"Nurse = nurse, not mini-doctor"

April 5, 2004 -- Today BBC News Online ran an interesting, if somewhat unclear, unsigned article about the growing number of English nurses who are being trained as "surgical practitioners" to perform a variety of surgical procedures, including vascular surgery, orthopedics, urology and gynecology.

The new training programs, which are sponsored by the national government's Modernisation Agency, have reportedly led to significant decreases in waiting times for the performance of certain surgical procedures. The story notes that both the Royal College of Nursing and the National Association of Theatre Nurses support the initiative, citing it as a way to keep nurses in the profession, allow them to fulfill their potential, and reduce what one nurse describes as "tribalism" in the British health service.

Evidently there has been some resistance to the programs from "traditional" physicians, including some who are concerned that having nurses perform the procedures will hamper training of junior physicians, and one who wrote on a medical web forum: "Nurse=nurse, not mini-doctor. Nurses should stick with what they are trained to do." However, the piece quotes other surgeons who support the initiative and are eager to reassure the public that it should not be concerned about quality of care, including one from the Royal College of Surgeons, which is "drawing up the training curriculum" for the new practitioners and which "prefers" to call them "surgical assistants."

It is not clear from the article how much autonomy the new practitioners will have, nor to what extent they will continue to perform tasks traditionally done by surgical nurses. The vice-president of the College of Surgeons is cited for the idea that a surgeon would "always be available" and that the new practitioners would be "limited to certain [specialty] areas." The story notes that the College says the new initiative is necessary because of "European limits on working hours," presumably meaning physician hours, but that it is concerned that the practitioners will not be "subject to regulation in the way that either surgeons or nurses are." It's not clear exactly what that means.

On the whole, the piece provides helpful and balanced information about the new initiative. It could probably have been a bit clearer as to how and why the initiative came about, the autonomy and scope of practice of the new practitioners, and how they will be regulated.

See the BBC's article "Training nurses to do surgery" fron the April 5, 2004 edition of BBC online.