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Implementing a surgical first assistant role into that of a clinical nurse specialist at an orthopaedic specialist hospital

11 November 2021
15 min read
Volume 30 · Issue 20



Clinical nurse specialists (CNSs) are experienced senior nurses with advanced clinical knowledge, communication and leadership skills and commonly take on extended roles to optimise care delivery within health and social care.


To critically explore the experience of one clinical nurse specialist who undertook an enhanced qualification to become a surgical first assistant.


A case-study approach based on Gibbs' reflective model is used to reflect on the experience, its benefits to patient care and the challenges and facilitators related to taking on advanced surgical roles.


Long-term benefits can be achieved by investing in CNSs educated to hold the enhanced surgical first assistant qualification. Advanced roles enhance evidence-based service delivery, while also benefitting the clinical nurse specialist, the patient and the trust.

A clinical nurse specialist (CNS) is an autonomous practitioner who works as part of a multidisciplinary team in both acute and community settings. A CNS requires advanced knowledge and skills, which include specialist expertise, the ability to integrate service improvement and evidence-based practice, and skills to effectively collaborate and communicate with all health professions (Mayo et al, 2017).

This article focuses on the role of a CNS in a surgical orthopaedic specialty. In addition to delivering nurse-led clinics, the CNS provides support and advice to patients both virtually and in person.

The role of a CNS role is ever expanding as healthcare demands grow but resources remain limited. Using a reflective case-study approach, the author explores the potential benefits of a CNS becoming competent as a surgical first assistant (SFA).

The Perioperative Care Collaborative (PCC) (2018) defines an SFA as ‘registered practitioner providing continuous, competent and dedicated surgical assistance under direct supervision of the operating surgeon’. This description, however, does not define the type of registered practitioner that can undertake this role. SFAs provide dedicated assistance under the direct supervision of the operating surgeon throughout a procedure. The Royal College of Surgeons of England (RCS) (2021) has drawn up a list of the activities that come within the remit of SFAs (Box 1).

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