International Federation of Nurse
Anesthetists: Where We Have
Been, Where We’re Going?
Sandra M. Ouellette, CRNA,
MEd, FAAN
President IFNA 2004-2010
Historical Development of IFNA
1978 Jan Frandsen (Denmark) and Hermi Lohnert
(Switzerland) attend AANA Annual Meeting
1985 First international symposium held Lucerne,
Switzerland
 250 nurse anesthetists
 11 countries
1988 Second international symposium held in Amsterdam
 511 nurse anesthetists
 16 countries
1988 September first organizational meeting held, Teufen,
Switzerland
Historical Development (cont.)
1989 May Sandy Maree and Ron Caulk attend ICN 19th
Quadrennial Congress in Seoul, Korea
June country representatives met in Tuefen,
Switzerland to adopt bylaws; 11 charter countries
accepted
Charter signed on June 10, 1989
World Congress Nurse Anesthetists
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1991 Oslo, Norway with 1,100 participants
1994 Paris, France with 2,606 participants
1997 Vienna, Austria with 1,646
participants
2000 Chicago, USA with 4,384 present
2002 Helsinki, Finland with 1,047 present
2006 Lausanne, Switzerland with 1278
present
Objectives of IFNA
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To promote cooperation between nurse anesthetists
internationally
To develop and promote educational standards in the
field of nurse anesthesia
To develop and promote standards of practice in the
field of nurse anesthesia
To assist nurse anesthetists’ association improve
standards and competence of nurse anesthetists
To promote recognition of nurse anesthetists
To promote cooperation among all in health care
community
Functions of the International
Federation of Nurse Anesthetists
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To promote continual high quality patient care
To serve as the authoritative voice of nurse
anesthetists and nurse anesthesia internationally
To provide a means of communication among
nurse anesthetists throughout the world
To promote the independence of the nurse
anesthetist as a professional specialist in nursing
To advance the art and science of
anesthesiology
IFNA Member Countries and Year of Admission
*Austria (1989)
Gabon (1994)
Jamaica (1997)
*South Korea
(1989)
Belgium ( 2009)
*Germany (1989)
Luxembourg ( 2005)
Spain (1992)
Benin (1994)
Ghana (1993)
Cambodia (1997)
Great Britain(1995)
Netherlands (1995)
*Switzerland
(1989)
Croatia (1999)
Hungary (1999)
Nigeria (1993)
Taiwan (1999)
Democratic
Republic of the
Congo (1992)
*Iceland (1989)
*Norway (1989)
Uganda (1996)
Poland (1998)
*United States
(1989)
Denmark (1997)
.
Indonesia (2006)
Morocco (1997)
*Sweden (1989)
Educational Activities of IFNA
Educational Standards: 1990; revised 1999
 Practice Standards:1991; revised 1996
 Code of Ethics: 1992
 Guidelines for Starting a Nurse Anesthesia
Program
 Monitoring Guidelines
 Teachers Session
( IFNA International Standards are endorsed by
the International Council of Nurses (ICN) 2002
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Liaison With Other Organizations
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European Economic Community (EU)
International Council of Nurses (ICN)
World Health Organization (WHO)
Center for Quality Assurance in International
Education (CQAIE)
World Federation of Societies of
Anaesthesiologists (WFSA)
International Hospital Federation
International Society for Quality in Health Care
IFNA Recognized By International
Council Of Nurses
There are 7 nursing organizations with ICN
affiliate status:
1European Federation Of Nursing Associations
(EFN)
2 Council on International Neonatal Nurses
(CINN)
3 International Federation of Nurse Anesthetists
(IFNA)
4 International Federation of Perioperative Nurses
(IFPA)
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ICN’s Affiliate Nursing
Organizations
5 International Society of Nurses in Cancer
Care (ISNCC)
6 International Skin Care Nursing Group
(ISNG)
7 World Federation of Critical Care Nurses
(WFCCN)
IFNA Education And Research Foundation
Collaborative study of IFNA (Dr Maura McAuliffe) and World
Health Organization: 1996 and 1999
1Nurses administer anesthesia in 107 countries
2 Provide 77% in rural areas and 75% in urban areas of the
world.
3 57% reported they were required to have a physician
anesthetist present (mostly European countries)
4 All had a formal educational program but some were outside
the country
5 50% reported continuing education was not available
6 74% reported hospital policies as well as governmental
regulation (60%) guide the practice of nurse anesthesia.
IFNA Education And Research
Foundation
1 Supported a collaborative program with
the World Federation Society of
Anesthesiologists in Malawi, Africa in
1999.
2 Provided a seminar in Kumasi, Ghana
for over 100 nurse anesthetists in 2005
IFNA: Accomplishments,
Needs, Its Future
The Future
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IFNA Education Committee: Anesthesia Program
Approval Process
WCNA 2010 The Hague, The Netherlands June
4-7, 2010.
WCNA 2012 Slovenia; 2014 Tunisia
History Book marking 20th Anniversary of IFNA:
1989-2009
Appointment of An IFNA Practice Committee
IFNA’s Anesthesia Program
Approval Process: APAP
Betty Horton CRNA, PhD
Chairperson IFNA
Education Committee
IFNA’s Belief
“ If nurses are utilized for preoperative or
postoperative preparation of the patient
and if they perform venous and arterial
cannulation, induction and emergence of
anesthesia, intubation, and extubation,
and if they are left alone for any reason,
they should be appropriately educated.”
IFNA’s Belief
“ If nurses are being utilized in such a
manner…IFNA is concerned that their
educational process is sufficient to support
anesthesia practice and patient safety.”
Professional Study & Resource
Guide For the CRNA
Philosophy of APAP
“IFNA believes that it is possible to improve the
health and welfare of humanity by promoting
international educational standards for nonphysician anesthesia programs. Based on this
belief and for the purpose of program approval.
It is the policy of IFNA to approve programs that
admit students who are nurses or who are
educated in another scientific area which
prepares students to succeed in their anesthesia
education.”
Philosophy Of APAP
“Although IFNA strongly supports a nursing
background for admission, it also believes
in an approval process that recognizes the
differences that currently exist in the
educational preparation of health
professionals worldwide that have
contributed to nurses and non-nurses
being enrolled in anesthesia programs.”
Philosophy of APAP
“IFNA believes that an inclusive process
provides the greatest opportunity to
improve anesthesia care to patients now
and in the future.”
APAP Operational Policies
Eligibility Criteria
Applications
Programs can apply for one of 3 categories:
Registration
Recognition
Accreditation
Three Categories Of Approval
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Recognizes
1 Diversity of nurse anesthesia programs
throughout the world;
2 The economic stage of development of a
country;
3The resources available to individual programs;
4 A commitment of diverse programs to a
common standard of educational quality.
Process To Develop APAP
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First draft of application process developed by
Education Committee with members from
Switzerland, Africa, Taiwan, Sweden & USA.
Three programs completed the pilot project and
were awarded “Recognition.”
1 Sweden
2 The Netherlands
3 USA
Goals OF APAP
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To encourage programs to comply with IFNA’s
Educational Standards for Preparing Nurse
Anesthetists through an approval process that
takes cultural differences into consideration.
To improve the health and welfare of humanity
by promoting international educational
standards.
To categorize educational preparation and scope
of practice throughout the world.
IFNA Practice Committee
Objectives
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Define the scope of practice in IFNA
member and nonmember countries.
Define required credentials to practice as
a nurse anesthetists and identify
regulatory body responsible.
Identify various payment models for
anesthesia services in member and
nonmember countries.
Practice Committee Objectives
Continued
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Develop a model for continuing education
for nurse anesthetists.
Review and revise Practice Standards and
Ethical Standards as needed.
Work with the IFNA Education Committee
to identify speakers and topics to CPC for
all future congress.
Financial Status Of IFNA
Stable now since dues were adjusted in
2004.
 We should, however, approach the future
with cautious optimism:
1 Must fund congress more often with a
two year cycle.
2 Congress may be successful or fail; ie
Volcanic eruption in Iceland
3 Unstable world economy
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Action Steps For Establishing A
Global Profession
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Act as an international witness for the
need for professional standards in nurse
anesthesia.
Interact effectively with appropriate
regional and international organizations
Act as a liaison to other globalizing
professions.
Action Steps For Establishing A
Global Profession Continued
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Consider the development of an IFNA
quality assurance process for nurse
anesthesia educational and professional
development programs.
Monitor and record its own progress
through research, publication, and
international forums.
Dr Marjorie Peace Lenn
Executive Director CQAIE (1997)
IFNA Relationships
“ Moving ahead to be the best, reaching
behind to help the rest”