Nurses Were the First Anesthesia Providers: CRNA History

Updated August 2026

A CRNA is a Certified Registered Nurse Anesthetist: an advanced practice registered nurse who administers anesthesia and manages patients before, during, and after procedures. It is the highest-paid nursing specialty the Bureau of Labor Statistics tracks, and one of the oldest advanced practice nursing roles in the country.

For the full definition, salary, and route in, start with our guide to what a CRNA is. This piece goes deeper on one part of that story: where the profession came from, and why the history still shapes the questions you get asked in interviews.

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CRNA History + Types of Anesthesia

The full lesson: how nurse anesthesia began, how the profession developed, and a working breakdown of general, regional, MAC, and local anesthesia.

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What does a CRNA do day to day?

A CRNA manages the entire anesthetic. That means:

• Before. Reviewing the chart and history, interviewing the patient, assessing the airway, and building the anesthetic plan.
• During. Inducing anesthesia, securing the airway, titrating agents, managing hemodynamics and ventilation, and responding to whatever the case does.
• After. Emergence, extubation, handoff to PACU, and managing post-operative pain and nausea.

CRNAs work in operating rooms, obstetric units, pain clinics, endoscopy and interventional suites, and dental and outpatient surgery centres. In much of rural America they are the only anesthesia provider in the building.

Were nurses really the first anesthesia providers?

Yes. This surprises people, and it is worth knowing if you are asked in an interview why you chose the nursing route.

Nurses were administering anesthesia in the United States in the 1800s, well before anesthesiology existed as a physician specialty. Nurse anesthetists worked in the Civil War era, and the role developed substantially through the World Wars, where nurse anesthetists provided the majority of anesthesia care to wounded soldiers.

The professional organisation that became the AANA was founded in 1931, and formal certification followed. So nurse anesthesia is not a newer offshoot of physician anesthesiology. It ran in parallel, and it started first.

What are the types of anesthesia?

• General anesthesia. The patient is fully unconscious, usually with a secured airway and controlled ventilation.
• Regional anesthesia. A region of the body is numbed with a nerve block, spinal, or epidural. The patient may be awake or sedated.
• MAC (Monitored Anesthesia Care). Sedation with monitoring, short of general. The provider can convert to general if the case requires it.
• Local anesthesia. A small area numbed directly, often without an anesthesia provider present at all.

Most CRNAs deliver all of the first three routinely, and the mix depends heavily on practice setting.

How do you become a CRNA?

Four steps, and the middle one takes the longest.

1. Become a registered nurse with a BSN, or an ADN plus a bachelor's degree.
2. Work at least one to two years in an adult ICU building high-acuity experience.
3. Complete an accredited doctoral nurse anesthesia program, a median of 36 months.
4. Pass the National Certification Examination.

Realistically that is seven to eight years from starting nursing school. Our full guide to how to become a CRNA walks through each stage, and if you are weighing the route against other options, CRNA vs NP compares them directly.

Why does the history matter for your application?

Because programs ask about the profession, and an applicant who understands where nurse anesthesia came from answers scope-of-practice questions much better than one who does not.

It also shapes how you talk about the care team. Knowing that nurse anesthesia developed in parallel with physician anesthesiology, rather than beneath it, lets you discuss practice models factually and without defensiveness. Committees notice that.

Our Final Thoughts

If you are early enough that you are still asking what a CRNA is, you are in a genuinely good position. The people who struggle are the ones who discover the ICU requirement two years into a career that did not build toward it.

Find out what the programs near you require now, and work backward from there.