History of Advanced Practice Nursing
In our past, lies our future
According to Hamric, advanced practice nursing is, “ the patient-focused application of an expanded range of competencies to improve health outcomes for patients and populations in a specialized clinical area of the larger description of nursing.” Advanced Practice Nurses (APN) includes Certified Nurse Anesthesiologists, (CRNA), Certified Nurse Midwives (CNM), Clinical Nurse Specialists (CNS) and Nurse Practitioners (NP). [ Hamric - 1]
In order to understand why and how advanced practice nursing evolved, it is necessary to understand the evolution of each practice area.
Nurse Administered Anesthesia
Chloroform anesthesia had been discovered in the 1830’s and along with Ether, come into use in surgery. In the Civil War (1860 – 1865) there was increased demand for anesthetics to care for the wounded. Chloroform was the anesthetic of choice because it was easily inhaled, acted quickly and was thus seen to be more efficient than ether Union records show that of more than 80,000 operations performed during the war only 254 were done without some kind of anesthetic. 
Due to the lack of formal schools of nursing, during the civil war professional nursing was provided by religious women – Catholic sisters and Lutheran deaconesses. When the civil war started, women from the North and South eagerly volunteered to help. In the North, minimal training was provided by Dorothea Dix, the newly appointed Superintendent of Army Nurses. In the South, the confederacy also relied on ‘healers’ among slaves who attended to illness and injuries.
Physicians , along with social restrictions of that day prevented direct, hands on care by females, so women volunteers helped by reading, writing letters and preparing and serving food. Even with these restrictions, a few women did assist physicians and surgeons. In 1861, Catherine S. Lawrence became the first nurse to provide anesthetics during the Civil War
After the war, Sister Mary Bernard in 1877 became the first nurse anesthetist at St. Vincent’s Hospital.
In 1893 Alice Magaw, known as the “Mother of Anesthesia”, began working for Drs. William J. and Charles H. Mayo at St. Mary’s Hospital. Alice Magaw wrote five articles between 1899 and 1906which were published in medical journals to detail the technical aspects of administering open drop ether anesthesia. Her research and clinical findings set new standards for safer delivery of anesthesia in those early days.
Sister Mary Barnard and Alice Magaw “Mother of Anesthesia”
Hamric, Ann B. , (2014). A Definition of Advanced Practice Nursing. Chapter 3 in Hamric, A., Hanson, C. M., Tracy, M.F. & Grady, E.T. Advanced Practice Nursing: An Integrative Approach