2. It is essential… Ira P. Gunn, MLN, CRNA, FAAN

3. OBJECTIVES  Identify the key historical legal cases that contributed to the definition and preservation of nurse anesthesia practice.  Describe the significant persons, dynamics, and outcomes of each case  Discuss the impact of the historical cases on the practicing CRNA  Discuss the role of the CRNA in practice preservation and interdisciplinary partnership.

4. Brief History…

5. Lakeside Hospital Dr. George W. Crile Dr. George Crile and staff The Lakeside Unit January 13, 1915 Agatha Hodgins Founder of AANA 1877-1945

6. THE FIRST CHALLENGE VS Dr. Francis H. McMechan Fit for Duty? Agatha Hodgins Neuilly-sur-Seine, France World War I

7. IMPACT  First anti-nurse anesthesia activity  Medicine, Licensure, & Supervision  Precedent for challenge

8. Frank Vs. South  KY House Bill 214  Dentist Supervision  Education & Training Good Point!

9. Chalmers-Francis Vs. Nelson Dagmar Nelson, CRNADr. Verne Hunt

10. Impact  Tested and Preserved Nurse Anesthesia Practice *first nursing specialty  Medicine vs. Nursing  First NANA (AANA) advocacy

11. Bahn Vs. NME, Inc. Antitrust Cases Vinod Bhan, CRNA (center) with attorneys

12. Impact  Nurse & Physician Providers  Right to bring suit  Protection from monopoly *other cases

13. Brave Advocates… … Discuss the issues…

14. “We must provide them (future providers) with the opportunity to develop, live up to, and contribute to the same proud professional identity and high quality service ethic that has brought us (CRNAs) so far and which will sustain our presence into the future.” - Ira P. Gunn

15. Our role…  Professionalism  Healthcare Policy  AANA & PAC What else…?

16. References Bankert, M. (1989). Watchful Care: History of America's Nurse Anesthetists. New York, New York : The Continuum Publishing Company. Becker, K. (1998). A Brief History of Nurse Anesthesia Practice. Seminars in Perioperative Nursing, 7 (1), 80-85. Blumenreich, G., & Markham, J. (1985, December ). Bhan vs. NME Hospitals, Inc. Antitrust Standing of CRNAs Sustained. Journal of American Association of Nurse Anesthetists, 526-527. Gunn, I. P. (1999). Issues and Perspectives Affecting CRNA Practice: Professional Identity and Historical Roots. CRNA: The Clinical Forum For Nurse Anesthetists, 10 (1), 41-47. Keeling, A. A Brief History of Advanced Practice Nursing in the United States. In A. Hamric, J. Spross, & C. Hanson, Advanced Practice nursing: An Integrative Approach (4 th ed.). St. Louis, Missouri : Saunders Elsevier. Kentucky State Medical Association. (1917, February 1). Frank Vs. South. Kentucky Medical Journal. Koch, B. E. (2010). Nurse Anesthesia: A History of Challenge. In J. Nagelhout, & K. Plaus, Nurse Anesthesia (4th ed.). St. Louis, Missouri : Saunders Elsevier. Matsusaki, T., & Sakai, T. (2011). The Role of Certified Registered Nurse Ansthestists in the United States. Journal of Anesthesia, 25, 734-740. doi: 10.1007/s00540-001-1193-5 McAuliffe, M., & Koch, K. (2011). Imagining in Time: Ira P. Gunn Educator, Advocate, Legend. Journal of American Association of Nurse Anesthetists, 79 (6), 459-463. Meeusen, V., Zundert, A., Knape, H., & Gatt, S. (2012). History of non-medical professionals in anaesthesia. The Journal of Perioperative Nursing in Australia, 25 (1), 48-52. Motenko, N. P. (2000, August). One More Battle In Competetive Struggle. Journal of American Association of Nurse Anesthetists, 68 (4), 291-294. Mund, A. R. (2012). Policy, Practice, and Education. The Journal of American Association of Nurse Anesthetists, 80 (6), 423-426. Pennsylvania Association of Nurse Anesthetists. (n.d.). Position Statement From the Pennsylvania Association of Nurse Anesthetists on HB 1256. Retrieved February 16, 2013, from PANA.org URL: www.pana.org/manuscripts/pana%20white%20paper%2010- 2007.pdf Thatcher, V. S. (1953). History of Anesthesia: With Emphasis on the Nurse Specialist. Philadelphia, Pennsylvania: J.B. Lippincott Company. Van Nest, R. L. (2006). The Life and Trial of Dagmar Nelson Part 2. The Journal of American Association of Nurse Anesthetists, 74 (4), 261-265. Van Nest, R. L. (2006). The Life and Trial of Dagmar Nelson Part I. The Journal of American Association of Nurse Anesthetists, 74 (3), 183-187. Wilson, W. O. (2012). Nurse Anesthesia: A Past, Present, and Future Perspective. Nursing Clinics of North America, 72 (2), 215-223. doi: 10.1016/j.cnur.2012.02.010