Geriatric Intensive care medicine Obstetric Oral sedation dentistry Pain medicine
Professions	Anesthesiologist Anesthesiologist assistant Nurse anesthetist Operating department practitioners Certified anesthesia technician Certified anesthesia technologist Anaesthetic technician Physicians' assistant (anaesthesia)
History	ACE mixture Helsinki Declaration for Patient Safety in Anaesthesiology History of general anesthesia History of neuraxial anesthesia History of tracheal intubation
Organizations	American Association of Nurse Anesthetists American Society of Anesthesia Technologists & Technicians American Society of Anesthesiologists Anaesthesia Trauma and Critical Care Association of Anaesthetists of Great Britain and Ireland Royal College of Anaesthetists Association of Veterinary Anaesthetists Australian and New Zealand College of Anaesthetists Australian Society of Anaesthetists International Anesthesia Research Society European Society of Anaesthesiology and Intensive Care
Category Outline