AANA Celebrates 95 Years of Defining Standards in Nurse Anesthesiology

The American Association of Nurse Anesthesiology (AANA) began on June 17, 1931, when 40 nurse anesthetists from 12 states gathered in a classroom at Lakeside Hospital in Cleveland. 

The meeting unfolded on a busy day for what was then Western Reserve University, with graduation exercises underway at Severance Hall and the dedication of University Hospitals taking place the same day. As Virginia S. Thatcher later wrote in History of Anesthesia with Emphasis on the Nurse Specialist, the nurse anesthetist meeting “went by unnoticed.” 

The decision made there did not. 

Agatha C. Hodgins, a Cleveland nurse anesthetist and AANA’s founding president, called the group to order at 2:30 p.m. Kay Sheehan was elected secretary pro tem. Gertrude Fife made the motion, seconded by Aida Allwein: “That a National Association of Nurse Anesthetists be formed.” The motion carried, and by 5:30 p.m., the meeting had adjourned.

Today, Certified Registered Nurse Anesthetists (CRNAs), also known as nurse anesthesiologists, practice in a profession built on advanced education and clearly defined professional standards. In 1931, those standards were still taking shape. 

Across the country, preparation varied widely. Some practitioners completed formal anesthesia programs; others trained with qualified instructors or gained experience in hospital settings. At the same time, nurse anesthetists faced challenges to their right to practice and pressure to define their role in healthcare. 

Patients and hospitals needed a clearer way to evaluate who was prepared to provide qualified anesthesia care, and Hodgins believed nurse anesthetists needed to organize nationally to help define those standards. 

That effort began taking shape in Cleveland before the 1931 meeting. Hodgins had helped build a local network through the Lakeside Hospital School of Anesthesia and its alumnae association. At an earlier meeting of Lakeside alumnae, she had presented a plan for a national association of nurse anesthetists. 

Local and state groups had formed before the 1930s. Some gave nurse anesthetists a place to discuss cases and learn from one another. Others formed in response to more urgent threats. In California, nurse anesthetists organized after facing efforts to outlaw their practice. Thatcher noted that, as nurse anesthetists faced pressure over their role, some hospital administrators and surgeons asked, “What sort of organization do you have to protect your interests?” 

In 1930, one year before the founding meeting, Hodgins wrote that improvement was “in the hands of the nurse anesthetists themselves.” If the work was to be safeguarded, she argued, nurse anesthetists needed to organize, establish educational standards and support stronger anesthesia education. They also needed to pursue state registration and continue improving the quality of their work through study and research. The goal, she wrote, was “still greater protection to the patient.”

Hodgins explained in 1932 that the new association was responding to “insufficient knowledge of, and proper emphasis on, the importance of education.” Nurse anesthetists, she wrote, needed to “define and help maintain the status of the educated nurse anesthetist” and establish the standards necessary before any nurse was legally entitled to administer anesthetic drugs. 

She was direct about the issue, writing that nurses with “little or no education” in anesthesia were creating “complex and disturbing difficulties.” The answer, in her view, was a classification that protected “all concerned.” 

By 1933, the association was beginning to put that vision into action. In Watchful Care: A History of America’s Nurse Anesthetists, Marianne Bankert described education as the most pressing practical issue facing nurse anesthetists at the first annual meeting of the National Association of Nurse Anesthetists. 

“We must … make an earnest effort to standardize the education of the nurse anesthetist,” Fife said. 

She called for the association to investigate schools of nurse anesthesia, create a list of accredited schools and establish national board examinations. The goal was to give hospitals and surgeons reliable information about the preparation and qualifications of nurse anesthetists seeking positions. 

Current nurse anesthesiology educational programs range from 36 to 51 months, and all programs are approved to award doctoral degrees for entry into practice. CRNAs maintain certification through the National Board of Certification and Recertification for Nurse Anesthetists and renew their credential every four years. 

The profession has evolved dramatically and with intention, but AANA’s earliest records point to a clear founding purpose: nurse anesthetists organized to define the education, preparation, and standards their profession required. 

What began quietly in a Cleveland classroom became one of the defining moments in nurse anesthesiology. Ninety-five years later, that decision continues to shape the profession’s commitment to rigorous education, clinical standards and patient-centered safety and care. 

Historical information in this article was drawn from AANA archival materials, including Marianne Bankert’s Watchful Care: A History of America’s Nurse Anesthetists, Virginia S. Thatcher’s History of Anesthesia with Emphasis on the Nurse Specialist, and original records from AANA’s 1931 organizational meeting.