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Anesthesia and Analgesia

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• 1844-Horace Wells, a Connecticut dentist began extracting teeth with nitrous oxide.
• 1846-William T.G. Morton demonstrated the anesthetizing properties of ether.
• 1847-James Simpson introduced chloroform into clinical practice for surgery.
• 1853-John Snow administered chloroform analgesia to Queen Victoria during childbirth.
• 1861 thru 1865-Catherine Lawrence and other nurses provided anesthesia for soldiers wounded in the Civil War.
• 1877-Sister Mary Bernard, a nurse at St. Vincent's Hospital in Erie, Pa., is credited as the first identifiable nurse to specialize in anesthesia.
• 1880-The administration of open drop ether and chloroform was taught to Sister Aldoza Eltrich at St. John's Hospital in Springfield, Ill.
• 1889-Edith and Dinah Graham began to administer anesthesia at St. Mary's Hospital in Rochester, Minn.
• 1893-Alice Magaw began working as a nurse anesthetist at St. Mary's Hospital in Rochester, Minn., for Dr. Charles Mayo.
• 1898-First published paper by nurse anesthetist. Alice Magaw described her observations of 1092 patients in the St. Paul Medical Journal.
• 1909-The first hospital-based nurse anesthesia training program was opened at St. Vincent's Hospital in Portland, Oregon by nurse anesthetist Agnes McGee.
• 1909-Florence Henderson published her first article "The Nurse as an Anaesthetist" in the American Journal of Nursing.
• 1914 thru 1917-Hodgins, along with Crile and other nurse anesthetists served in volunteer American medical units that provided anesthesia for casualties during World War I.
• 1915-Hodgins established the Lakeside Hospital School of Anesthesia in Cleveland, Ohio. The first graduating class included six physicians, two dentists, and eleven nurses.
• 1916-Lakeside Hospital School of Anesthesia closed after receiving a letter from the Ohio State Medical Board stating that only registered physicians should be allowed to administer anesthesia.
• 1917-Lakeside Hospital School of Anesthesia reopened within the Medical Practice Act for nurses appropriately educated in anesthesia to administer anesthesia under the supervision of a physician, the first mention of nurse anesthetists or physician supervision in statute.
• 1917-1,100 nurses deployed to Britain and France. The need for pain relief and anesthesia care for the wounded soldiers created an immediate demand for nurse anesthetists' knowledge and skills.
• 1917-Frank versus South lawsuit sought to establish that anesthesia was solely a practice of medicine; however, the Kentucky Court of Appeals ruled that nurse anesthetist Margaret Hatfield was not engaged in the practice of medicine for surgeon Louis Frank's cases.
• 1922-Alice Hunt received an appointment as instructor of anesthesia with university rank at Yale Medical School.
• 1931-Hodgins founded the National Association of Nurse Anesthetists (NANA) in Cleveland, Ohio.
• 1932-NANA was incorporated in Ohio.
• 1933-The first annual NANA meeting, which was held in Milwaukee with 120 attendees; Hodgins was elected honorary president.
• 1934-In the lawsuit, Chalmers-Francis versus Nelson, the California Supreme Court affirmed the superior court ruling for nurse anesthetist Dagmar Nelson who was accused of practicing medicine after physician anesthetists obtained a statement produced by the California Board of Medical Examiners that said anesthesia was the practice of medicine. The NANA filed its first amicus curiae brief for the case. The decision confirmed the legality of nurse anesthesia practice and was considered a victory.
• 1935-Board of Trustees of the American Hospital Association adopted the resolution "…that any legislations that bars, or tends to bar, the use of properly trained anesthetists would be a mistake and a step backwards."
• 1939-NANA was reincorporated as the American Association of Nurse Anesthetists (AANA).
• 1940-The AANA seal with the design "Watchful Care of the Sleeper by the Light of the Lamp of Learning" was adopted.
• 1941 thru 1945-Nurse anesthetists provided anesthesia for the wounded in World War II.
• 1945-AANA administered its first certification exam.
• 1945-Agatha Hodgins died.
• 1946-The first School of Anesthesiology Assembly, an offshoot of the Institute of Instructors of Anesthesiology was held. This would later be called the Assembly of School Faculty.
• 1949-Hunt's test: Anesthesia Principles and Practice: A Presentation for the Nursing Profession, was published.
• 1950-AANA members served in the Korean War.
• 1950-The plan for the accreditation of schools of anesthesia for nurses was approved at the annual meeting.
• 1954-First AANA Code of Ethics was adopted.
• 1954-First Refresher Course was available, a course designed to allow non AANA members with nurse anesthesia experience but without formal training to become eligible for membership.
• 1954-Nurse anesthetist Edward Lyon becomes the first male to be commissioned in the U.S. Army Nurse Corps (AANA).
• 1955-United States Department of Health, Education, and Welfare recognized the AANA as the accrediting agency for schools of nurse anesthesia.
• 1955-AANA became an organizational member on the American Committee of Maternal Welfare.
• 1956-The credential Certified Registered Nurse Anesthetist (CRNA) was adopted.
• 1961-Nurse anesthesia program at Walter Reed General Hospital graduated its first class, consisting of all male graduates.
• 1966-AANA public relations Committee and the executive staff met with American Society of Anesthesiologists (ASA) leaders to explore ways the two associations could collaborate to improve anesthesia service to patients.
• 1971-ASA formally challenged the AANA's right to accredit nurse anesthesia programs.
• 1971-First bachelor's degree program in anesthesia began at Mount Marty College in Yankton, S.D.
• 1972-John Garde, CRNA, became the first male president of the AANA and membership passed 15,000.
• 1973-AANA became a charter member of the Federation of Specialty Nursing Organizations.
• 1974-Standards for Nurse Anesthesia Practice were adopted.
• 1977-Mandatory continuing education for CRNA;s was approved and became effective in 1978.
• 1978-Council on Recertification of Nurse Anesthetists was established.
• 1978-First Master's of Science degree in Nurse Anesthesia; granted from the Kaiser Permanente Nurse Anesthesia clinical Program by the Department of Nursing at California State University in Long Beach.
• 1980-AANA Board of Directors endorsed a minimum of a baccalaureate degree and mandated that nurse anesthesia education should be at the post baccalaureate level by1986.
• 1983-Direct reimbursement legislation for CRNAs was introduced in the Senate.
• 1984-Bahn versus NME Hospitals, Inc,--United States Court of Appeals ruled that under certain circumstances CRNAs working with physicians other than anesthesiologists can compete with anesthesiologists and thus have standing to bring a federal antitrust suit under circumstances prescribed in antitrust law.
• 1984-CRNA Political Action Committee was established to promote and facilitate voluntary contributions from AANA members.
• 1986-Congress passes legislation providing CRNAs direct reimbursement under Medicare Part B, making nurse anesthesia the first nursing specialty/nonphysician group to be granted direct reimbursement rights under Medicare (AANA).
• 1994-First grant awarded to the Council on Accreditation in the amount of $340,000.
• 1996-Task Force on Doctoral Education formed.
• 1997-Foundation began sponsoring a mentoring program pairing CRNA doctoral students with CRNAs holding doctoral degrees.
• 1997-The Health Care Financing Administration of the U.S. Department of Health and Human Services released a proposed rule to defer to the states on physician supervision of CRNAs for Medicare cases.
• 1998-Council on Accreditation of Nurse Anesthesia Educational Programs required that graduates of all nurse anesthesia programs must be awarded at least a master's degree by October 1 of that year.
• 1998-Movement of schools of anesthesia from hospitals to universities was finally accomplished, taking over half a century to fulfill the visions of early nurse anesthesia leaders.
• 2001-Iowa became the first state to opt out of the federal physician supervision requirement.
• 2002-Nebraska, Idaho, Minnesota, New Mexico followed as opt-out states.
• 2002-AANA joined 60 other nursing organizations in Call to the Profession: Nursing's Agenda for Change a cooperative attempt to tackle the nursing shortage.
• 2003-Physician supervision opt out states increased to 11with the addition of Kansas, North Dakota, Washington, Alaska, and Oregon.
• 2003-The study "Surgical Mortality and Type of Anesthesia Provider" was published, demonstrating that surgical death rate is not linked to provider type.
• 2004-A Minnesota lawsuit was instrumental in bringing about considerable regulatory changes regarding anesthesia reimbursement and successfully resolved the legal actions that had been pending against hospitals and anesthesiologists in the Twin Cities and St. Cloud regarding wrongful termination of nurses, antitrust violations and Medicare fraud.
• 2004-AANA and ASA entered into a mediation process to help improve communication between the two organizations.
• 2004-Montana opted out of the federal physician supervision requirement.
• 2005-South Dakota and Wisconsin opted out of the federal physician supervision

Schultz H, Wood J, Woodard C. A Historical Review of the Nurse Anesthesia Profession. Wichita, KS: Newman University. 2009.