A nurse anesthetist is an advanced practice nurse who administers anesthesia for surgery or other medical procedures. They are involved in the administration of anesthesia in a majority of countries, with varying levels of autonomy, which may include some or all anesthesia services before, during, and after surgery. They are also concerned with patient advocacy, safety and professional development. In some localities, nurse anesthetists provide anesthesia to patients independently; in others they do so under the supervision of physicians. The International Federation of Nurse Anesthetists was established in 1989 as a forum for developing standards of education, practice, and a code of ethics.