The Arizona Association of Nurse Anesthesiology (AZANA) boasts a rich history of commitment to advancing the practice and profession of nurse anesthetists throughout Arizona. Since its founding in 1956 by pioneering leaders such as Jeanette S. Boone, AZANA has evolved into a formidable organization marked by strong leadership, strategic advocacy, and remarkable legislative accomplishments.

Leadership and Achievements

Over the decades, leaders like Felgar Annabel R. (1969), Williams Mildred (1975), Richard Marks (1977), and a succession of dedicated individuals have shaped AZANA's mission and broadened its influence. The 1990s were characterized by a focused effort to enhance the association's advocacy role, notably during Edward H. Triebel's presidency in 1994 and Mary Ann Applegate's leadership through to 1999.

Critical Milestones

A pivotal moment in AZANA's history occurred in 1997 under the leadership of Theresa Bertolo, CRNA, MS, when the association committed to preserving the traditional practice of anesthesia amidst regulatory challenges. This period laid the groundwork for subsequent advocacy and legislative efforts that have shaped AZANA's role in Arizona.

Legislative Achievements

In 2011, CRNA practice was codified into statute, solidifying the role of CRNAs in Arizona and recognizing CRNAs as Advanced Practice Nurses (APRNs). However, this transition unintentionally eliminated CRNA prescriptive authority according to the DEA, causing issues for some CRNAs, particularly those working in federal facilities such as the VA or IHS.

In the summer of 2012, with support from the American Association of Nurse Anesthesiology, a strategic planning meeting was held with key CRNA leaders in Arizona. Goals were set to remove barriers to patient access to anesthesia care and CRNA practice over the next decade. These goals included forming a state CRNA PAC, removing or redefining “direction and presence” in statute, and ultimately achieving opt-out status for CRNA supervision in CMS rules.

CRNAs of Arizona PAC

The CRNAs of Arizona PAC was formed in 2013 as a small state PAC for CRNA advocacy. Over the years, due to the growing need for advocacy and the generosity of CRNAs recognizing the importance of political advocacy, the PAC has grown into the largest healthcare PAC in Arizona. A well-funded PAC allows for greater influence at the state capitol.

Sunrise Hearing and Legislative Efforts

In December 2015, the Arizona APRN Coalition presented their case at a Sunrise hearing at the Arizona state legislature to allow for an expansion in the scope of practice for all Advanced Practice Registered Nurses. The application was narrowly approved by the committee, marking a pivotal moment for CRNAs, Nurse Practitioners, Certified Nurse-Midwives, and Clinical Nurse Specialists in Arizona. Unfortunately, the APRN Coalition's bill proved too complicated and did not pass through the legislature. The Coalition decided to continue supporting each other, but each specialty would pursue legislative efforts independently in subsequent sessions.

SB1336 and Beyond

During the 2017 legislative session, SB1336 was passed, marking the most significant legislative achievement for Arizona CRNAs. This legislation restored prescriptive authority for CRNAs, redefined “presence” to reflect actual practice, and established surgeon immunity for CRNAs' actions. The new law states that a “physician or surgeon is not liable for the act or omission of a CRNA who orders or administers anesthetics.” This new law clarified that CRNAs could practice independently and do not require physician supervision.

Following this success, efforts continued to update statutes to reflect CRNA education and training and to remove unfriendly language in various government agencies, including discharge rules from facilities and at the dental board. Efforts in 2019 and 2020 focused on collaborating with medical societies on reimbursement issues and petitioning the Arizona Insurance Commission for fair treatment of APRNs.

Achieving Opt-Out Status

In March 2020, the ultimate goal of the 2012 strategic planning meeting was achieved when then-Governor Doug Ducey signed a letter to CMS, making Arizona the 19th opt-out state. It had been eight years since a US state had opted out. Since 2020, six more states have opted out of the CMS rule for CRNA supervision, demonstrating that Arizona leads the nation in CRNA advocacy.

Rebranding to Arizona Association of Nurse Anesthesiology

In 2022, the Arizona Association of Nurse Anesthetists (AZANA) rebranded itself as the Arizona Association of Nurse Anesthesiology. This update more accurately represents the high-quality, specialized care that Certified Registered Nurse Anesthetists (CRNAs) provide to patients and enhances clarity in the terminology used for the public.

Arizona Continues to Lead the Nation

From 2023 to 2024, AZANA pushed through legislative efforts and worked with regulatory agencies to implement advancements and improvements for CRNAs and patients in Arizona in an effort to access state funding for CRNA training in Arizona. Now, facilities that provide specialty training to CRNA residents in areas such as cardiac, pediatric, obstetric, and neurosurgery can apply for grant funding from the state. This new law will dramatically increase the workforce of anesthesia providers in Arizona. Arizona is the first state in the nation where facilities can receive state funding for the training of CRNAs.

In the world of dental anesthesia, SB1602 passed in 2023. SB1602 allowed for the rules to change to a first-in-nation, completely level playing field among anesthesia providers in dental offices (dentist anesthesiologists, physician anesthesiologists, and CRNAs) as well as adding many layers of safety for patients receiving sedation and anesthesia in dental offices in Arizona.

Conclusion

AZANA's journey reflects a dynamic history of leadership, advocacy, and community, underscored by a commitment to the highest standards of care and professional practice. Looking to the future, AZANA remains dedicated to championing the role of nurse anesthesiologists, advocating for supportive policies, ensuring the highest quality of anesthesia care for patients across Arizona, and leading the nation in efforts to advance and protect CRNA practice.