Effectiveness of the Non-Medical Surgical Assistant measured by patient outcome assessment

AIMS

To investigate effectiveness of the nurse clinician as a Non-Medical Surgical Assistant compared with the Medical Surgical Assistant.

BACKGROUND

Non-Medical Surgical Assistants are clinicians who are not medical practitioners. The surgical assistant works directly with the primary surgeon intraoperatively.

DESIGN

A pragmatic, retrospective, observational study on patients undergoing Laparoscopic Inguinal Hernia Repair or Primary Unilateral Total Hip Arthroplasty. Each patient received intraoperative care from a consultant surgeon and a Medical Surgical Assistant or Non-Medical Surgical Assistant. All surgical assistants were registered with the Australian Health Practitioner Regulation Agency.

METHODS

Data were collected between 01/07/2014 and 30/06/2017. The effect that surgical assistant choice had on patient outcomes was estimated using regression statistical models. Six dependent variables, including length of stay, for clinical outcome assessment were specified.

RESULTS/FINDINGS

The groups were equivalent in age, gender, and American Society of Anaesthesiologists scores. There were more emergency procedures in the Medical Surgical Assistant group and more hip surgery in the Non-Medical Surgical Assistant group. Patient outcome assessment showed no statistically significant differences for surgical assistant types.

CONCLUSION

The nurse clinician in the role of Non-Medical Surgical Assistant was shown to be effective with equivalent patient outcomes compared with the Medical Surgical Assistant.

Development and validation of an assessment tool for nursing workload in emergency departments

AIMS

To develop the Workload Assessment of Nurses on Emergency (WANE) tool and to test its validity and reliability to measure nursing workload in the emergency departments.

BACKGROUND

Ensuring safe nursing staffing in emergency departments is a worldwide concern. There is no valid tool to measure emergency nursing workload in order to determine the needed nurse staffing in the emergency departments.

DESIGN

A two-year, cross-sectional, multicenter study.

METHODS

Workload was operationalised as the time nurses spent with nursing activities, classified into direct and indirect care. A board of experts provided content validity. Construct validity was evaluated by examining the WANE's correlations and group-discriminations patterns within the network of variables known to determine nursing workload. Reliability was assessed by the tool's ability to yield consistent results across repeated measurements. Reporting of this research adheres to STROBE guidelines.

RESULTS

Seven emergency departments, including 3,024 patients, were involved in the first year and 18 emergency departments and 7,442 patients in the second year. Direct care time correlated positively and significantly with patient dependency on nursing care, age and length of emergency department stay and discriminated between the categories of dependency on nursing care, age and hospitalisation. Both direct and indirect care time discriminated between the emergency departments according to different patient care profiles and unit characteristics. WANE showed consistent results across measurements.

CONCLUSIONS

Results support the WANE's reliability and validity to measure emergency nursing workload. This tool could be used to determine, on patient and unit, a baseline nurse staffing and the nursing skill mix in the emergency departments. WANE is also an evidence-based management tool for benchmarking purposes.

RELEVANCE TO CLINICAL PRACTICE

The use of an evidence-based workload tool in making staffing decisions in emergency departments is crucial to ensure safe patient care and prevent work overload in nursing staff.

Implementation of a model of emergency care in an Australian hospital

AIM

Emergency departments are characterised by a fast-paced, quick turnover and high acuity workload, therefore appropriate staffing is vital to ensure positive patient outcomes. Models of care are frameworks in which safe and effective patient-to-nurse ratios can be ensured. The aim of this study was to implement a supportive and transparent model of emergency nursing care that provides structure - regardless of nursing staff profile, business or other demands; improvement to nursing workloads; and promotes individual responsibility and accountability for patient care.

METHOD

A convergent parallel mixed-method approach was used. Quantitative data were analysed using descriptive statistics and the qualitative data used a thematic analysis to identify recurrent themes.

RESULTS

Data post-implementation of the model of emergency nursing care indicate improved staff satisfaction in relation to workload, patient care and support structures.

CONCLUSION

The development and implementation of a model of care in an emergency department improved staff workload and staff's perception of their ability to provide care.

Practice audit of the role of the Non-medical surgical assistant in Australia, an online survey

The term Non-Medical Surgical Assistant (NMSA) encompasses all roles where healthcare clinicians without a medical degree provide clinical services during the perioperative cycle. The role of NMSA is gaining momentum within Australia. It is timely to ascertain who is preforming the role and quantify the practice setting and scope of practice to enable a nationally recognised platform for role evolution. For two months in 2015 a NMSA Practice Audit was available online. Sampling was initially of a convenience modality. A total of 83 clinicians responded. The majority of NMSAs were experienced RNs [>11yrs]; held post-graduate qualifications [80%], practiced predominantly in metropolitan areas [65%] and had been performing the role for 8 years or less. The specialty with the highest uptake of the NMSAs is orthopaedic surgery. This paper provides an overview of NMSAs practicing in Australia and provides cost effective evidence of the need for this service in Australian healthcare.