Surgical Care Practitioners

Introduction

Surgical care practitioners are senior nurses, working at an advanced clinical level. They provide surgical and clinical care across the entire patient journey. This includes the outpatients department, pre-admission clinic, operating theatre and post-surgery ward care.

Who is in the team

The team consists of 6 highly trained nurses, all educated to masters level. Each has undergone a robust and comprehensive training programme, under the direct supervision of a consultant cardiothoracic surgeon. This programme is approved by the Department of Health and Royal College of Surgeons.

Surgical care practitioners have the following skills and competencies:

  • Work independently in theatre, harvesting veins and arteries for coronary artery bypass surgery
  • Assist a surgeon for cardiac (heart) or thoracic (lung) surgery.
  • Take a history and examine a patient, formulating a management plan in either an outpatient clinic or an inpatient ward.
  • Independently prescribe medication.
  • Order investigations and interpret results.
  • Provide emergency surgical interventions to post surgery patients.

To provide a high level of care each surgical care practitioner works for an individual consultant cardiothoracic surgeon. This close working relationship allows the surgeon and surgical care practitioner to understand each other’s ways of working, ensuring that all patients receive a consistently high quality of care.

What do we do

A typical working day for a surgical care practitioner is varied;

Ward rounds

Each consultant has a ward round at 8am daily. The surgical care practitioner, with a surgical registrar and the named ward nurse, will review each patient. The aims of the ward round are to review the patient’s progress to date, setting goals and targets for the next 24 hours, managing any complications or problems following surgery, preparing the patient for discharge and answering any questions or concerns the patient has.

Preadmission clinic

A preadmission clinic is available to all elective surgery patients. Either a surgical care practitioner or cardiothoracic specialist nurse will see each patient. The aim of the clinic is to:

  • Review the patient’s history, ensuring all investigations are complete for surgery to take place.
  • Review the patient’s medication, identifying any changes which need to be made prior to surgery.
  • Assess the patient for any potential anaesthetic problems and liaise with a Consultant Anaesthetist if need be.
  • Discussing the surgery and post-surgery phase. Ensuring the patient has a good understanding of the process.
  • Answer any questions or address any concerns the patient or their family may have.

Inpatient ward care

A specialist nurse in cardiothoracic surgery or a surgical care practitioner provides a service on the surgical inpatient wards between 8am and 6pm Monday to Friday. The surgical care practitioner or specialist nurse is the first point of contact for the ward nurse and will provide the following services.

  • Participate or lead in the daily ward round.
  • Provide a first on call service, managing any inpatient issues which the named ward nurse needs to escalate.
  • Respond to any emergency situations on the ward.
  • Work with the ward nurse and physiotherapy team to ensure all patients have an active discharge plan.
  • Ensure patients are discharged home with the correct medication and any medication stopped for surgery is restarted if required.
  • Provide a daily review of all inpatients awaiting urgent surgery.
  • Liaise with other medical teams for patients who require specialist opinions and interventions while an inpatient.
  • Liaise with GPs and other hospitals for patients requiring on-going medical treatment.
  • Provide a drop in service for the assessment and management of post-operative problems.
  • Provide telephone advice to GPs, community nurses, patients and their families.

Operating theatre

Approximately 50% of the surgical care practitioner’s working day is in the operating theatre. Surgical care practitioners are involved in almost all coronary artery bypass graft operations. Their role in these operations is to harvest the conduit (vein or artery) for the surgeon to perform the operation.

Surgical care practitioners are also involved in other cardiac (heart) and thoracic (lung) operations. Their role is that of first assistant. This role requires a competent person with a detailed understanding of the surgical procedure to assist the operating surgeon.

Outpatient clinic

The outpatient clinic is often the last place a patient has contact with the cardiothoracic surgery team, before care is handed back to the referring physician or GP. Typically an outpatient review will be scheduled for 6 weeks after surgery. The surgical care practitioner will review each patient, with a number of aims.

  • To discuss any questions the patient may have.
  • To review progress since the patient was discharged home.
  • To review, and if needed, adjust the patient’s medication.
  • To discuss any further treatment options, and arrange a referral if needed.
  • To provide an update to the referring consultant or GP.