The Role of a Nurse as First Assistant

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The Role of a Nurse as First Assistant

This essay will critically analyse on the role of a nurse as a first assistant in modern theatre. It will also provide a study on the effectiveness of the first assistant's role, whether the first assistant activities constitute an extended role and whether today's scrub nurse's role is expanded and extended, and what implications has this made for today's healthcare system and its staff.

NATN (1993) defines first assistants as registered nurses who provide skilled assistance under the supervision of the surgeon but do not intervene surgically. Their standard of care must be of a very high order. Holding retractors, using suction, Handling tissues and organs, skin preparation, assisting with skin closure and haemostasis, cutting sutures and ligatures, prepping, draping and general assistance to the surgeon are examples of this role. Patient safety is paramount and to ensure this, the importance of undertaking training beforehand is emphasised. The role is not to be confused with that of a surgeon's assistant where nurses have more extensive involvement during surgeries NATN (1994)

Theatre nurses began to function as first assistants during World War Two when there was a shortage of surgeons and their juniors. Recently this role has evolved as nurses expand their practice as well as compensating for a similar shortage of surgeons, resulting from a reduction of doctors' working hours NHSME (1991). By assuming this role, nurses are acquiring greater responsibility and therefore greater legal accountability. Studies show that considering the amount of time nurses are spending on these expanded role activities, the continuing expansion has created cost implications which include training costs and the costs of increased hours required to enable the nurses to carry out these procedures.

As the years are going by, it has become clear that the roles of all healthcare workers have changed and are still changing. Reforms in healthcare delivery have arisen from the move to degree level education of the nurses and the implementation of the New Deal (NHSME1991), which concerned doctors' working hours and delegating to nurses activities previously undertaken by medical staff. Professional and legal developments such as the United Kingdom Central Council's (UKCC) Code of Professional Conduct (1992), Scope of Professional Practice (1992) and Exercising Accountability (1989) have all acted as guide-lines for the nurse when developing practice and expanding their roles.

In 1989, the Government agreed that the number of hours worked by junior doctors was unacceptable and it was necessary to reduce their workload. This initiative also had implications for nurses to take on some of the activities or tasks which had been considered a part of the junior doctors remit Higgins (1997). The author continues by saying that this extension and expansion of the nurse's role would also fulfil the key requirements of the New Deal. In the process, the training incentives would also enhance and expand the scope of nursing practice, and provide a more holistic approach to patient care. To ensure that these training programmes complied with the scope of professional practice requirements (UKCC 1992), each programme has three centre objectives to be achieved by the participant. By the completion of the course, each participant must be able to recognise the legal and the professional issues surrounding the practice, gain skills and experience required to perform the procedure and attained all the requisite knowledge underpinning the practice with improvement in communication between disciplines. DHSS (1997)

Theatre nurses working as first assistants have many matters such as accountability, responsibility, autonomy and duty of care to the patient with which to contend. Hind (1997) declares that there are four issues to consider, which are professional, legal, contractual and self, as described below:

* Professional: UKCC (1996) states that a registered nurse must promote and safeguard the interests and well being of patients and clients, acknowledge any limitations in knowledge and competence and decline any duties unless able to perform them in a safe and skilled manner. Bernthal (1999) advocates this by saying that nurses are totally accountable and surgeons can only supervise and not take responsibility for any action of the nurse acting as a first assistant.They must not help the surgeon out without adequate education.
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* Legal: Bernthal (1999) says that nurses are accountable to the public through criminal law and to the patient through civil law. Theatre nurses need to be aware of the possibilities of litigation as they extend their role. If a theatre nurse does not feel competent in a role, they have a duty in civil law as well as in the guidelines set by UKCC to refuse to act, thereby ensuring patient safety. Lack of experience is never an excuse for incompetent care, once a duty of care is breached causing harm to the patient, the result is ...

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