Before the Checklist: How Early Nurse Anesthetists Made Patient Readiness a Clinical Art

Long before electronic health records, preoperative clinics, and standardized checklists, nurse anesthetists understood that safe anesthesia began before induction. However, contemporary readiness can be reduced to completion of forms, risk scores, and electronic alerts rather than recognized as a clinical determination. This historical column traces the evolution of preanesthetic readiness from individualized observation and psychological preparation to education, professional standards, and digitally supported evaluation. The experiences of Alice Magaw, Agatha Hodgins, and the early profession show that technology can strengthen consistency and access, but cannot replace patient-centered communication, professional review, and clinical judgment. The enduring lesson for certified registered nurse anesthetists is that readiness requires turning information into understanding, resolving uncertainty, and accepting responsibility for an individualized plan of care.