JOB AT NHS

The NHS was created in 1948 following years of attempts to reform Britain’s health services in

response to Britain’s post-war mood and economic difficulties. The Beveridge Report (UK) The

British Parliament 1942), the product of a review commissioned by the Government,

recommended universal health coverage and served as the seminal document for the NHS. The

Labour Health Secretary, Aeurin Bevan, refined the centralized and unitary structure of the NHS

(Holiday 1995; Rivett 1998). Britain’s experience in World War II coalesced the prior reform

efforts. The successful voluntary and Area Health Authority hospitals under the direction of the

central Government and demonstrated the benefits of coordinated health care planning, which

was lacing in the UK’s disorganized health service delivery prior to 1948.

The NHS, a near monopoly, is available to all residents of the UK. Of the 61,383,000 people that

live in the UK, fifty-one and one half million people are residents of Britain, and the majority,

forty-eight and one half million, reside in England (UK OHE 2009). There is a modest private

health sector in the UK, which represents 3.4 percent of the total UK health expenditures.

NHS health services are firmly based on primary care, with less emphasis on the provision of

territory care. The NHS provides health services to a proportionality larger number of women

and children and offers maternity and pediatric services.

Employees at NHS

At present, the NHS has employed more than 1.7m people in different job categories who serve

people with their specific skills and experiences. Among these employees, about half of them are

clinically qualified while the others serve in other non-qualified jobs. The qualified employees
include “120,000 hospital doctors, 40,000 general practitioners (GPs), 400,000 nurses and

25,000 ambulance staff.” (About the NHS, 2010).

Job of Advanced Scrub Practitioner (ASP)

The role of Advanced Scrub Practitioner (ASP) has emerged within the perioperative

environment which requires clear definition of role and responsibilities (NAASP ADVANCED

SCRUB PRACTITIONER POSITION STATEMENT, 2009). The Nursing and Midwifery

Council, 2008) has stated that the ASP is accountable for their practice and would normally be

covered by the employers’ liability (NMC 2008).

The role of ASP has evolved over time and is vitally important for assessing and assisting the

peculiar needs and requirements of patients undergoing surgery (Jennifer Al-Hashemi, (2009).

According to Boss (2002), the new role of ASP is concerned with serving the interests of

patients, providing him or her best advice and guidance about the operation and any

postoperative implications. The other responsibilities of Nurses acting as an ASP relate to

autonomy in the operating room and professional accountability for the role assigned. Besides, it

is also important consider that ASPs should not undertake and assume the new role unless she is

well trained and competent (Dowling et al., 1996; Hughes, 2002).

In order to meet the changing needs patients at NHS, it is vitally important to analyse

perioperative tasks and align ASP role through proper training (Role and responsibilities of the

advanced scrub practitioner). It is also imperative that the duties of an ASP should be considered

individually because the majority of the nurses do not generally undertake exposure prone

procedures (Kane A, 2009)

The most distinguishing element of the job of perioperative nursing apart from all other nursing

practices is that a surgical procedure may not be performed without the presence of the

perioperative nurse. This requirement is addressed in the employing institution’s policies, in state

regulatory bodies, and by the Joint Commission on Accreditation of Healthcare Organization

(JCAHO, 1996). Moreover, surgery requires the services of a team consisting of the surgeon,

anaesthesiologist, and perioperative nursing. Each team member performs a specific role

throughout the surgery and should work in concert throughout the preoperative and postoperative

periods of a surgical patient’s care, as well for the benefit of the patient. The phenomenon of

interest in this article is the role of preoperative visit of the nurse as it relates to the well being of

the patient.

An operating room environment that is not conducive to collaboration among patient and nurse

or is deficient in its relationship for whatever reason will suffer as a result. A chaotic situation

can have its legal implication as well. According to Pietro (2001), “Nursing is now recognized

by law as a profession with its own legally imposed standards of care and personal liability” (p.

286). Pietro advised that a retained foreign object is the most common malpractice claim against

perioperative nurses. The perioperative nurse is responsible for verifying the operative site with

the patient, which is a potential liability for the nurse. Medication errors occur in the

perioperative setting and have inflicted serious injury. Current operative techniques as a result of

new technology have increased the complexity of equipment in the perioperative environment.

Pietro explained: “The perioperaitve nurse has the obligation to conduct herself or himself

reasonably when obtaining providing and using equipment” (p. 298).

Perioperative nursing is pivotal in the provision of surgical patient care. The focus of

perioperative nursing is the patients who experiences the prospect of, or performance of surgery.
The need for perioperative nursing care begins with the decision that surgery is necessary. It is

most evident throughout the surgery in the operating room, and contiguous postoperatively

through the patient’s recovery and return home. AORN, Inc. (2000) explained that

“Perioperative nursing occurs within a social setting characterized by rapidly changing

technological, economic and cultural forces that require continuous adaptation by professional

practitioners” (p. 15). Adaptation, as a defining characteristic of this surgical team, will also

become the theoretical framework as the basis upon which this study examines perioperative

nursing as it relates to its team members. What is fundamental to and characteristics of

perioperative nursing is that it provides patient care within a team framework. The team consists

of the perioperative nurse, surgeon, and anesthesiologist.

Perioperative nursing has been continuously threatened over the years by proposed legislation to

take the Registered Nurse out of the operating room. This proposed legislation would not apply

to the Registered Nurse who is a Nurse Anesthetist, is licensed and hired solely to provide

anesthesia services to the surgical patient.

References

About the NHS (2010). Retrieved online from

http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx

Holiday. I. (1995). The NHS Transformed. Baseline Books. Manchester.

Jennifer Al-Hashemi (2009). The role of the advanced scrub practitioner. Journal of

Perioperative Practice. Retrieved March 11, 2010 from

http://findarticles.com/p/articles/mi_m0748/is_2_17/ai_n25000886/

Joint Commission on Accreditation of Healthcare Organization (1996). Comprehensive

accreditation manual. Oakbrook, IL: Department of Publication

Kane A, G. C. (2009). Reasonable adjustments in nursing and midwifery: A literature review.

Retrieved March 11, 2010, from Nursing and Midwifery Council: http://www.nmc-

uk.org/aDisplayDocument.aspx?DocumentID=5772

NAASP ADVANCED SCRUB PRACTITIONER POSITION STATEMENT. (2009). Retrieved

March 11, 2010, from NAASP: http://www.naasp.org.uk/index.php?
option=com_content&task=view&id=246&Itemid=98

Nursing and Midwifery Council (2008) The Code: Standards of conduct performance and ethics

for nurses and midwives. Nursing and Midwifery Council, London.

Pietro, J.A. (2001). Nursing malpractice (2nd ed.) In Iyer, P.E. (Ed.), Perioperative Nursing

malpractice issues, (pp. 283-311). Tucson, AZ: Lawyers and Judges Publishing Co., Inc.

Rivett, G. 1998). From Cradle to Grave. King’s Fund, London