Nurse Anesthetist- Surgeon Collaboration: To address the Anesthesia Provider Shortage


In 1936, Dr. George W. Crile, one of the greatest surgeons of all time, said regarding nurse anesthetists: “I think this is one of the most beneficent movement we have seen in the whole field of operative surgery (Bankert, 2013, p. 39).” Anesthesia care in the United States dates back to the 1800s and the turn of the twentieth century. To meet the needs of patients, American surgeons trained and recruited nurses during the Civil War (Koch, 2015). A shortage of anesthesia providers, combined with the reluctance of physicians to accept lower pay and a subordinate role, led nurses to take on the role. Surgeries were made possible by the introduction of certain techniques and a collaborative effort of the nurse anesthetist-surgeon relationships. The purpose of this paper is to highlight three nurse anesthetist-surgeon collaborations to purport their use in the anesthesia shortage in low and middle-income countries like Uganda and Kenya.  The insight of each collaboration reflects a potential road to success for future collaborations and contributions to anesthesiology innovation and techniques.

Surgeon-Nurse Anesthetist Collaborations

Alice McGaw and Charles Mayo

Alice McGaw and Charles Mayo mastered the open-drop technique of anesthesia when they administered ether and chloroform by dropping it through a cloth instead of pouring, making the induction of anesthesia less barbaric. Medical providers came from all over the world to watch the nurse anesthetist techniques that were being performed at the Mayo Clinic. “Notes on the Administration of Anesthetic in America, with Special Reference to the Practice at the Mayo Clinic” was presented to the Section of Anesthetic of the Royal Society of Medicine in 1912 (Bankert, 2013, p. 35). This highlighted the significant impact of the nurse anesthetist role in the changing world of surgery.

Hodgins and Crile

Agatha Hodgins was celebrated for the nitrous oxide technique she performed with surgeon Dr. George Crile. Dr. Crile acknowledged “the administering of an anesthetic is not only an art but a gift. In my mind, it ranks close to the work of the operating surgeon… Miss Hodgins made an outstanding anesthetist for she had to a marked degree both the intelligence and the gift” (Bankert, 2013, p. 41). Crile and Hodgins also succeeded in starting the Lakeside Hospital of Anesthesia where the nurse anesthetist service and training flourished. Hodgins later went on to become the founder of the American Association of Nurse Anesthetist (AANA).

Graham and Lamb

Finally, Dr. Evarts A. Graham was considered the father of modern-day chest surgery, working alongside his nurse anesthetist, Helen Lamb.  Lamb introduced and taught the practice of endotracheal intubation. This duo worked together to come up with an anesthetic plan for the first pneumonectomy in the US. Koch (2015) mentioned that Helen Lamb understood the concept of positive pressure ventilation well before her time, as she compressed the breathing bag continuously throughout the 165-minute operation. Lamb proved that aside from her innovative ideas, she was also built to be a leader when she served as president of the American Association of Nurse Anesthetists and chaired its powerful Education Committee (Koch, 2015).

Anesthesia Shortage in Low and Middle-Income Countries

Dubowitz et al. (2009) mentioned that sub-Saharan African countries are suffering from a lack of anesthesia providers. In Uganda, there are approximately 14 physician–anesthesiologists for a population of more than 30 million people. Neighboring country Kenya has a total population of 32 million people, yet there are only 13 out of 120 anesthesiologists who work in public hospitals. In comparison, in the US the ratio is an estimated 1 anesthetic provider per 4,000 population. Uganda and Kenya have programs in place utilizing “nurse anesthetists” in an attempt to address the anesthesia shortage in these countries.  Similar successful programs have been implemented in Malawi and Mozambique, Nepal, and Iran (Dubowitz et al., 2009).

Professional Role

In the future, the United States and the AANA should employ humanitarian efforts to alleviate the anesthesia shortage in the developing world. Alongside other US-trained nurse anesthetists, I hope to partake in the start of many nurse anesthetist schools. This will increase utilization of the anesthesia provider to close the growing gap between the number of providers and surgical need. By doing so, we can encourage leadership roles in the nurse anesthetist profession.


In the United States, the birth of nurse anesthesia came from a dire shortage of anesthesia providers in the surgical arena. Anesthetists have pioneered the field of anesthesia with arrays of techniques and devices to enhance patient experience during surgery. Good rapport, training, and teamwork are reflected in the aforementioned nurse anesthetist-surgeon collaborations. In these examples, it is evident that nurse anesthetists are competent in providing safe anesthetic care and are respected by fellow surgeons, in addition to trailblazing the profession by taking upon leadership roles in the national association (AANA). By understanding and learning the history of anesthesia practice and development, it is crucial to employ the nurse anesthetist- surgeon collaboration method to address the shortage of anesthesia providers around the world and to promote future leaders in the nurse anesthesia profession.


Bankert, M. (2013). Watchful care: a history of Americas nurse anesthetists. Park Ridge, IL:

American Association of Nurse Anesthetists.

Dubowitz, G., Detlefs, S., & Mcqueen, K. A. (2009). Global anesthesia workforce crisis: a

preliminary survey revealing shortages contributing to undesirable outcomes and unsafe practices. World Journal of Surgery,34(3), 438-444. doi:10.1007/s00268-009-0229-6.

Koch, B. E. (2015). Surgeon-Nurse Anesthetist collaboration advanced surgery between 1889

and 1950. Anesthesia & Analgesia,120(3), 653-662. doi:10.1213/ane.0000000000000618




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