Responses to questions raised by members at Congress

There were some really interesting questions and issues raised by members at last years RCN Congress 2022. Here we provide our responses to these.

Should we be looking to standardise perioperative ‘best practice’ teams across UK? 

This is a tricky one to answer, as ‘best practice’ means many different things to different people, and that’s even before we discuss the different levels of patient acuity and type of surgery. 
We recommend that the AfPP’s staffing template for operating theatre practice is adopted which states that for most operating lists, a theatre team comprising of a registered practitioner in the anaesthetic practitioner role, with two staff in the scrub roles (an appropriate combination of registered practitioners and nursing associates/assistant practitioners) and a circulator role is necessary. Registered practitioners with expertise in post-anaesthesia care are also required to support patient recovery. 

We are currently in the process of developing guidance about how the RCN’s workforce standards can be applied to operating theatre practice – watch this space.

Are patients coming through operative cancer treatment pathways at risk of experiencing frailty related problems?

Yes, we recognise that this is challenge for perioperative care. Over half of all adults undergoing elective and emergency surgical procedures are aged 65 years or older. We recommend that the CPOC/BGS joint guidance on caring for patients with frailty is used to support staff knowledge and practice, and to inform patient care decisions across the perioperative pathway. 

We will be delivering some webinar style education sessions on frailty and delirium, which we hope members will find useful and there are resources available through RCNi online. The British Geriatric Society has an online resource called the Frailty Hub which is free to access and brings together some useful information on frailty in surgical and orthopaedic settings.

Could theatre nurses work an on-call rota rather than night shifts?

There are many factors that influence whether an on-call rota could be facilitated rather than night shifts. For example, the type of services that your hospital provides - does this include obstetric services, trauma surgery and/or emergency surgery? It is essential that obstetric emergency surgery is available 24/7 if your hospital has an obstetrics unit. Emergency surgery and trauma surgery services are usually designed across a network. Travel distance to the hospital could also have an influence on this. We would advise that you contact your employer for information about onsite theatre services. 

Are Universities and Trusts not supporting peri-op placements well enough?

Support on placements is variable, we would recommend discussing any concerns you have with your Practice Education Facilitators, or with the universities involved. The provision of operating theatre education in pre-registration nursing and AHP education courses varies widely across the UK. Often, it is well-led and integrated into acute care modules by passionate staff. Many organisations rely on student induction days arranged by perioperative staff; these are often highly valued by students. Could you raise this with your teams at your next quality-improvement opportunity?

Are we heading towards a Perioperative workforce crisis?

The nursing workforce crisis is occurring across the NHS. Theatres are not alone in experiencing both a lack of staff and the loss of knowledge and skills as colleagues leave the profession. We would advise that inadequate staffing is reported following escalation procedures, and that datix incident forms are utilised for near misses and if patient harm occurs. Ensure you work at a pace that is safe for patients and staff, slow the pace as required, follow patient safety procedures such as the WHO five steps to safer surgery. Contact the RCN if you are struggling to raise concerns in your workplace, as officers are able to support you in doing this. 

We are always keen to hear from members and encourage you to get in touch with any issues you think are important to the Forum.