Physician Assistants in NHSScotland

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• Physician Assistants in NHSScotland
• 25/26 October 2007

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Nurse practitioners and their role

• Sheila Mair
• Gastroenterology Nurse Practitioner

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• History
• Definition
• Roles
• Present
• Future

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History
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Drivers
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Definition

• NONE in UK
• Not a doctor substitute
• Not a cheap option for service provision

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• A registered nurse who has command of an
  expert knowledge base and clinical competence, is
  able to make complex decisions using expert
  clinical judgement, is an essential member of an
  interdependent health care team and whose role is
  determined by the context in which s/he
  practises.
• NMC 2004 Consultation on a framework for the
  standard for post-registration nursing

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Nurse Practitioners

• Registered Nurse, at least degree level
• Professionally autonomous
• Screens patients for disease
• Makes differential diagnosis
• Orders investigations, provides treatment and
  care
• Provides counselling and health education
• Admits/discharges patients
• Provides leadership and consultancy

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Roles

• Present
• Primary care
• nurse practitioner
• Secondary care
• GI nurse practitioners/ endoscopy nurse
  practitioners
• Emergency nurse practitioners
• Hospital at night
• Future

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Future

• Clear definition
• Defined core competencies
• Framework for practice and practice development
• Speciality Nurse Practitioners
• Nurse Consultants
• What of the general nurse?

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Results

• Deskilling general nurses
• Depleting number of general nurses
• Targets met
• Job satisfaction
• Career development
• Closer team working

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• Physician Assistants in NHSScotland
• 25/26 October 2007

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New and Advancing Roles in Surgery

• Rosanne Robinson
• SAB Professions Allied to Surgery
• Rodney Mountain
• Chair, SAB Professions Allied to Surgery

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Session Aims

• Identify the new and extended roles within
  theatre practice
• Provide a brief history of new and extended roles
  within perioperative practice
• Discuss the current situation in Scotland in
  relation to new and extended roles
• Stimulate discussion around some of these new and
  extended roles

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Examples of new/developing roles in
perioperative/surgical practice

• Advanced Scrub Practitioner (ASP)
• Surgical Care Practitioner (SCP)
• HCSW in the Scrub Role
• Physicians Assistant
• Anaesthetic Practitioner
• Perioperative Emergency Care Practitioner
• Perioperative Specialist Practitioner
• Endoscopy Practitioner

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ASP (First Assistant) Audit

• Perioperative Development Programme
• Nurse as First Assistant (NATN 1993)
• 4 week period during November 1999
• Ninewells Hospital, NHS Tayside

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951 records (73.1) showed some degree of scrub
nurse involvement in first assistant duties
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Percentage of Cases Involving Scrub Nurses
Undertaking Particular First Assistant Activities
Assisting with skin closure
Assisting with haemostasis
Handling tissues/ organs
Holding retractors
Skin preparation
Cutting sutures and ligatures
Draping
0
10
20
30
40
50
60
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Overview of Why Nurses Undertake First Assistant
Duties
Other reasons (0.6)
They wanted to (12.1)
This is a normal part of my role (38.8)
Were asked to by surgeon (25.8)
No one else was free (22.7)
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General Observations Arising From Audit Data
Included

• Despite increasing emphasis on professional
  accountability, are nurses locally undertaking
  activities out-with their normal scope of
  practice or...
• is this the flexibility associated with the
  Scope of Professional Practice (UKCC 1992)?

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Issues to be addressed locally

• Accountability
• Vicarious liability
• Creeping Role developments
• Standard of Education/Training

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Advanced Scrub Practitioner (ASP)

• The term Advanced Scrub Practitioner (ASP) can
  be defined as the role undertaken by a healthcare
  practitioner providing skilled assistance, under
  direct supervision of the operating surgeon,
  while not performing any form of direct
  supervision (PCC 2003).

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Responsibilities associated with the role of
Advanced Scrub Practitioner (ASP)

• Communication
• Patient positioning
• Tissue viability assessment
• Skin preparation
• Draping
• Handling of tissues
• Manipulation of tissues/organs for exposure
• Handling instruments
• Male/female catheterisation

• Assisting with haemostasis
• Indirect application of electro-cautery under
  supervision
• Camera holding for minimal access surgery
• Assistance with wound closure
• Application of dressings
• Transfer to recovery
• Documentation

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Framework for New Nursing RolesScottish
Executive June 2004

• Drivers needs assessment
• Skills, knowledge, experience
• Governance
• Competencies/education
• Individual accountability
• Evaluation

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Rationale for developing a National ASP Training
Programme

• Safe, holistic patient care
• Compliance with professional codes of conduct
• Compliance with the PCCs recommendations
• Clinical Governance Agenda
• Vicarious liability
• Continuing support of the surgical team
• Support continued development of the ASP role
• Recognition of skills in other areas

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HCSW in the Scrub Role

• Consultation for the development of HCSWs
• Codes of Conduct and Practice
• Regulation
• Perioperative Care Award

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Surgical Care Practitioner (SCP)

• A non-medical practitioner, working in and out
  of the operating theatre, who performs surgical
  intervention under defined levels of supervision
  by a consultant surgeon (CFSCP 2005).

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Responsibilities associated with the role of
Surgical Care Practitioner (SCP)

• Venepuncture
• Cannulation
• Arterial blood sampling
• Pre-op site marking
• ECG conduct/interpretation
• Patient preparation
• Patient positioning
• Draping
• Handling instruments
• Maintenance of haemostasis
• Documentation
• Guideline and policy development

• Tissue retraction, exposure and handling
• Performing incisions
• Maintenance of specimens
• Suturing of skin and deeper layers
• Insertion/fixation of drains
• Application of suction
• Application of diathermy
• Minimal access surgery camera skills
• Application of dressings
• Male/female catheterisation

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Further Discussion

• Surgical Care Practitioner versus Physicians
  Assistant in Surgery?
• Further determination of the need for new and
  extended roles within perioperative and surgical
  practice
• Which roles are most appropriate in relation to
  the meeting the needs of the Scottish workforce?
• Which roles are most appropriate in relation to
  meeting the needs of the Scottish population?
• How will new and extended roles impact on the
  training of future surgeons?
• What is the face of the future surgical team?
• How will these new and extended roles be funded?
• Sustainability and succession training career
  frameworks?
• Medical support for development of the role

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Any Questions?
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• Physician Assistants in NHSScotland
• 25/26 October 2007