practitioners, including u.s. navy ships at sea. they also provide anesthesia for the veterans administration and public health service medical facilities. during world war i, america's nurse anesthetists cared for troops in france. from 1914 to 1915, three years prior to america entering the war, dr. george crile and nurse anesthetists agatha hodgins and mabel littleton served in the lakeside unit at the american ambulance at neuilly-sur-seine in france. in addition, they helped train the french and british nurses and physicians in anesthesia care. in 1917, the american participation in the war resulted in the u.s. military training nurse anesthetists for service. the army and navy sent nurses anesthesia trainees to various hospitals, including the mayo clinic at rochester and the lakeside hospital in cleveland before overseas service. among notable nurse anesthetists are sophie gran winton. she served with the red cross at an army hospital in château-thierry, france, and earned the french croix de guerre in addition to other service awards. in addition, anne penland was the first nurse anesthetist to serve on the british front and was decorated by the british government. american nurse anesthetists also served in world war ii and korea. second lieutenant mildred irene clark provided anesthesia for casualties from the japanese attack on pearl harbor. during the vietnam war, nurse anesthetists served as both crnas and flight nurses, and also developed new field equipment. nurse anesthetists have been casualties of war. lieutenants kenneth r. shoemaker, jr. and jerome e. olmsted, were killed in an air evac mission en route to qui nhon, vietnam. at least one nurse anesthetist was a prisoner of war. army nurse anesthetist annie mealer endured a three-year imprisonment by the japanese in the philippines, and was released in 1945. during the iraq war, nurse anesthetists provide care at forward positioned medical treatment facilities. in addition, they play a role in the continuing education and training of department of defense nurses and technicians in the care of wartime trauma patients. certification board certification and recertification process is governed by the national board on certification and recertification of nurse anesthetists (nbcrna). the nbcrna exists as an autonomous not-for-profit incorporated organization. crnas also have continuing education requirements and recertification check-ins every two years thereafter, plus any additional requirements of the state in which they practice. the new recertification pathway focuses on: maintenance of certification, lifelong learning, and continued competence. the continued professional certification (cpc) program consists of 8-year periods, and each period comprises two four-year cycles. scope of practice the degree of independence or supervision by a licensed provider (physician, dentist, or podiatrist) varies with state law. some states use the term collaboration to define a relationship where the supervising physician and the crna work together to provide the anesthetic. other states require the consent or order of a physician or other qualified licensed provider to administer the anesthetic. the licensed crna is legally authorized to deliver care under the particular nurse practice act of each state. scope of crna practice is commonly further defined by the practice location's clinical privilege and credentialing process, anesthesia department policies, or practitioner agreements. clinical privileges are based on the scope and complexity of the expected clinical practice, crna qualifications, and crna experience. this allows the crna to provide core services and activities under defined conditions with or without supervision. in 2001, the centers for medicare and medicaid services (cms) published a rule in the federal register that allows a state to be exempt from medicare's physician supervision requirement for nurse anesthetists after appropriate approval by the state governor. to date, 22 states and guam have opted out of the federal requirement, instituting their own individual requirements instead. salary according to the u.s. bureau of labor statistics, a crna salary is around $225,555. salaries within the us vary by state. connecticut is the highest-paying state for crnas at an average salary of $276,540. it is followed by new jersey ($263,850), illinois ($250,280), and west virginia ($247,650). overall employment for nurse anesthetists and other medical professions is projected to grow 45 percent from 2020 to 2030. duties crnas typically work in healthcare settings such as emergency rooms, intensive care units, and operating rooms. their environment is with medical and surgical teams with procedures that can occur anytime. some partnerships they work with are dentists, surgeons, podiatrists and other healthcare providers in serving patients who need of receiving anesthesia. nurse anesthetists are an essential part of everyday medical facilities. the need of crnas is anticipated to grow. skills and procedures nurse anesthetists practice independently (depending on the state law) or they practice in collaboration with anesthesiologists, surgeons, and doctors to supply anesthetics to patients. crnas are responsible to communicate with the surgeon or team of the patient's health history and designing a plan for anesthesia. the procedures that nurse anesthetists offer include: evaluation of the patient prior to anesthesia physical assessment and teaching before the anesthesia administering patients' anesthesia administering regional anesthesia/analgesia such as spinals and epidurals placing ultrasound guided blocks for surgery managing patients is the post-operative period cope the recovery from the anesthesia roles and responsibilities crnas have important roles when it comes to patient care. they need to meet all the patients' standards and help ensure the patient is in good condition before receiving an anesthesia plan. some of the roles and responsibilities a crna need to require for this position include: bedside manner record-keeping skills communication skills teamwork with other nurses and physicians inhaled anesthesia administration ultrasound guided nerve blocks point of care ultrasound administration of blood and medication epidural placement placement of arterial and central lines in relation to the recent covid-19 pandemic, there has been an increase in the number of individuals who need respiratory assistance due to coronavirus symptoms. crna's are trained medical professionals who understand the airway and are also trained in mechanical ventilation. based upon a patients needs, a crna, or any healthcare professional, must select a specific type of ventilator in order to combat covid-19 symptoms. if an improper ventilator is chosen, this could result in injury or death for a patient. terminology the aana recognizes certified registered nurse anesthetist, crna, nurse anesthetist, and nurse anesthesiologist as equivalent titles. the use of nurse anesthetist is substantially more common than the use of nurse anesthesiologist; terms anesthesia nurse and anesthetist nurse are unheard of. the term “nurse anesthesiologist” or certified registered nurse anesthesiologist is used to recognize that crnas are expert in their field. furthermore, it is meant to end confusion of crnas being utilized as assistant by their physician anesthesiologist (mda) colleagues. use of the term nurse anesthesiologist has been criticized by those who argue that the term anesthesiologist should be limited to medical doctors. for example, groups representing anesthesiologists and other medical doctors, such as the american medical association (ama) and american society of anesthesiologists (asa), oppose the use of this phrase to describe crnas and call it misleading. in 2021, after a year-long rebranding effort, the american association of nurse anesthetists changed its name to the american association of nurse anesthesiology. the name change was condemned by physician groups, including the ama, asa, american board of anesthesiology, american board of medical specialties, and american osteopathic association. physicians' organizations said that the name change was "title misappropriation" that was deceptive, misleading to patients, and cause confusion in care settings.