In 1846, the first public demonstration of ether anesthesia changed surgery forever.
But behind this breakthrough lies a deeper story.
While medical innovations grabbed the spotlight, nurses stepped in. They quietly learned the art and science of anesthesia long before it became a formal specialty.
Over time, their role expanded, and their contributions became impossible to overlook.
So, how did nurses move from the sidelines to becoming independent anesthesia providers trusted with millions of procedures each year?
Let’s take a closer look at the real journey of nurse anesthesia and how CRNAs became a vital part of modern healthcare.
Foundations of Nurse Anesthesia: Origins and Early Practice
The origins of nurse anesthesia are rooted in necessity. As surgery became safer with the introduction of anesthesia, someone had to step up to manage this new, life-altering technique. And nurses did exactly that.
Long before structured programs or certifications existed, nurses took on the responsibility of delivering anesthesia. And that often implied learning through experience and improvisation.
Let’s look at how this foundation was built.
From Ether to Expertise
Before 1846, surgery was brutal. Patients endured amputations and tumor removals fully awake, held down by force, and often dying from shock, infection, or hemorrhage.
Historical accounts describe scenes where patients, even young children, faced excruciating pain and overwhelming psychological trauma during procedures.
Without anesthesia, every second under the knife meant higher chances of death and unbearable suffering. Surgeons tried to work quickly, but pain was a constant and deadly reality.
That changed on October 16, 1846, when dentist William T.G. Morton publicly demonstrated the use of ether anesthesia at Massachusetts General Hospital.
The success of that event sent shockwaves through the medical community, proving that pain-free surgery was possible. And that transformed patient care forever.
But anesthesia wasn’t instantly adopted everywhere. Surgeons needed skilled hands to administer ether while they operated. Physicians focused on surgery; anesthesia required constant, precise adjustments. And that responsibility quickly fell to nurses.
In the absence of formal protocols, early nurse anesthetists developed critical skills: they learned to drip ether steadily onto gauze, monitor breathing patterns, and adjust dosages in real-time.
Their work laid the foundation for safe anesthesia delivery, long before anesthesia machines or monitors existed.
Early Pioneers in the Field
Several figures played pivotal roles in legitimizing and advancing the history of nurse anesthetist practice:
- Catherine Lawrence became the first nurse to administer anesthesia during the American Civil War. On the battlefield, she delivered ether to wounded soldiers under extreme conditions. That set an early and powerful precedent for nurse-led anesthesia care.
- Sister Mary Bernard Sheridan delivered her first anesthetic at St. Vincent Hospital in Erie, Pennsylvania, in 1877. She’s also recognized as one of the first documented nurses to skillfully administer anesthesia.
- Sister Mary Joseph Dempsey, a respected surgical assistant and nursing leader, founded the St. Mary’s Hospital School for Nurses in 1906. This program offered anesthesia training to both sisters and laywomen..
These pioneers didn't just fill a gap; they defined a new clinical role. Even without formal titles, they elevated anesthesia from a risky experiment to a safer, trusted practice.
Formalization of the CRNA Role in the 20th Century
By the early 1900s, the demand for skilled anesthesia providers had grown. And nurses who had mastered the skill were ready to formalize their role.
Through organized education, military service, and legal milestones, the groundwork for the Certified Registered Nurse Anesthetist (CRNA) profession took shape.
Here’s how the profession advanced.
Establishing Training Pathways
The early 1900s marked a turning point for nurse anesthesia education.
In 1909, Agnes McGee launched the first formal nurse anesthetist program at St. Vincent’s Hospital in Portland, Oregon. This laid the groundwork for structured anesthesia education in the United States.
A few years later, in 1915, Agatha Hodgins, a surgical nurse and anesthetist working at Lakeside Hospital in Cleveland, Ohio, founded the Lakeside Hospital School of Anesthesia.
While not the first, Hodgins’ program quickly set a new national standard. This program offered structured instruction in anatomy, pharmacology, and clinical anesthesia practice at a depth unmatched at the time.
Hodgins wasn’t just creating a curriculum. She was professionalizing the field: training nurses and physicians alike, and directly influencing the birth of the American Association of Nurse Anesthetists (AANA).
Shortly after, other institutions like Hopkins Nursing began establishing their own nurse anesthesia programs. This helped to expand access to formal training nationwide.
The concept of a "CRNA school" truly began to take shape during this period. Structured nurse anesthesia education spread quickly, giving rise to generations of graduates of nurse anesthesia programs with consistent, advanced skills.
This shift helped define nurse anesthesia as a distinct clinical nursing specialty, setting the profession on the path to national recognition.
Wartime Expansion and Clinical Authority
World War I and World War II became pivotal accelerators for the history of CRNA evolution.
During wartime, the demand for anesthesia providers skyrocketed, and nurse anesthetists were often the only available option on the frontlines.
Two influential figures who shaped nurse anesthesia during this period were:
- Mildred Irene Clark distinguished herself in WWII, overseeing anesthesia care in field hospitals across Hawaii and later influencing military nursing policies at large.
- Ruth Satterfield strengthened the profession from within the Army Nurse Corps. In 1941, she launched a formal anesthesia course at Fort Jackson, paving the way for structured CRNA education across the military.
Wartime urgency allowed CRNAs to demonstrate independent judgment, quick decision-making, and technical excellence under extreme conditions. These qualities would later support calls for full practice authority.
Legal and Regulatory Milestones
In 1934, CRNA Dagmar Nelson became the central figure in a landmark legal case defending the right of nurse anesthetists to practice.
After being sued for allegedly "practicing medicine without a license," Nelson prevailed. The court recognized anesthesia administration by trained nurses as legal, establishing an important precedent that protected the emerging CRNA profession.
This victory strengthened the professional standing of CRNAs and paved the way for the creation of their national association just a few years later.
The Rise of the AANA and Institutional Structure
As the nurse anesthesia profession grew, nurse anesthetists realized they needed more than clinical skills. They needed protection, advocacy, and official recognition.
That’s when they got organized and changed the game.
Creation and Mission of the AANA
In 1931, Agatha Hodgins led the creation of the National Association of Nurse Anesthetists (NANA), the first national organization representing nurse anesthetists.
By 1939, it evolved into the American Association of Nurse Anesthetists (AANA).
The AANA set standards for education, promoted certification, and defended practice rights. This laid the foundation for what would become the modern nurse anesthesia practice. It also launched the AANA Journal, a trusted publication for sharing clinical research, case studies, and new techniques. It still serves as a major resource for graduates of nurse anesthesia programs today.
Key insight: Headquartered in Park Ridge, Illinois, the AANA remains the profession’s strongest advocate, steering policy initiatives and pushing for broader clinical authority.
Long-Term Influence of the AANA
The AANA didn't stop at education. It also reshaped the legal and political aspects, elevating the visibility, autonomy, and credibility of CRNAs nationwide.
Some key milestones in leadership mark this evolution:
- John F. Garde, the first male president of the AANA, whose tenure helped broaden perceptions about gender diversity in the field.
- Goldie Brangman, a pioneer among African-American nurse anesthetists, was elected in 1973 as the AANA’s first Black president. She famously participated in the surgical team that saved Dr. Martin Luther King Jr.'s life after a stabbing attempt.
Through decades of strategic advocacy, education reform, and leadership development, the AANA positioned CRNAs as essential contributors to healthcare policy and innovation.
Academic and Certification Evolution
Clinical skills weren't enough. To meet the demands of modern surgery, the nurse anesthesia profession had to level up its educational foundation.
From Technical to Doctoral-Level Education
Early nurse anesthetists were trained mostly through hospital-based programs like the one at Lakeside Hospital in Cleveland, Ohio, founded by Agatha Hodgins in 1915.
But healthcare changed, and CRNA education had to change with it.
Today, all new CRNAs must complete a doctoral program: either a Doctor of Nursing Practice (DNP) or a Doctor of Nurse Anesthesia Practice (DNAP).
This shift aligns CRNAs with other Advanced Practice Registered Nurses (APRNs), such as nurse practitioners, clinical nurse specialists, and certified nurse midwives.
Leading institutions like Hopkins Nursing helped pioneer this transition. They turned nurse anesthesia educational programs into robust university-based degrees focused on clinical excellence and leadership.
Even getting accepted into a program became tougher. Resources like the CRNA School Prep Academy (CSPA) emerged to help candidates tackle the demanding admissions process. This reflects the rising standards for the recruitment of nurse anesthetists.
Students today are expected to demonstrate both clinical readiness and leadership potential. This is a big leap from early 20th-century apprenticeship models.
Certification and Ongoing Education
Completing a degree in nurse anesthesia is just the beginning.
New CRNAs must pass the rigorous National Certification Examination (NCE) administered by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA).
But certification doesn’t end there.
Through the Continued Professional Certification (CPC) program, registered nurse anesthetists must engage in ongoing education, clinical practice assessments, and professional development cycles.
Staying sharp is essential, and the AANA Journal plays a huge role here. It gives CRNAs access to the latest clinical evidence, best practices, and case studies that directly impact providers of anesthesia care across all practice settings.
Today, CRNAs aren’t just meeting expectations. They’re raising them.
CRNAs Today: Independent Providers in an Evolving System
Today’s CRNAs aren’t just assistants. They are critical providers of anesthesia care across hospitals, surgical centers, and rural clinics nationwide.
And their role keeps expanding.
Scope of Practice and Autonomy
The scope of practice for CRNAs isn’t uniform across the United States. While some states still require physician supervision, others grant CRNAs full authority to deliver anesthesia services independently. This allows them to practice at the top of their training.
As of the latest available updates, at least 22 states officially allow CRNAs to practice independently without physician supervision, according to the American Association of Nurse Anesthetists (AANA).
However, some sources, like NurseJournal and Medicus, cite higher numbers, up to 32 states, including California, Arizona, and Washington, that have opted out of the federal physician supervision rule.
Since information may vary by source and timing, it's best to check the AANA’s interactive state map here for the most current and accurate guidance based on your location.
In rural hospitals and underserved regions, CRNA autonomy is essential. However, rural CRNA recruiting remains a major hurdle.
A study published in the Journal of Rural Health reported a harsh reality: 58.1% of rural counties have no Certified Registered Nurse Anesthetists, and over 81.2% lack an anesthesiologist. That’s why strategic recruitment is critical to maintaining access to safe anesthesia care.
CRNAs as APRNs: Their Role in Advanced Nursing Practice
CRNAs are one of four recognized categories under the Advanced Practice Registered Nurse (APRN) designation, alongside nurse practitioners, clinical nurse specialists, and certified nurse midwives.
This classification isn't just academic. It solidifies their legal authority, reinforces their scope of independent practice, and ensures their training matches national standards for advanced clinical providers.
Many CRNAs pursue additional leadership roles within healthcare organizations, regulatory boards, and educational institutions. By doing so, they extend their influence well beyond the operating room. Their advanced education requirements, including earning a degree in nurse anesthesia, place them among the most highly trained clinicians in the APRN community.
P.S: Want to see how CRNAs compare to physician anesthesiologists in training, duties, and outcomes? Check out our full comparison: CRNA vs. Anesthesiologist.
Evidence-Based Outcomes
Clinical studies consistently show what CRNAs have known for decades. Here’s what the data says:
- AANA Journal (2003): Medicare patients had similar surgical mortality rates whether anesthesia was provided by CRNAs, anesthesiologists, or mixed teams. No significant differences were found.
- Nursing Research (2007): Complication rates during cesarean deliveries were just as low with CRNAs as with physician anesthesiologists.
- Health Services Research (2009): Hospitals staffed with only CRNAs delivered maternal outcomes comparable to those staffed only with anesthesiologists.
- Health Affairs (2010): States that let CRNAs work independently saw no increase in patient risk or mortality after opting out of the federal supervision rule.
- Cochrane Review (2014): A global review found no evidence that physician-delivered anesthesia leads to better patient outcomes than CRNA-delivered anesthesia.
- Journal for Healthcare Quality (2015): CRNAs safely performed fluoroscopic-guided epidural injections with complication rates matching those reported for physicians.
- Medical Care (2016): Research on anesthesia scope of practice laws found no measurable impact on complication rates when CRNAs practiced independently.
These outcomes aren’t isolated cases; they’re consistent across specialties, settings, and patient populations. CRNAs continue to prove they are safe, effective, and essential providers of anesthesia care nationwide.
Challenges and Future Opportunities for CRNAs
The future for CRNAs is bright, but it comes with new challenges and opportunities.
As healthcare evolves, CRNAs must continue advancing their profession, embracing innovation, and adapting to new patient care models.
Policy and Professional Tensions
Despite decades of strong outcomes, CRNAs still face resistance from parts of organized medicine. Some physician groups continue to push back against full CRNA autonomy, citing differences in training compared to physician anesthesiologists.
This ongoing reluctance of physicians fuels legal and political tensions. That’s why sustained advocacy, through initiatives like the AANA Mid-Year Assembly and direct engagement on Capitol Hill, remains critical to defending CRNA practice rights.
Technological Integration and Innovation
CRNAs aren’t just adapting to technology; they’re driving its adoption across anesthesia practice. Advanced monitoring systems, real-time imaging, AI-assisted anesthesia management, and telehealth consults are becoming daily tools.
By embracing these innovations, CRNAs fine-tune anesthesia delivery, improve outcomes, and stay at the cutting edge of perioperative care.
Expanding Patient-Centered Care Models
Healthcare is shifting toward patient satisfaction, not just clinical outcomes. CRNAs are leading this change by designing anesthesia experiences that prioritize communication, personalization, and recovery comfort.
In fields like outpatient surgery, labor and delivery, and trauma care, they’re building models that meet today’s higher standards for quality and accountability.
Workforce Growth and Emerging Career Paths
Demand for CRNAs is projected to surge over the next decade. Several trends are fueling this rise:
- Hospitals are expanding anesthesia teams to meet growing surgical volumes.
- Rural and underserved areas increasingly depend on CRNAs as primary anesthesia providers.
- Travel CRNAs are emerging as a fast-growing segment, filling staffing gaps nationwide.
Beyond clinical practice, opportunities in research, education, leadership, and policy advocacy continue to grow. The need for strong nurse anesthesia educational programs and ongoing investment in the recruitment of nurse anesthetists has never been greater.
The profession isn’t just thriving; it’s reshaping the future of anesthesia care.
Key insight: If you want to see how CRNAs are leading changes in salaries, technology adoption, and independent practice models, don’t miss our full breakdown of CRNA industry trends in 2025.
Enhance Your Team with Exceptional CRNAs
The journey of the nurse anesthesia profession proves one thing: progress doesn't happen by accident. It takes decades of advocacy, education, and clinical excellence to change the system, and CRNAs did exactly that.
Today, CRNAs stand as key clinical providers, shaping the future of anesthesia care with skill, autonomy, and leadership.
At AAG/H, we recognize the critical role CRNAs play. That’s why we stand ready to support healthcare systems in the recruitment of nurse anesthetists who continue to push the boundaries of excellence.
Looking for exceptional CRNA talent to strengthen your anesthesia team? Get in touch with AAG/H today to see how we can help.
Frequently Asked Questions (FAQs)
Who was the first nurse to specialize in anesthesia?
Several trailblazers helped shape early nurse anesthesia. Catherine Lawrence administered ether during the Civil War, becoming the first nurse known to deliver anesthesia in combat.
Meanwhile, Sister Mary Bernard Sheridan delivered anesthesia at St. Vincent Hospital in 1877. Lastly, Alice Magaw became known as the "Mother of Anesthesia" for her groundbreaking work in patient safety.
What is the oldest CRNA program?
The first formal nurse anesthetist program was launched in 1909 at St. Vincent’s Hospital in Portland, Oregon, led by Agnes McGee. But the Lakeside Hospital School of Anesthesia, founded by Agatha Hodgins in 1915, is often credited with setting the national standard for formalized nurse anesthesia education.
What is the history of CRNA service in the military?
CRNAs have been stepping up on the battlefield since World War I. During World War II, leaders like Mildred Irene Clark and Ruth Satterfield proved that nurse anesthetists could deliver critical anesthesia care under extreme, combat-zone conditions. And that was often without direct physician support.
When did the AANA start, and what was its original name?
The American Association of Nurse Anesthetists (AANA) was founded in 1931, originally named the National Association of Nurse Anesthetists (NANA). Its mission? To advance education, set practice standards, and defend CRNA rights across the U.S.
Are CRNAs considered APRNs?
Yes. Certified Registered Nurse Anesthetists (CRNAs) are one of four recognized Advanced Practice Registered Nurse (APRN) roles. The other three are nurse practitioners (NPs), clinical nurse specialists (CNSs), and certified nurse-midwives (CNMs).
Their APRN status gives CRNAs full recognition for their doctoral-level education, clinical expertise, and authority to practice independently in many states.
Do CRNAs advocate for their profession?
Absolutely, yes. CRNAs are strong, vocal advocates for their profession, especially through the AANA Mid-Year Assembly on Capitol Hill. They work directly with lawmakers to defend full practice authority and make sure healthcare policies recognize their proven safety and effectiveness.
Who was the first Black president of the AANA?
Goldie Brangman broke barriers in 1973 when she became the first Black president of the AANA. She also helped save Dr. Martin Luther King Jr.'s life after an assassination attempt; a historic contribution to both medicine and civil rights.
Why do CRNAs now need a doctorate?
Since 2025, all new CRNA graduates must complete a doctoral degree in nurse anesthesia (DNP or DNAP). This move aligns CRNA education with national APRN standards. Also, ensure today's CRNAs are fully prepared to deliver complex, high-quality anesthesia care across every healthcare setting.
