Surgical assistants competence to practice

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Sorry to bother with this one, but searching for information about your own profession sometimes comes up surprisingly blank!

Here's the problem:

Setting up a surgical team for foot and ankle surgery. Surgeon is an orthopaedic surgeon, but we want scrub nurse role, 1st assistant and pre- and post-op care to be done by Podiatrists not nurses.

The 1st assistant role is covered by NAASP qualifications and competencies, but the pre and post-op bits (e.g. identifying post-op emergencies and taking blood pressure, knowing when to request for bloods, x-rays etc) is being disputed.

The dispute is that Podiatrists are not qualified to do this, only registered nurses (and medics) are......

Having filled that role in a Pod Surgery team myself, I thought it would be easy to point to Podiatric scope of practice / qualifications to demonstrate that, indeed we are competent to do this...........until you actually look for evidence of this!

Having looked at the Society Website and HPC website, I can't find any evidence to back up my own knowledge of what I can and can't competently do professionally. Does anyone know of any info that may help us in this respect?

Any info would, quite literally, save me such a huge headache!

Thanks!

Nicola

 

You can't find evidence because there is no (or little) evidence available. I suppose much will depend on whether the employer is willing to contemplate such an unusual situation and whether your insurances will back you should a problem occur and the employer/litigant counter sue the individual practitioner. This is because British law is based on precedent and it will require a patient to sue in that situation before precedent is established.

Why put yourselves in that position and not simply employ the appropriate staff? Nurses bring a particular set of skills to fulfil the role you describe and have done sofor many years.

Just out of interest, as you are setting up a foot and ankle surgical service why are your Trust not employing a podiatric surgeon rather than an orthopaedic surgeon? This seems strange as you state that you have already worked in a podiatric surgery team.

Bill Liggins

 

Hi Bill,

It's an orthopod backed by pods because that is the existing structure really - we are basically using an existing team to expand into new contractual areas, rather than setting up a new team as such - bit complicated, I know!

However, it still begs the question about the support staff of all those Podiatric Surgeons out there who also do not have nursing support and are solely supported by Podiatrists, not all of whom are surgical trainees - does this mean they are all 'operating outside the law'?

Perhaps some of the other NHS based Podiatric Surgeons working in such teams have looked into this?

Thanks Bill, anyway!

 

As I say, it's not a question of 'operating outside the law', because nothing 'illegal' per se is occurring. The 'law' would only be interpreted by a judge when a case was drawn to his/her attention by a litigant. At that point an award (if any) against the offender (if deemed such) would be made and precedent would be created for future reference. Also, as I mentioned, if I were in your position I would obtain a written statement from the management of the Trust that they recognise the position and will back you in the case of litigation. Likewise, a written statement from your insurance to the same effect may prevent sleepless nights!

If it's of any help, in my Trust we have used podiatrists (non-surgical trainees) in the past for follow-up dressings; however, they have always been overseen by the podiatric surgeon. We now use qualifed nurses. Purely as an opinion, I think that the pre-op. review is a different situation and it is advisable to have a person carrying out the role who has recognised expertise in that area.

Since you have elected to have an orthopod carrying out the surgery rather than a colleague, ultimately, the responsibility for the patient will lie with him/her. It would be interesting to seek their opinion.

It would be of benefit to others if you will kindly post the outcome.

All the best

Bill Liggins