Controversy: the nurse-surgeon

EH correspondent Holger Zorn reports

Nurse-surgeon training in the UK is lively discussed for other European countries doing the same to address their lack of qualified surgeons.

The concept is not entirely new. In the 1970s the Netherlands introduced training for ‘operation assistants’, and the USA has had ‘registered nurse first assistants’ for 15 years. A ‘surgical assistant’ course began in Germany in 1999, and the first course for surgical assistants in cardiology was introduced this March.
‘The General German Medical Council, the umbrella organisation that represents German doctors, was not prepared to make a statement on this subject. However, the Marburger Bund (Marburg Association) - with 80,000+ members the largest organisation in Europe representing salaried doctors - was more forthcoming: Unfortunately, doctors (particularly hospital doctors) must carry out an increasing volume of non-medical work. But surely, the solution cannot be to remove their real medical work - particularly since it is difficult to recruit sufficient numbers of medical and nursing staff to begin with! It would make far more sense to relieve doctors of many documentation-related administrative tasks - about a third of their workload. Non-medical staff, i.e. nurses, could carry out, for example, infusion therapy, which they used to do.

Dr Udo Wolter, a member of the Marburger Bund and President of the Brandenburg Medical Council, who specialises in hand and emergency surgery, is against nurse-surgeon training, arguing that, due to the ruling by the European Court of Justice on hospital working hours (being on-call is considered time worked), assistants are left with less time to assist and learn to operate. ‘Assistance through qualified doctors is the most important form of further training,’ he said, adding that this must be ensured for future needs in general and specialist surgery. Although the nurse-surgeon training aims to improve and continuously ensure the quality of surgical assistance - and provide surgery at a lower cost - young doctors could miss chances to pass their medical qualification in surgery: ‘No cardiac surgeon commenced his/her career with an organ transplant.’

The Catholic Institute for Nursing, Marienhospital, Osnabrück provides conventional nursing training and, since 1999, has offered a course to train as operating theatre assistants (OTA). In March, Ulrich Barlag, Head of the Institute, and nursing academic, announced that in a new course, nurses working in operating theatres will be trained as second and first assistants for surgical interventions in cardiology, e.g. removal of a leg vein or preparation of the internal thoracic artery.
Nine CAs (Chirurgie-Assistant) were trained during a pilot phase in 2001, and over 200 enquiries for places have been received for the first regular course, which will begin later this year. To qualify for acceptance, applicants must be qualified nurses or operating theatre assistants with 2-3 years experience in cardiosurgery, and must be familiar with all aspects of instrument handling.

The six-month course will cover theory and practice. Subjects: anatomy and physiology of the lower extremities, diseases of the arterial and venous systems and treatments, water and electrolyte metabolism plus blood coagulation and anticoagulation; intra and postoperative complications and wound-healing problems; the basics of HF surgery and the legal status of surgery assistants. A written exam will follow forty hours of theoretical study.

The operating theatre programme is based on that for specialist surgery training for doctors. Typical vein removal will be demonstrated and practised on dummies and the students will be taught stitching and knotting techniques. They will also assist surgeons by removing leg veins in preparation for a bypass for 80-100 cases, all closely monitored by a mentor.
Nurses who successfully complete all the categories will receive a certificate.

07.08.2006

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