Who provides
your anesthesia

The earliest nurse anesthetists

1. 1877

   The first nurse to specialize in anesthesia

   Sister Mary Bernard, a Catholic nursing sister at St. Vincent's Hospital in Erie, Pennsylvania, became the first nurse to specialize in anesthesia.[2]

2. 1889

   Mayo Clinic's first anesthetist

   Edith Graham became the first nurse anesthetist at St. Mary's Hospital in Rochester, Minnesota, the hospital that grew into the Mayo Clinic.[3]

Setting the standard for safety

1. 1893

   Alice Magaw, "Mother of Anesthesia"

   Alice Magaw became the anesthetist for Drs. William and Charles Mayo. Dr. Charles Mayo gave her the title "Mother of Anesthesia" for her mastery of open-drop ether.[2]

2. 1899

   The first published nurse anesthetist

   Magaw published "Observations in Anesthesia," the first article by a nurse anesthetist, and went on to publish additional papers on her technique. She documented more than 14,000 anesthetics without an anesthesia-related death, a safety record at a time when anesthesia deaths were common.[3][4]

3. 1904–1914

   Refining and teaching the technique

   Florence Henderson, trained by Magaw, became Mayo's ether specialist. She refined open-drop ether technique and published her work in the American Journal of Nursing (1909) and The Saint Paul Medical Journal (1914).[3][5]

New anesthetic techniques

1. 1908

   Nitrous oxide-oxygen anesthesia

   Agatha Hodgins became surgeon George Crile's personal anesthetist at Lakeside Hospital in Cleveland and perfected the administration of nitrous oxide-oxygen anesthesia.[6]

2. 1911

   Influence on physicians

   Her work at Lakeside prompted further interest in the technique among physicians, including Walter Boothby's 1911 work on nitrous oxide-oxygen anesthesia.[7]

3. 1915

   Anesthesia in wartime

   Hodgins served at the American Ambulance Hospital in Paris during World War I, where the Lakeside team showed the advantages of their anesthetic technique for patients in shock or injured by gas. Nurse anesthetists have served in every American conflict since.[6]

4. 1920s–1930s

   Endotracheal anesthesia for lung surgery

   Helen Lamb, chief anesthetist at Barnes Hospital in St. Louis, was one of the first nurse anesthetists in the United States to use endotracheal anesthesia and pioneered the endotracheal technique in lung surgery.[8][9]

5. 1933

   The world's first successful pneumonectomy

   Helen Lamb gave the anesthetic for Dr. Evarts Graham's first successful one-stage removal of a lung for cancer, a landmark in thoracic surgery.[8][9]

6. 1930s

   Equipment designed by a nurse anesthetist

   Lamb wrote to the Foregger company describing the anesthesia machine she needed. Foregger built it and offered to name it the "Lamb Model." She declined and asked that it be called the "Barnes Model."[10]

Pioneers of pediatric and cardiac anesthesia

1. 1930s–1960s

   Betty Lank, Boston Children's Hospital

   Before pediatric anesthesia was a specialty, children were anesthetized with one-size-fits-all equipment. Chief nurse anesthetist Betty Lank designed child-sized masks and ventilation bags and became the first person in the U.S. to use cyclopropane with children.[11]

2. 1938

   Equipment for the first congenital heart surgery

   She had a hospital engineer build small blood pressure cuffs and masks for pediatric patients before any were commercially available, and she used them while providing anesthesia for Dr. Robert Gross, who founded congenital heart surgery with the first ligation of a patent ductus arteriosus in 1938. The infant blood pressure cuff later became known as the "Smith cuff," after the physician chief who adopted it.[12]

3. 1940s

   Olive Berger and the "blue baby" operations

   Olive Berger, chief nurse anesthetist at Johns Hopkins, gave anesthesia for the famous "blue baby" operations performed by Alfred Blalock, Helen Taussig, and Vivien Thomas, and had taken over anesthesia for these operations by 1946.[13][14]

4. 1946–1952

   Logbooks and recognition

   Her detailed logbooks of the first operations for cyanotic congenital heart disease survive in the Hopkins archives. She was left out of the 1946 physician report on anesthesia for these cases. In 1952 she was made an instructor in anesthesia in the Johns Hopkins School of Medicine.[14][13]

Building anesthesia education

1. 1909

   The first formal anesthesia education program in the United States

   Agnes McGee opened the first formal nurse anesthesia education program at St. Vincent's Hospital in Portland, Oregon. By 1920, almost 20 hospitals offered graduate programs in nurse anesthesia, while only one postgraduate anesthesia course existed for physicians.[15]

2. 1927

   Physician departments follow

   The first academic anesthesiology department for physicians was founded in 1927.[16]

3. 1911–1915

   The Lakeside School of Anesthesia

   Agatha Hodgins began teaching anesthesia to nurses and doctors at Lakeside Hospital in 1911 and formally established the Lakeside Hospital School of Anesthesia in 1915.[2]

4. 1931–1939

   The first national curriculum

   Helen Lamb chaired the AANA Education Committee from 1931 to 1939 and established the curriculum and minimum standards for schools of nurse anesthesia.[9]

5. 1971

   Advancing degrees

   First bachelor's degree program in anesthesia.[17]

6. 1978

   Advancing degrees

   First Master of Science degree in nurse anesthesia.[17]

7. 1998

   Advancing degrees

   Master's degree required for all graduates of accredited programs.[17]

8. 2022

   Advancing degrees

   All students entering an accredited program must be enrolled in a doctoral program.[18]

Building a profession

1. 1931

   First national association of nurse anesthetists

   Agatha Hodgins founded the National Association of Nurse Anesthetists, today the American Association of Nurse Anesthesiology (AANA).[2]

2. 1934

   Practice affirmed by the courts

   In Chalmers-Francis v. Nelson, the California Supreme Court confirmed the legality of nurse anesthesia practice.[2]

3. 1942

   The backbone of American anesthesia

   There were still 17 nurse anesthetists for every one anesthesiologist in the United States.[15]

4. 1945

   National certification

   The AANA gave the first national qualifying (certification) exam for nurse anesthetists.[2]

5. 1955

   Accreditation

   The U.S. Department of Health, Education, and Welfare recognized the AANA as the accrediting agency for nurse anesthesia schools.[2]

6. 1956

   The CRNA credential is adopted

   The CRNA credential is adopted.[2]

7. 1963

   Military leadership

   COL Mildred Irene Clark, CRNA, became the first nurse anesthetist to serve as Chief of the Army Nurse Corps.[2]

8. 1977

   Mandatory continuing education

   AANA members approved mandatory continuing education for CRNAs.[2]

9. 1986

   Direct Medicare reimbursement

   Congress made nurse anesthesia the first nursing specialty, and the first non-physician group, to receive direct reimbursement under Medicare Part B.[2]

The modern era

1. 2001–2003

   Removing outdated supervision requirements

   Iowa became the first state to opt out of the federal physician supervision requirement in 2001. Kansas opted out in 2003.[2][17]

2. 2010

   Evidence of safety

   A study in Health Affairs found no harm when nurse anesthetists work without physician supervision, and its authors recommended that Medicare repeal the supervision requirement.[2]

3. Today

   The legacy continues

   CRNAs continue this legacy in operating rooms, labor and delivery suites, pain clinics, military hospitals, and the rural hospitals where they are often the only anesthesia providers.