When we think of medical breakthroughs, discoveries like penicillin or the polio vaccine often come to mind. Anesthesia is another transformative advancement, turning once-impossible surgeries into routine procedures. At the heart of this progress are Certified Registered Nurse Anesthesiologists/Anesthetists (CRNAs) — advanced practice providers who have been administering safe, expert anesthesia care and pain management services for more than 150 years.
Due to a recent debate over regulations proposed by the District of Columbia’s Department of Health on the question of whether CRNAs can use the descriptive term “nurse anesthesiologist,” I’m providing historic and clarifying context for how CRNAs helped pave the path for the profession as a whole.
The Pioneering Path of Nurse Anesthesiologists
Nurse anesthesiology dates back hundreds of years. Sister Mary Bernard Sheridan became one of the first documented nurses to skillfully administer anesthesia in the late 1800s at St. Vincent’s Hospital in Erie, Pennsylvania. She was part of a wave of nurses who developed the expertise needed to safely administer anesthesia at a time when the science of anesthesiology was still in its infancy. During this time, surgeons routinely chose nurses to give anesthesia to patients.
Nurse Alice Magaw, who was dubbed the “Mother of Anesthesia” by Charles Mayo, MD, published multiple articles in peer-reviewed journals of medicine between 1899 and 1906, detailing the technical aspects of administering open drop ether anesthesia. Her documentation was used as evidence to support a landmark legal decision allowing nurses to be employed as anesthesia providers, and her commitment to patient safety resulted in delivering anesthesia for 14,000 surgeries without a single fatality. Magaw established the patient-centered approach, prioritizing diligent physiological monitoring and calm reassurance that continues to inspire and define CRNA practice to this day.
Fast forward to the early 20th century to Agatha Hodgins, a nurse who pioneered nitrous oxide anesthesia while working as chief anesthetist for surgeon George Crile, MD. Hodgins established the nation’s first formal postgraduate program in anesthesia, Lakeside Hospital School of Anesthesia, in 1915, and her leadership laid the foundation in 1923 for what is now the American Association of Nurse Anesthesiology (previously the American Association of Nurse Anesthetists).
Trailblazers like Magaw and Hodgins mastered technical skills while prioritizing a holistic approach to patient care — an ethos that remains central to nurse anesthesiology today and helped position CRNAs as leaders in opioid-free pain management. Their multifaceted approach to pain, rather than a procedural or opioid-based approach, incorporates alternative medicine and behavioral health techniques to ensure both the physical and psychological components of pain are addressed.
From founding practice techniques to exemplifying effective leadership in nursing, anesthesiology, medical education, and pain management, CRNAs have administered anesthesia independently for centuries — even longer than the term “anesthesiologist” and well before “anesthesiology” became a formal specialty.
A Fitting Descriptor
Today, many healthcare professionals use the term -ologist, which stems from ology, meaning “the study of” to highlight their specializations in key areas, like epidemiologists, audiologists, virologists, and speech-language pathologists, to name a few. Similarly, “nurse anesthesiologist” reflects CRNAs’ advanced education in the science of anesthesia, their specialized and extensive clinical training, and commitment to safe, independent administration of anesthesia.
The descriptor “nurse anesthesiologist” also signals to patients that CRNAs approach anesthesia care from the lens of nursing, which is founded in compassion, trust, and transparency — the very traits that result in the profession being ranked as the most honest and ethical 23 years in a row, according to Gallup.
Recognizing CRNAs as nurse anesthesiologists aligns the profession with their indispensable role in patient care, from anesthesia to pain management. It also reflects the fact that the standard of care for anesthesia services delivered by a nurse or physician is met by CRNAs.
Overall, the descriptor mirrors the ongoing evolution of professional terminology, representing improvements in education, experience, and responsibilities (i.e., pharmacists graduating with PharmD degrees; physician assistants being recognized as “physician associates”; the evolution of the study of pain medicine; etc.). It also fosters mutual respect and clarity among CRNAs, physician anesthesiologists, and other healthcare professionals, ensuring collaboration based on excellence, evidence-based practices, and interprofessional teamwork.
Extensively Educated and Trained
CRNAs were among the first healthcare providers to prioritize continuing education, a commitment that remains a cornerstone of their professional development. This dedication to lifelong learning has helped CRNAs maintain their reputation as highly skilled, adaptable, and responsive practitioners in the ever-evolving fields of anesthesiology and pain management.
To become a CRNA, an individual must first become a registered nurse with a Bachelor of Science in Nursing or other appropriate field, and pass a national nursing board certification exam. After this, candidates fulfill 1-to-3+ years of full-time critical care nursing experience.
Next, a CRNA candidate must enroll in an accredited Doctoral Nurse Anesthesiology Program (Master’s programs were previously accepted) and complete 3 years of didactic and clinical training. With over 24 months of full-time clinical education, nurse anesthesia residents train in all aspects of the field, inclusive but not limited to pediatrics, cardiology, pain, transplant, outpatient, and hospital-based surgery.
Honoring the Past, Embracing the Future
By the early 20th century, CRNAs became vital to anesthesia care and services, particularly in rural and underserved communities. And during World War II, CRNAs were essential providers on the front lines, showcasing their ability to work independently under pressure.
This is still true today, with CRNAs continuing to be the primary providers of anesthesia care to U.S. military personnel and our nation’s veterans. By providing anesthesia and chronic pain management services independently or collaboratively, CRNAs help ensure that patients receive seamless, high-quality care. In fact, numerous independent studies, including a 2010 study from Health Affairs, show that CRNAs administer anesthesia with the same safety and efficacy as physician anesthesiologists.
The legacy of CRNAs is built on resilience, expertise, and compassion, and CRNAs continue to shape modern healthcare today, ensuring safety and efficacy.
Emily Francke, CRNA, is president of the California Association of Nurse Anesthesiology.
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