(Sacramento, CA)—California Association of Nurse Anesthesiology (CANA) President Emily Francke, CRNA today issued the following statement commending the California Board of Registered Nursing (BRN) for their unanimous vote in support of AB 876 (Flora) during their board meeting on March 20, 2025:

“AB 876 makes it abundantly clear how critical a role Certified Registered Nurse Anesthetists / Anesthesiologists (CRNAs) play in California. The BRN’s unanimous support for this crucial piece of legislation underscores their commitment to patient safety and strengthening California’s anesthesia workforce.

“Despite our longstanding independence, special interests are purposefully exploiting misinterpretations of state statute to challenge CRNAs’ established practice, risk patient safety, and undermine patient access to timely and affordable anesthesia care. By providing legislative clarity and codifying existing statutes in one place, AB 876 will help avoid confusion, protect patient access, and prevent costly and unnecessary disruptions in anesthesia care.

“CANA remains dedicated to advocating for policies that safeguard the ability of CRNAs to practice to the full extent of their education and training. Ahead of the March 20 meeting, more than 200 CRNAs contacted the BRN to ensure they understood the urgency and critical importance of this legislation. Together, under the umbrella of CANA, California CRNAs will remain focused on expanding access to anesthesia care while ensuring that patients receive the highest quality of care possible.”

— A legacy of care and expertise

by Emily Francke, CRNA

When we think of medical breakthroughs, discoveries like penicillin or the polio vaccine often come to mind. Anesthesia is another transformative advancement, turning once-impossible surgeries into routine procedures. At the heart of this progress are Certified Registered Nurse Anesthesiologists/Anesthetists (CRNAs) — advanced practice providers who have been administering safe, expert anesthesia care and pain management services for more than 150 years.

Due to a recent debate over regulations proposed by the District of Columbia’s Department of Health on the question of whether CRNAs can use the descriptive term “nurse anesthesiologist,” I’m providing historic and clarifying context for how CRNAs helped pave the path for the profession as a whole.

The Pioneering Path of Nurse Anesthesiologists

Nurse anesthesiology dates back hundreds of years. Sister Mary Bernard Sheridan became one of the first documented nurses to skillfully administer anesthesia in the late 1800s at St. Vincent’s Hospital in Erie, Pennsylvania. She was part of a wave of nurses who developed the expertise needed to safely administer anesthesia at a time when the science of anesthesiology was still in its infancy. During this time, surgeons routinely chose nurses to give anesthesia to patients.

Nurse Alice Magaw, who was dubbed the “Mother of Anesthesia” by Charles Mayo, MD, published multiple articles in peer-reviewed journals of medicine between 1899 and 1906, detailing the technical aspects of administering open drop ether anesthesia. Her documentation was used as evidence to support a landmark legal decision allowing nurses to be employed as anesthesia providers, and her commitment to patient safety resulted in delivering anesthesia for 14,000 surgeries without a single fatality. Magaw established the patient-centered approach, prioritizing diligent physiological monitoring and calm reassurance that continues to inspire and define CRNA practice to this day.

Fast forward to the early 20th century to Agatha Hodgins, a nurse who pioneered nitrous oxide anesthesia while working as chief anesthetist for surgeon George Crile, MD. Hodgins established the nation’s first formal postgraduate program in anesthesia, Lakeside Hospital School of Anesthesia, in 1915, and her leadership laid the foundation in 1923 for what is now the American Association of Nurse Anesthesiology (previously the American Association of Nurse Anesthetists).

Trailblazers like Magaw and Hodgins mastered technical skills while prioritizing a holistic approach to patient care — an ethos that remains central to nurse anesthesiology today and helped position CRNAs as leaders in opioid-free pain management. Their multifaceted approach to pain, rather than a procedural or opioid-based approach, incorporates alternative medicine and behavioral health techniques to ensure both the physical and psychological components of pain are addressed.

From founding practice techniques to exemplifying effective leadership in nursing, anesthesiology, medical education, and pain management, CRNAs have administered anesthesia independently for centuries — even longer than the term “anesthesiologist” and well before “anesthesiology” became a formal specialty.

A Fitting Descriptor

Today, many healthcare professionals use the term -ologist, which stems from ology, meaning “the study of” to highlight their specializations in key areas, like epidemiologists, audiologists, virologists, and speech-language pathologists, to name a few. Similarly, “nurse anesthesiologist” reflects CRNAs’ advanced education in the science of anesthesia, their specialized and extensive clinical training, and commitment to safe, independent administration of anesthesia.

The descriptor “nurse anesthesiologist” also signals to patients that CRNAs approach anesthesia care from the lens of nursing, which is founded in compassion, trust, and transparency — the very traits that result in the profession being ranked as the most honest and ethical 23 years in a row, according to Gallup.

Recognizing CRNAs as nurse anesthesiologists aligns the profession with their indispensable role in patient care, from anesthesia to pain management. It also reflects the fact that the standard of care for anesthesia services delivered by a nurse or physician is met by CRNAs.

Overall, the descriptor mirrors the ongoing evolution of professional terminology, representing improvements in education, experience, and responsibilities (i.e., pharmacists graduating with PharmD degrees; physician assistants being recognized as “physician associates”; the evolution of the study of pain medicine; etc.). It also fosters mutual respect and clarity among CRNAs, physician anesthesiologists, and other healthcare professionals, ensuring collaboration based on excellence, evidence-based practices, and interprofessional teamwork.

Extensively Educated and Trained

CRNAs were among the first healthcare providers to prioritize continuing education, a commitment that remains a cornerstone of their professional development. This dedication to lifelong learning has helped CRNAs maintain their reputation as highly skilled, adaptable, and responsive practitioners in the ever-evolving fields of anesthesiology and pain management.

To become a CRNA, an individual must first become a registered nurse with a Bachelor of Science in Nursing or other appropriate field, and pass a national nursing board certification exam. After this, candidates fulfill 1-to-3+ years of full-time critical care nursing experience.

Next, a CRNA candidate must enroll in an accredited Doctoral Nurse Anesthesiology Program (Master’s programs were previously accepted) and complete 3 years of didactic and clinical training. With over 24 months of full-time clinical education, nurse anesthesia residents train in all aspects of the field, inclusive but not limited to pediatrics, cardiology, pain, transplant, outpatient, and hospital-based surgery.

Honoring the Past, Embracing the Future

By the early 20th century, CRNAs became vital to anesthesia care and services, particularly in rural and underserved communities. And during World War II, CRNAs were essential providers on the front lines, showcasing their ability to work independently under pressure.

This is still true today, with CRNAs continuing to be the primary providers of anesthesia care to U.S. military personnel and our nation’s veterans. By providing anesthesia and chronic pain management services independently or collaboratively, CRNAs help ensure that patients receive seamless, high-quality care. In fact, numerous independent studies, including a 2010 study from Health Affairs, show that CRNAs administer anesthesia with the same safety and efficacy as physician anesthesiologists.

The legacy of CRNAs is built on resilience, expertise, and compassion, and CRNAs continue to shape modern healthcare today, ensuring safety and efficacy.

Emily Francke, CRNA, is president of the California Association of Nurse Anesthesiology.

Article Source: https://www.medpagetoday.com/opinion/second-opinions/114436

(Sacramento, CA) – Today, Assemblymember Heath Flora (R-Ripon) introduced his California Anesthesia Access Package, a comprehensive legislative package to increase access to high-quality and coordinated anesthesia services and ensure uninterrupted care for Californians throughout the state.

“For decades, Certified Registered Nurse Anesthetists/Anesthesiologists (CRNAs) have practiced independently in rural and urban areas of the state to ensure Californians have access to quality services,” said Emily Francke, CRNA, President of CANA. “Unfortunately, this last year saw unprecedented attacks on our profession that directly impacted Californians’ ability to receive the timely, high-quality anesthesia care they need and deserve. Assemblymember Flora’s legislative package is urgently needed to prevent care disruptions, improve patient safety, and ensure CRNAs can continue their 40-year legacy of delivering high-quality services in the Golden State.”

Assemblymember Flora’s California Anesthesia Access Package (AB 876 and AB 1215) will improve care quality, promote interdisciplinary collaboration, and better address provider redundancies. Specifically: AB 876 seeks to clarify existing statutes within the Nurse Anesthetist Act to safeguard patients’ access to quality and timely anesthesia care and improve health outcomes; AB 1215 aims to amend California Code Regulations Title 22 to ensure CRNAs are represented on medical boards, thereby improving patient-centered care and ensuring anesthesia services are never unnecessarily disrupted.

“Current regulations are outdated, overlook significant contributions of non-physician providers, and deprive health care facilities of the ability to comprehensively assess the quality of anesthesia care provided to patients,” said Assemblymember Flora. “Never again will my constituents – nor any Californians – be negatively impacted by unnecessary care disruptions. Through these two important pieces of legislation, California will create a more collaborative, accessible, and efficient anesthesia environment for providers and residents alike.”

In 2024, nearly 1,000 surgeries were unnecessarily canceled due to facility bylaws failing to align with CRNA practice authority, disproportionately affecting Medi-Cal and Medicare patients. By clarifying existing regulations, California can increase access to anesthesia services, improve health care facilities’ governance and decision-making, promote patient-centered care, prevent misinterpretations, and strengthen interdisciplinary collaboration.

(Sacramento, CA) – Today, the California Association of Nurse Anesthesiology (CANA) brought together legislators, health care experts, policymakers, and community advocates to tackle one of California’s most pressing public health challenges. CANA’s 2025 Opioid Epidemic Symposium: Identifying Obstacles, Inspiring Solutions featured powerful testimonials, practical strategies, and innovative approaches to help address the crisis in California, including the role of Certified Registered Nurse Anesthesiologists (CRNAs) in providing opioid-free pain management techniques.

“Today’s Symposium demonstrated the critical importance of partnerships to reduce care gaps and advance meaningful recovery policies,” said Emily Francke, CRNA and President of CANA. “California CRNAs are at the forefront of compassionate, evidence-based pain management, working collaboratively with physicians, policymakers, and community leaders to ensure patients receive exceptional care. By working together, we can expand access to innovative solutions, protect those at risk of substance use disorder (SUD), and save lives across the state.”

The all-day event, held during National CRNA Week (January 19-25) at the Secretary of State’s Auditorium, included expert policy panels focused on effective strategies to combat the opioid crisis and areas in need of improvement, such as empowering youth to make informed decisions and prioritize their mental well-being.

“My 14-year-old son tragically died in 2020 after unknowingly ingesting a counterfeit, fentanyl-laced pill,” said Amy Neville, President of the Alexander Neville Foundation. “Alexander’s story is a heartbreaking reminder of the opioid crisis’ widespread reach and that we must do more to protect our youth. Prevention and education are critical tools in this fight.”

The event also emphasized how California CRNAs can help prevent SUD by providing safe and effective opioid-free pain management solutions. A 2018 Stanford University School of Medicine study published in JAMA Internal Medicine found an alarming link between opioid prescriptions for routine procedures, like wisdom teeth extractions, and SUD risk in teens and young adults. By offering opioid-free pain management, in addition to Medication Assisted Treatment (MAT), CRNAs have the ability to help reduce the risk of long-term opioid misuse for first-time users and provide evidence-based recovery techniques for those living with SUD.

“The opioid epidemic impacts every community in California,” said Assemblymember Heath Flora (R-Ripon), Vice Chair of the Business and Professions Committee. “By empowering health care providers, like CRNAs, to expand access to proven care techniques and ensuring collaboration among our local leaders, we can bridge resource gaps, implement effective strategies, and better protect our neighbors – particularly those in rural and underserved regions of the state.”

Through open dialogue and innovative thinking, the Symposium encouraged diverse perspectives on tackling the opioid crisis.

“Every day I see firsthand the devastating toll the opioid epidemic takes on our communities. To truly combat this epidemic and seek justice for victims, we need comprehensive tools, including enhanced prevention efforts, effective treatment programs, and strong partnerships that prioritize public safety and the wellbeing of those impacted,” said Nina Salarno, Modoc County District Attorney and Founder of Crime Victims United. “Together, we can forge a path to recovery and resilience for our families and neighborhoods.”

By working together to implement sustainable, evidence-based solutions, California policymakers, health care providers, and community leaders can better address the immediate challenges of opioid misuse while promoting long-term recovery and prevention strategies.

“We cannot overstate the importance of meeting people where they are and providing the help they need when they need it – whether it’s treatment, recovery support, or lifesaving interventions,” said Shasta County Sheriff Mike Johnson. “This means balancing compassion with responsibility to ensure we’re offering the support needed to break the cycle of addiction while maintaining public safety.

(December 6, 2024)—Assemblymember Heath Flora (R-Ripon) today issued the following statement in response to revised guidance by the Centers for Medicare & Medicaid Services (CMS) for surveyors and health care providers regarding immediate jeopardy:

“On behalf of my constituents, I commend CMS’ decision to revise their immediate jeopardy (IJ) guidelines. By introducing more precise and evidence-based criteria, health care facilities in California can address safety concerns without undue overreach. The revisions promote fairness and accountability in regulatory oversight, and should help reduce the risk of arbitrary enforcement that can destabilize health care facilities and jeopardize access to care.

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