Workforce issues: the blurring of boundaries in surgical care

We, like many of our colleagues, have welcomed the introduction of advanced and extended nursing practice within the UK healthcare sector over recent decades.

During this period, a plethora of titles and roles have emerged which, in our opinion, have assisted in slowing the haemorrhage of experienced healthcare staff leaving the NHS, and provided a clinical career ladder to rival the traditional managerial pathway while also providing aspirational career routes for new and existing staff.

However, as these roles have gained greater uptake across the sector, it has become apparent that within our particular area of practice, surgery, that a blurring of the boundary lines has developed in terms of who can do what and when.

A familiar trend within surgery has often seen scope of practice developments go hand in hand with technological strides. Robotic-assisted surgery has seen a steady uptake within the NHS and private sector since its inception at the beginning of the millennium. This particular piece of technology lends itself well to the adoption of a permanent patient-side assistant, responsible for working within the sterile field and undertaking tasks such as retraction, suction, irrigation, use of stapling or clipping devices passed independently into the patient via laparoscopic ports. The operating surgeon, working outside of the sterile field but within the operating room, sits at the surgeon's console performing the operation via the manipulation of controls that are replicated by small robotic instruments residing within the patient.