Nurse anesthetist
A nurse anesthetist (AE) is a registered nurse and advanced practice nurse who has acquired additional education and training to administer anesthesia. The title, Certified Registered Nurse Anesthetist (CRNA), reflects the nurse's qualifications and abilities.
Education
In the United States, education is overseen by the American Association of Nurse Anesthetists (AANA) Council on Accreditation of Nurse Anesthesia Educational Programs (COA). The nurse anesthetist's education, training, and official title vary in different nations.
Historically, American CRNAs received an anesthesia bachelors degree, diploma or certificate. As early as 1976, the COA was developing requirements for degree programs. In 1981, guidelines for master’s degrees were developed by the COA. In 1982, the official position of the AANA board of directors was that registered nurses will be baccalaureate prepared and then attend a master's level anesthesia program. At that time, many programs started phasing in advance degree requirements.[1] As early as 1978, the Kaiser Permanente California State University program had upgraded 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.[2] This is now the current point of entry into the CRNA profession and a majority of practicing CRNAs have completed this level of education. As CRNAs trained under the older certificate or baccalaureate programs retire, the percentage of advanced degree prepared CRNA steadily rises.
Nurse anesthetists must first complete a four-year baccalaureate degree in nursing or a science related subject. They must be a licensed registered nurse. Then, the AANA requires a minimum of one year of full-time nursing experience in an acute care setting, such as medical intensive care unit or surgical intensive care unit. CRNAs also have continuing education requirements and recertification every two years thereafter, plus any additional requirements of the state in which they practice.[3]
Nurse anesthetists may continue their education to the terminal degree level, either earning a
Scope of practice
Nurse anesthetists practice in all 50 of the United States and administer approximately 27 million anesthetics given to patients in the United States each year (AANA 2005 Practice Profile Survey). The American Association of Nurse Anesthetists (AANA) is the professional organization representing greater than 90 percent of the nation's CRNAs. There are 36,000 members in the AANA. This includes certified, recertified, and student members. Approximately 46% of the CRNAs are men, versus approximately 8% in the nursing profession as a whole. Some states use the term collaboration to define a relationship of independence between the two parties yet mutual agreement and open communication on the anesthetic techniques. Other states require the consent of a physician to administer the anesthetic. No state requires supervision by an anesthesiologist. To date, 14 states have opted out of the federal requirement. The International Federation of Nurse Anesthetists (IFNA) has flourished in membership and has become an authoritative voice for nurse anesthetists worldwide. They have developed standards of education and practice, and a code of ethics. Delegates from member countries participate in the World Congress every few years. If you have problems with finding a reliable essay service that offers assistance not only with creating essays but term and research paper writing as well, I highly recommend you to visit BestWritingService.Com. Recent studies by the IFNA found anesthesia care worldwide is both a medical and nursing function. Researchers identified 107 countries where nurse anesthetists train and practice and 9 countries where nurses assist in the administration of anesthesia.[4]
Compensation
According to numerous salary reports throughout the years, CRNAs remain the highest compensated of all nursing specialties. Their average reported annual salary range in 2006, reported by the AMGA Medical Group Compensation and Financial Survey, was $140,396.[5]
History
Nurse anesthetists have been providing anesthesia care in the United States for over 125 years. Nurse anesthetists were the first "nursing specialty group" in the United States.
The first nurse to provide anesthesia was Catherine S. Lawrence, and probably along with other nurses, administered anesthesia for Since physician residences in anesthesia did not exist very early on, doctors attended these programs to learn anesthesia. For example, in 1915, chief nurse anesthetist Agatha Hodgins established the Lakeside Hospital School of Anesthesia in Cleveland, Ohio. This program was open to graduate nurses, physicians, and dentists. The training was 6 months, and the tuition was $50.00. A diploma was awarded on completion. In its first year, it graduated 6 physicians, 2 dentists, and 11 nurses.[6] Later, in 1918, it established a system of clinical affiliations with other Cleveland hospitals.[6] Ms. Hodgins was originally appointed as anesthetist in 1908 by Dr. George W. Crile. Under Dr. Crile's direction, she became an expert in the administration of anesthesia, and had administered 575 anesthetics by 1909.[6]
Some nurse anesthetists were appointed to medical school faculties to train the medical students in anesthesia. For example, Agnes McGee also taught 3rd year medical school students at the University of Oregon.[6] Nurse anesthetist Alice Hunt was appointed instructor in anesthesia with university rank at the Yale University School of Medicine in 1922. She held this position for 26 years.[6] In addition, she authored the 1949 book Anesthesia, Principles and Practice. This is most likely the first nurse anesthesia textbook.
Early nurse anesthetists were also involved in publications. For example, in 1906, nurse anesthetist Alice Magaw (1860-1928) published a report on the use of ether anesthesia by drop method 14,000 times without a fatality (Surg., Gynec. & Obst. 3:795, 1906). She had many other publications, beginning in 1899, with some published and many ignored because of her status as a nurse. Ms. Magaw was the anesthetist at St. Mary’s Hospital in Rochester for the famous Drs. William J. Mayo and Charles H. Mayo.[6] This became the famed Mayo Clinic in Rochester, Minnesota. She is often referred to as "the Mother of Anesthesia." She set up a showcase for surgery and anesthesia and attracted students from across the United States and the world. Recently, the city of Corunna, Michigan, discovered that Alice Magaw and family are interred in Corunna's Pine Tree Cemetery.
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All Images: AANA Archives, 222 S. Prospect Avenue, Park Ridge, IL 60068
After much growth, the nurse anesthesia specialty was formally organized on June 17, 1931, when the National Association of Nurse Anesthetist (AANA) held their first meeting.[6] It was Agatha Hodgins who organized the event, inviting members from the Alumnae Association of the Lakeside School of Anesthesia and also nurse anesthetists from across the United States. As a new organization, it had two main objectives: establish a national qualifying exam, and establish an accreditation program for nurse anesthesia schools.[6] The first national certification exam was held on June 4, 1945, with 92 candidates sitting for the exam. After many years of preparation, on January 19, 1952, a program for the accreditation of nurse anesthesia schools when into effect.[6] This has been recognized by the U.S. Department of Education since 1955.[7]
Legal Challenges
In the United States, there have been three challenges brought against nurse anesthetists for illegally practicing medicine (Hodgins and Crile, 1919; Frank v. South, 1917; and Chalmers-Francis v. Nelson, 1936).[8][7] All occurred before 1940 and all were found in favor of the nursing profession. Prior to World War II, the delivery of anesthesia was mainly a nursing function. In 1942, there were seventeen nurse anesthetists for every one anesthesiologist.[7] The numbers of physicians in this specialty did not greatly expand until the late 1960s. Therefore, it was legally established that when a nurse delivers anesthesia, it is the practice of nursing. When a physician delivers anesthesia, it is the practice of medicine. When a dentist delivers anesthesia, it is the practice of dentistry. There are great overlaps of tasks and knowledge in the health care professions. Administration of anesthesia and its related tasks by one provider does not necessarily contravene the practice of other health care providers.<ref name="legal1">Blumenreich, G.A. JD (1999). Legal Briefs, Anesthesia -- It's Finally the Practice of Medicine. Retrieved May 25, 2007 from http://, G.A. JD (1990). Legal Briefs, The Administration of Anesthesia and the Practice of Medicine. Retrieved May 25, 2007 from http://, endotracheal intubation (placing a breathing tube into the windpipe) is performed by physicians, nurse anesthetists, respiratory therapists, paramedics, and dental (oral) surgeons. 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.
Military Service
In the United States military, CRNAs provide a critical peacetime and wartime skill. During peacetime, they provide the majority of anesthesia services for retired service members, active duty military, and their dependents. CRNAs function as the only licensed independent anesthesia practitioners at many military treatment facilities, including Navy ships at sea. They are also the leading provider of anesthesia for the Veterans Administration and Public Health medical facilities.
CRNAs have made a significant contribution in the provision of anesthesia services in every U.S. war during the 20th century. During
See also
References
- ↑ Horton, B. (2007). "Upgrading Nurse Anesthesia Education Requirements (1933-2006) - Part 2: Curriculum, Faculty and Students." AANA Journal Vol. 75, No. 4.
- ↑ American Association of Nurse Anesthetists (2007). A Brief Look at Nurse Anesthesia History Retrieved May 23, 2007, from http://www.aana.com/brieflookhistory.aspx
- ↑
- ↑ McAuliffe, M.S., Henry B. (2002). Nurse Anesthesia Worldwide: Practice, Education, and Regulation. Retrieved May 23, 2007, from http://ifna-int.org/ifna/e107_files/downloads/Practice.pdf
- ↑ AMGA Medical Group Compensation and Financial Survey (2006). 2006 AMGA MID-LEVEL COMPENSATION. Retrieved May 23, 2007 from http://www.cejkasearch.com/compensation/amga_midlevel_compensation_survey.htm
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8
- ↑ 7.0 7.1 7.2 Garde, J.F. (1996) The Nurse Anesthesia Profession, A Past, Present, and Future Perscpective. Nursing Clinics of North America, Vol 31, Number 3.
- ↑ Bankert, M. (1989) Watchful Care; A History of America's Nurse Anesthetists. New York: The Continuum Publishing Company.