Anesthesiology

CRNA 2
CRNA. History and Definition of Nursings First Clinical Specialty
Ether. Who would have thought that a small carbon based organic compound such as ether would spawn a new field of medical specializations, changing the history of medicine for ever. Ether was discovered in 1275 by a Spanish chemist named Raymundus Lullius,(Evans,1995,p 1). It was his discovery that allowed William E. Clark to use ether as an anesthetic for the first time in 1842. He administered the ether on a dental patient for Elijah Pope as he performed a dental extraction on Miss Hobbie,(Evans,1995.p 1). This was the first step in the creation of the field of anesthesia. This new technology was quickly put to use to relieve pain in all areas of medicine, and its use was seen in hospital operating rooms, dentists’ offices and battle fields.
This new practice in medicine was primarily taken on by the physicians of that time. This new method added to a doctors routine of operating on patients, this proved to be to taxing on the doctor as well as their patients. The added burden of administering the anesthetics along with doing the operation and resuscitation of the patient safely was too much for the doctors. This fact was proven by the increase in mortality rates of patients put under by doctors who administered their own anesthetic. The increasing mortality rates forced the medical proffesion to demanded a change in how anesthesia was given. It was thought that the person administering the anesthetic should do that and only that during an operation. This would free up the physicians so that they could concentrate on the operation at hand. The remaining question was, who do we get to administer the anesthesia? This person would have already be trained in some aspect of the medical field and demonstrate good critical thought and good cognitive reasoning. The doctors only needed to look up from the operating table and to their assistants in health care CRNA 3 to get their answer, it was the nurse. From that moment on the first specialization in clinical nursing was born and those in that specialty were named nurse anesthetists,(Thatcher,1952,p11).

The earliest documentation of anesthetic care given to a patient by a nurse was the work done by Sister Mary Bernard in 1887. She was a catholic nun who worked at the St. Vincent hospital in Erie Pennsylvania,(Thatcher,1952,p 12). The nurse anesthetists of that time were trained by physicians at first, but as time went on the nurses took a more active role in the study and research of anesthetics and eventually surpassed their teachers in the field of anesthesiology. This advance led to role reversal, where the teacher became the student and the student became the teacher. By 1909 the first formal educational program designed for nurse anesthetists was started at St. Vincents Hospital in Portland Oregon,(Evans,1995,p 3). Upon graduation from the school, the nurse anesthetists were placed in all sorts of settings. Most impressive were the teaching positions held by nurses in the medical schools of that time. They became the primary instructors of anesthetic to medical students. The nurse anesthetist also held positions in the battlefields. During World War One, the American nurse anesthetist was the primary health giver to troops in the European theaters of combat. While at war the American nurses influenced other foreign nurses and that led to the spread of nurse anesthetists throughout the world. With the wars came a sharp increase in the demand of anesthetists, and this in turn increased the number of institutions needed for training and broadened the criteria for educating the nurses. By the end of war it was evident that the nurse anesthetist was an invaluable profession that had established itself as one of the most important of all in medicine. With all of this growth and evolution it became necessary that the profession of nurse anesthetists needed to have some structure and governance. On June 17, 1931 the American Association of Nurse Anesthetists CRNA 4 (AANA), wasformed and held its first meeting. From that point on the nurse anesthetist had a new name, they were also known as Certified Registered Nurse Anesthetist, (CRNA).

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Up until World War Two, anesthesia was considered a nursing specialty. This fact was credited in 1942 when the ratio of CRNA’s to anesthesiologists(M.D.) was seventeen to one. Those statistics stayed relatively the same until the sixties,(Evans,1995,p 3).

The construction of criteria and guidelines for CRNA programs has been the responsibility of the AANA and government organizations. Together they also created the criteria that was necessary for schools to follow to keep their accreditation and licensure of practicing anesthetists,(AANA,1998,p 3).
The CRNA of today is not much different than their counterparts that practiced in the late eightteen hundreds and early nineteen hundreds. One noticeable difference between the CRNA’s of today and those of yesteryear is the constantly changing technologies and new developments in the drugs available to them. Along with new advances came the need for additional schooling and training. The new demands put on training institutions assured that only the best and most qualified nurses be accepted into the CRNA programs. The schooling required by nurses in this field is a rigorous and challenging set of didactic and clinical classes that can last twenty four to thirty six months with little or no breaks. The criteria for entrance into most accredited schools is strict. Most require a GPA of 3.00 to 3.50,(UNE,1996,p6), previous experience in an ICU ward and a bachelors of science in nursing. The degrees that can be earned in anesthesia are CRNA, Ed in anesthesiology or a doctorate degree, (Evans,1995,p3). Due to the current trends in health care and demands for highly qualified CRNA’s in the work place, all accredited school must offer a masters of CRNA program as a mandatory degree by CRNA 5 the end of1998,(Evans,1995,p4). To this date there are some twenty seven thousand CRNA’s in practice in the United States alone and that number is constantly growing,(AANA,1998,p 1). Timothy Gale is one out of the twenty seven thousand CRNA’s in the U.S. and is presently employed at the Aroostook Medical Center. He received his CRNA degree in 1992 from the Eastern Maine Medical Center. He loves his profession and the esteem that comes with it. He is among the CRNA’s that administered 65% of the 26 million anesthetics given to patients last year,(AANA,1998,p 1). These anesthetics were given in a wide array of settings that range from dentists offices to hospital operating rooms to training facilities. Tim also described his work in a hospital environment as very rewarding and challenging. The autonomy given to CRNA’s is an important part of the job to him. Not all CRNA’s are granted the same levels of autonomy as others. It all depends on previous performance and competency, luckily Tim is competent enough to be left alone in his job.

Looking at CRNA’s from an economical aspect, they make perfect fedutiary sense. When comparing the salaries of CRNA’s to MD’s that give anesthetics the difference is quit staggering. A CRNA makes about 70-100 thousand dollars a year compared to the 250+ thousand dollars a year that the MD makes,(ANA,1997,p3). The Health Care Financing Administration launched a study of the job performances and pay scales of CRNA’s and MD’s. They discovered that the quality of care between the two was the same(AANA/NOTICES,1998,p1). This led the HCFA to work with the U.S. Congress to help change the rules allowing CRNA’s absolute freedom from physician supervision while administering anesthetics. The U.S. Congress has even sat up and CRNA 6 taken note of the value of qualified CRNA’s and, they unanimously support more autonomy for
the CRNA. They believe that if CRNA’s can be reimbursed by Medicaid and Medicare and be expected to go to war for the U.S., then should be autonomous,(AANA/NOTICES,1998,p1).

The future of the CRNA looks as bright and prosperous as its past has been. As hospitals and government keep trimming the fat in medical care the more cost effective CRNA’s will gain more ground as an independent source of quality care. The schooling that CRNA’s go through will keep evolving to the demands of the field. The demand for higher qualities in applicants to these schools will rise as the medical community demands more bang for its buck. I am excited that I have chosen this field to be my future specialty and look forward to the challenges that lay before me.


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