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Watchful Care: A History of America’s
Nurse Anesthetists by Marianne Bankert depicts the history of the nurse
anesthetist profession and nurse pioneers who helped to create the field over
150 years ago. According to the Association of Nurse Anesthetists, Certified
Registered Nurse Anesthetists (CRNA) administer approximately 43 million
anesthetics per year in the United States. CRNA’s are able to practice in all
types of settings where anesthesia is used such as, “traditional hospital
surgical suites and obstetrical delivery rooms; critical access hospitals;
ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists,
plastic surgeons and pain management specialists; and United States military,
Public Health Services, and Department of veterans Affairs healthcare
facilities” however, this was not always the case (AANA, 2017). CRNA’s were the
first anesthesia providers in the United States during the American Civil War,
however it has been an ongoing struggle since then for CRNA’s to establish
their autonomy in anesthesia practice and leadership.

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Nurse Anesthesia Pioneers

Anesthesia was first discovered in the
United States and due to the unwillingness of physicians to administer
anesthetics; nurses were placed in the forefront of the specialty profession. One
of the first nurses who took on anesthetic duties was discovered to be Sister
Mary Bernard who was a Catholic nun practicing in 1877 at St. Vincent’s
Hospital in Erie, Pennsylvania. Her influence expanded and other Catholic nuns
began to train in anesthesia. Nurses administering anesthesia developed into “Undoubtedly
a prevailing practice in many Catholic hospitals” (Bankert, 1989, p. 25). Since
then the field grew to include 52,000 CRNA’s and student registered nurse
anesthetists just in the United States and 115 accredited nurse anesthesia
programs across the country (AANA, 2017). One of the most well known nurse
anesthetists was Alice Magaw, who was a revolutionary part of the CRNA
profession and helped pave the path for nurse anesthesia education. Numerous
reports were published based on her experiences in anesthetic techniques and
skills while working with Dr. Charles Mayo, a renowned surgeon during the
1800’s, giving her the title of “Mother of Anesthesia”. Alice MaGaw helped
spread her knowledge to medical professionals all over the world and her
anesthetic influence was greatly valued (Bankert, 1989, p. 28). One of her
major accomplishments was her expertise of safe administration using open drop
inhalation method of anesthesia with ether and chloroform. Magaw stressed the
uniqueness of each patient’s needs and her work helped attain success for CRNAs
across the country. She helped to change perspectives of many people as to what
nurses are capable of however, some still “Denied the nurse anesthetist
contribution to the founding of the field” (Bankert, 1989, p. 38).

Catherine S. Lawrence was among one of
the first American nurses to provide anesthesia during the Civil War (1861-1865),
however it wasn’t until years later in 1877 that Sister Mary Bernard was
identified (Ray & Desai, 2016). Some of the pioneering anesthesia nurses
were trained by surgeons and it was not until 1909 when Agnes McGee opened the
first school of nurse anesthesia in Portland, Oregon along with St. John’s
Hospital, Springfield, Illinois (1912), The New York Post Graduate Hospital in
New York City 1912, and Long Island College Hospital Brooklyn, New York 1914 (Bankert,
1989, p. 43). Nurse Anesthetists began to establish their presence in the First
World War in aiding wounded men that were depending heavily on their skill,
however it did not come without a price.

Challenges Faced in the Profession

“As nurses were building their
reputation, Actions were being taken to legislate them out of existence” (Bankert,
1989, p. 57).  Dr. Francis Hoeffer
McMechan who was an encouraging force in physician anesthesia, believed that
the profession of anesthesia was solely for physicians and “There was again a
denial of any contribution on the part of nurse anesthetists. Nor will McMechan
even utter their name, only the denigrating label, “technicians” (Bankert,
1989, p. 59). He took legal action against nurse anesthetists in the 1920’s to
abolish the presence of nurse anesthetists and their care of patients. In 1911
in New York, one of the first challenges to the nurse anesthetists right to
administer anesthesia was challenged and the validity of nurse anesthetists
came into question by the counsel for New York State Medical Society. In this
year they had a great setback when it was declared that the administration of
anesthesia by nurses was in violation of the law. Action was also taken in Ohio
against the nurse anesthesia program and that no one other than a physician
would give anesthesia. Another legal challenge that nurse anesthetists were
faced with was when the Louisville Society of Anesthetists rallied that only
medical physicians can administer anesthetic. A Louisville surgeon named Dr.
Louis Frank and his nurse anesthetist Margaret Hatfield appealed the motion and
won, which was a great feat for the profession. It was said “In the future no
member of the American Association of Anesthetists shall instruct any
undergraduate nurse or orderly in the art of anesthesia, with the intention of
granting them a certificate or diploma qualifying them as competent
anesthetists (Bankert, 1989, p. 64).


The American Association of nurse Anesthetists
was formed in 1931 and today represents more than 52,000 CRNA’s and student
registered nurse anesthetists nationally. It is a professional organization to
provide quality education, develop and train nurse anesthetists to provide the
safest patient care. Nurse anesthesia has advanced over a long period of time
and the pioneering nurses helped pave the way for the professions survival
today. CRNA’s play a very strong role in anesthesia care and the healthcare
system depends on them greatly to provide safe patient care. One of the most
important issues CRNA’s face today is to be able to practice in full autonomy.
A study from 2010, states that, “Anesthesiologists and CRNAs are
interchangeable. They can perform the same set of anesthesia services, including
relatively rare and difficult procedures such as open heart surgeries and organ
transplantations, pediatric procedures, and others” (Hogan, Seifert, Moore,
& Simonson, 2010). CRNA’s have had the ability to practice autonomously
challenged to this day. Certified Registered Nurse Anesthetists are vastly
educated medical professionals who are able to administer anesthesia in a safe
manner to the same extent as anesthesiologists and allowing them to practice to
their full capacity is vital to the healthcare field.






American Association of Nurse
Anesthetists. (2018). Retrieved January 21, 2017, from

Bankert, M. (1989). Watchful care: a history of Americas nurse anesthetists. Park
Ridge, IL: American Association of Nurse Anesthetists.

Desai, S.P., MD., Ray, W.T., PhD. (2016).
The History of the Nurse Anesthesia Profession. Journal of Clinical Anesthesia, 30, 51-58. Retrieved January 21,
2018, from

Hogan, P.F., Moore, C.S., Seifert, R.F., &
Simonson, B.E. (2010, June).  Cost
Effectiveness Analysis of Anesthesia Providers. Retrieved January 21, 2017,

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