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My Story as a SFA Nurse (Theatres)

Updated: Nov 9, 2020

If you've worked as an Operating Room nurse in the Philippines, chances are you have assisted a surgeon in a specific surgery. However, in the United Kingdom assisting the surgeon is a specialised skill that you need to train for upon completion of the Surgical First Assistant (SFA) course. Even if you're a very experienced scrub nurse in the surgical field, you must've completed a validated university programme in line with the national standards before assisting in an operation. Ever wonder why?

We are featuring Phillip, a Surgical First Assistant and a Theatre practitioner in the UK.

My name is Phillip and I am a Surgical First Assistant. I am trained and qualified in this particular role 5 years ago when I was still working in the NHS. I am currently working as a theatre practitioner in a private sector but also fulfilling the duties of a SFA. To answer the question why a scrub nurse can't assist the surgeon... because it means he/she is undertaking a dual role. The position statement by Perioperative Care Collaborative, a governing body for perioperative professionals, stipulates that a scrub practitioner must focus on the management of intraoperative care to patients and therefore must not assume additional duties such as assisting, (PCC, 2018).

What my typical day is

I still work in Operating Theatres fulfilling scrub and circulating duties where a typical day encompasses adequate preparation of equipment and sets for the list, anticipating the surgeon's needs, maintaining sterile field and ensuring the patient is safe under our care. Being a SFA just means I have an extended role and wider scope of practice within the perioperative setting.

I provide skilled assistance to the surgeon under his/her direct supervision. I am allowed to perform basic surgical assistant tasks such as handling and manipulation of tissue or organ to allow access and exposure of operative field, nerve and deep tissue retraction; cutting deep sutures; assist with haemostasis such as indirect application of diathermy and suctioning to maintain clear surgical field. Since we do varied cases in Theatres, my duty as a SFA may shift depending on what the surgery calls for. For instance, I can hold and manipulate the camera during laparoscopic surgeries and for Anterior Cruciate Ligament (ACL) surgeries, I can prepare the hamstring tendon graft to be used for ACL reconstruction.

Why I chose this path

I like working in Theatres and in fact, I haven't moved to other areas since I qualified more than a decade ago. Assuming the SFA role gave me the opportunity to learn extra skills as a perioperative practitioner which have benefitted me, my team and my department. It added another dimension to my work, as I'm not just restricted to scrub and circulating duties. In the NHS, being able to perform an extended role can also ease the shortage for surgical assistants which are normally assumed by the junior doctors. However, in the private sector, it is essential for a theatre practitioner to be a SFA, as consultants do not have junior doctors to assist them. Hence, most private hospitals offer SFA courses to their theatre staff as part of their career development as well as meeting the service needs. An added bonus with this role is the lucrative rate for agency shifts which can be financially rewarding as well as promotion to Band 6 but still dependent on the Trust and departmental vacancies.

How to be a Surgical First Assistant Nurse

The course is normally funded by the theatre department. There are some instances where an individual funds himself/herself if the department doesn't offer the opportunity. It's best to talk to your practice development manager to check if it's available. To be qualified as a SFA, I had to complete a 30 unit course in an accredited university. The course is divided into two parts. Part 1 course requirements included writing an academic essay, completion of work-based competencies and evidence of practice hours done as a surgical assistant. The competencies must be supervised, confirmed and signed by a consultant surgeon to show evidence of learning and practise. The second part allows a SFA to develop further scope of practice such as suturing superficial layers such as skin or fascia, securing and suturing wound drains, superficial use of diathermy and administering superficial local anaesthesia.

The additional skills I acquired as a SFA also allowed me to hone my reliability as a nurse in the theatre setting. I serve as an extension of the surgeon ensuring that we're working in rhythm with the rest of the surgical team in order to achieve positive patient outcomes. I'm passionate about establishing the best practice within the team and being the advocate for patients. Patient's safety is my utmost priority and that means despite my extended role, I practise within the limits of my competency and remain accountable for all my actions. One of the challenges comes from making mistakes. There is little room for error whilst being very much involved in the operation. Gaining adequate experience and proficient knowledge as a scrub nurse in different specialities and knowing your limitations can prevent errors and near misses.

If you're a theatre nurse and you're looking for something different within your current role, this is a good training to develop further in your career. Whilst surgical expertise comes with hands-on experience, a nurse who values continuous learning and development can boost his/her performance and gain better insight when given more complex responsibilities and decisions. Hence, this advanced certification to be a Surgical First Assistant can be your bridge to be a more proactive, assertive and proficient theatre practitioner.

About the Writer:

Phillip is a Theatre Nurse practitioner and a Surgical First Assist in a private hospital in the Midlands. He is also one of the co-founders of the Filipino UK nurses online community and website. Aside from work, he is busy creating content & building the online community, whilst taking care of his beautiful toddler.

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