The California Association of Nurse Anesthesiology (CANA) has always provided a voice for nurse anesthetists through biannual meetings, a regular bulletin, continuing education in anesthesia, and professional representation in Sacramento and Washington, DC. Today, Californians benefit from nurse anesthetists enjoy an independent scope of practice because of legislative and regulatory gains made by CANA. Because nurse anesthetists provide cost effective and high quality care, they are an integral part of the answer to California's health care crisis. Nurse Anesthetists have provided quality anesthesia care and services for over 150 years. Today, Certified Registered Nurse Anesthetists (CRNAs) administer approximately 34 million anesthetics in the U.S. each year to patients of all ages and acuities. CRNAs practice in every setting where anesthesia is delivered: hospital surgical suites and obstetrical delivery rooms; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists; the U.S. military; Public Health Services; and Veterans Affairs healthcare facilities. CRNAs are recognized for providing the highest quality anesthesia care with reduced expense to patients, healthcare facilities, and healthcare systems. The cost-efficiency of CRNAs helps control escalating healthcare costs. CRNAs are critical to healthcare access. Nurse anesthetists are the primary anesthesia providers in rural America, enabling healthcare facilities in medically underserved areas to offer obstetrical, surgical, pain management, and trauma stabilization services. CRNAs practice autonomously in a wide variety of settings in 82% of California’s 55 counties which provide surgical and obstetric services in the state. California is also home to seven rural counties that depend solely upon nurse anesthesia services. CRNAs are an integral part of health care reform. California’s nurse anesthetists possess the knowledge, skills, and professionalism that our state’s rapidly changing healthcare market requires and demands as it moves through the 21st century. Today, CANA serves as a leader to promote partnerships with local communities and other healthcare professionals in its ongoing mission to advance patient safety and provide access to the highest quality anesthesia care for all Californians.