Agatha Hodgins: Nurse Anesthetist Pioneer

Nurse anesthetists have been around since the around 1887 and it was trial and error for many of the nurses. Doctors at that time had begun using the nurse anesthetists to enable them to concentrate on the surgery while the nurse concentrated on the patient. The patient then received a much better quality of care, both from the physician and the nurse. Until the use of nurse anesthetists, many patients died or had severe complications during and after surgery.

This was due to little training on the part of the person administering the anesthesia and the physician having to divide his attention between the anesthesia and the actual surgery. (Postotnik, P. 1984)

There have been quite a few famous women who pioneered the field of nurse anesthetist. One of these was Agatha Hodgins. She was appointed to be the nurse anesthetist to Dr. George W. Criles in 1908. Under Dr. Crile’s tutelage, she became and expert in the administration of nitrous oxide anesthesia. Dr. Crile was an advocate for the use of nitrous oxide because he felt that ether or chloroform lead to surgical shock. By 1909, Hodgins had administered anesthetics to 575 patients.

At this time, nurse anesthesia was in its infancy and although great strides would be made in this field, it was the courage and foresight of people like Agatha Hodgins who set the stage for today’s nurse anesthetist.

This study is to educate the public about the advances and improvements that have been made in the field of nurse anesthesia during the last 125 years. Agatha Hodgins not only perfected the application of nitrous oxide anesthesia, she led the way on organizing education and accreditation for the future of nurse anesthetists.

Hers was a vision of unity and compliance for the nurse anesthesia profession and it still exists today. While she may not be well known to the public, she is an icon among the current nurse anesthetists as they continue to benefit from her work.

The first nurse anesthetists were trained by the few doctors who had experience with anesthetics. During the Civil War (1861-1865) most anesthesia was administered by people with little or no training. This made using anesthesia on the wounded very dangerous and so it was used very little.

During World War I, Agatha Hodgins served in France from 1914 to 1915. It was during this time that she helped train physicians and nurses from France and England in the administration of anesthesia. At this time the United States had not yet entered the war.

Thank to the efforts of Agatha Hodgins and those she trained, nurse anesthetists have been the primary anesthesia administrators in combat areas. This has been the case in every war the United States has fought since World War I. (Schrefer, S. 2000)

Agatha Hodgins did much more that teach nurses how administer anesthesia under combat conditions, she looked to the future of the profession and where it could go. There was a demand for nurse anesthetists but no formal training facility.

Like wise, there was no formal degree for learning such a specialized skill. Most nurse anesthetists learned from each other or from the few physicians who trained nurses to assist them in the surgeries.

The physicians noticed that not only did the nurse anesthetist free them to concentrate on the patient, it dramatically decreased the complications and death due to the administering of anesthesia. More and more nurses began training for the specialized field.

Most nurse anesthetists at that time were women. Physicians were considered the authority in the surgeries and many men did not want what they considered to be a subservient position. With the rapid growth and increasing respect for the nurse anesthetist profession, this began to change.

Agatha Hodgins saw that a formal training school was needed and set out to create one. In 1915, Hodgins created the Lakeside Hospital School of Anesthesia. It was located in Cleveland,

Ohio and the program was open to graduate nurses, physicians and dentists. Training at Lakeside was 6 months long and the tuition was fifty dollars. A diploma would then be given upon the student completing the course. This school was the first formal training facility for nurse anesthetists that included a degree program.

Lakeside had 19 graduates the first year it was open. This consisted of 6 physicians, 2 dentists and 11 nurses. The number of students increased with each consecutive year and in 1918 Lakeside School formed a system of clinical affiliations with other Cleveland hospitals. Each consecutive year the school boasted more and more graduates and other schools opened across the United States, following the example set by Lakeside Hospital and Agatha Hodgins.

With the rising success of the training program, Agatha Hodgins turned her attention to furthering the future of nurse anesthetists. In 1923 the Alumnae Association of the Lakeside School for Anesthesia was formed. This was the only group of its kind regarding nurse anesthetists.

It wasn’t until 1930, at the American Nurses Association convention, that Agatha Hodgins proposed organizing the nurse anesthetists into a national group. This group would promote, organize and uphold the standards of nurse anesthetists.

In 1931 the National Association of Nurse Anesthetists (NANA) was formed. The first meeting was held on June 17th, 1931 and was organized by Agatha Hodgins. She started the NANA to establish consistent criterion for the training and the certification of nurse anesthetists.

In 1939, the NANA became the American Association of Nurse Anesthetist (AANA) and continues under this name today.

The goals that Hodgins set for the AANA were to create a national qualifying exam for the nurse anesthetists and to establish an accredited program to be used in all the nurse anesthesia schools. The AANA mission statement was to advance patient safety and excellence in anesthesia. (AANA 2006)

Agatha Hodgins was successful with the American Association of Nurse Anesthetists and on June 4, 1945, ninety-two candidates sat down to take the national certification exam. This was a first in the history of nurse anesthesia and set the precedent for schools thereafter.

On January 19, 1952, an agenda for the accreditation of nurse anesthesia programs across the country was put into effect. In 1955 this program was recognized by the U.S. Department of Education.

Today the Certified Registered Nurse Anesthetists (CRNA)are professional licensed nurses who have undertaken additional extensive training in nurse anesthesia. They are required to have a Registered Nurse (RN) degree before continuing on to anesthesia. Since this a considered a specialty field, they must be board certified by state exam before practicing as a CRNA. CRNAs can be licensed and practice in all fifty states.

Although the general public knows little about nurse anesthetists as a profession, the medical community has embraced the specialized field and gives it the respect it deserves. (Evans, T 1998)