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My Story as an Advanced Clinical Practitioner in Surgery

As a typical NHS employee I will introduce myself, “Hi my name is Uchi and I am an Advanced Clinical Practitioner (ACP) – Surgical Care Practitioner (SCP)”. The title ACP was previously known as the Advanced Nurse Practitioner (ANP), as other health care professionals undertake advanced roles with which has been changed to ACP later on.

I arrived in the UK in October 2003 and began my journey as a scrub nurse. The transition was easy as I already have eight years’ experience in the Philippines. We started on a student visa whilst completing our adaptation and were given six to eight months to complete the requirements to NMC and qualify as a UK registered nurse.

When I received my NMC pin, my manager encouraged me to apply for the senior theatre staff position which I managed to secure. After three years she offered me again to attend university to become a Nurse-Operating Department Practitioner (ODP). It took a year in university to finish the course and train for anaesthetics and airway management. After qualifying, it gave me the opportunity to apply and secure the Band 6 team leader for vascular/ emergency theatres. I had the best of both worlds in theatres as I have days to scrub and days to help with the anaesthetic team at the same time managing the vascular, transplant and emergency theatres.

After 12 years in theatre, an opportunity arose for a Perioperative Specialist Practitioner. I got the job with the provision to go to university for my MSc in Surgical Care Practice in General Surgery. After a year on the job, the title was changed to trainee SCP. After graduation, I have pursued my non-medical prescribing (NMP) qualification. These consequent courses I have undertaken allowed me to become an ACP- Surgical Care Practitioner. All the university, accommodation and travel expenses were paid by the Trust as it goes with the role. Currently, I am an ACP-SCP for the Hepatobiliary team.

My Typical Day

I am lucky to have a job where no days are the same. On Mondays, I have my nurse-led clinic. I work under nine consultant surgeons to see patients referred by the GP and other specialities e.g. gastro, colorectal, those with gallbladder diseases and hernia (inguinal, umbilical and incisional) problems. I have the autonomy to do consultation and assist patients to decide the best pathway to take either to go for conservative or surgical management. If patients will choose for conservative management I provide advice on how to manage symptoms and if they choose surgical management I can book them for pre -assessment, waiting list and start the consent process.

Tuesday is my surgical assessment unit (SAU) shift, the ACP’s take turn as GP liaison and seeing patients. As a GP liaison, I take GP referrals, advise or patient transfer to hospital for an easy flow. I clerk, assess and manage patients that come to SAU. I can request investigations such as bloods; VBG/ABG, AXR/CXR, USS, endoscopy, etc. and prescribe medications and fluids if needed. A review from the registrar or consultant is done after I assess and manage the patient. As an SCP I can also perform excision of sebaceous cyst and I&D of abscesses in the treatment room if the patient is keen to have the procedure done under local anaesthetic. If a patient needs to undergo general anaesthetic, I consent and prep them for theatres either on the day or the next available slot.

Wednesdays and Fridays are my theatre days. I meet the patients in the surgical on day admissions unit to get their consent for the procedures – I am allowed to consent in certain surgical procedures under 15 named surgeons, complete the VTE online and complete the drug kardex for VTE and prescriptions if the patient will stay overnight. I am also the surgeons’ assistant for laparoscopic, robotic and open cases. There are days that we do minor to major surgical cases and days that we do complex surgeries such as robotic/open Whipple's procedure and complex liver resections. After a day case procedure, I complete the patients’ TTO –discharge summary as they normally would not stay in hospital for long.

If we have enough registrars to go to theatres, I help the team with the ward rounds, we see our HPB patients in the wards, do jobs as junior doctors does- review daily bloods, implement consultant’s plan, action on results and reports, referrals with other team/specialties and start discharge planning/TTO.

In between, I also coordinate the rota for surgical ACP’s and the HPB team, I coordinate the emergency laparoscopic cholecystectomy Iist, do audits for my clinic and projects too. I help teach medical students with laparoscopic skills and suturing and also train non-medical staff on consenting.

Why have I chosen this area of nursing?

I have never expected to do this job. Having zero experience in the ward as a nurse, I have always seen myself in theatres. But an opportunity opened its doors and I just grabbed it.

I can say that I have the best of both worlds as a surgical practitioner; working in the Operating Theatres and in the ward/clinic. I have the opportunity to work with the multidisciplinary team, and with patients as they go through their surgical journey. I have the chance to see patients in the clinic, during their surgery until discharge and sometimes during follow up.

What qualities and skills does an ACP-SCP should possess and acquire in the process?

You need to have the ability to adapt working autonomously and with a team/MDT, resilience, good communication skills, and critical thinking. I need to manage my time wisely, as working with the MDT requires loads of patience and understanding. As I do my nurse led clinic, theatre and ward duties I constantly communicate with patients, relatives, colleagues and the wider multidisciplinary team. The job is not easy as there are loads of responsibilities, it is your ability to get through it, is what’s important. Every day is a learning day. You need to possess the quality to accept what you can and can’t do and have the courage to ask for help.

Do you think you are making a difference as a nurse in this field?

Yes, I think I am making a difference as a nurse in this field. Being one of the first ACP-SCPs in our Trust, we were given the task to create and develop the role in surgery. Advanced clinical roles for nurses are widely known to the medical department but the surgical division lacks this kind of role.

I managed to create a nurse led clinic as one of my projects whilst undertaking my MSc. I coordinate the emergency gallbladder list, and review the patients that come to SAU or inpatient referrals with biliary problems where we aim to do a Laparoscopic Cholecystectomy on admission or within seven days. This is in collaboration with the Royal College of Surgeon’s CholeQUiC project. I am also involved in helping with the surgical teaching for medical students – laparoscopic and suturing and non-medical consenting.

The ACP’s also engage with projects such as service improvement for the surgical department, audits- we audit our projects and present results to the surgical QuIPs/meetings, manage patient feedbacks, COP/protocols, research, and teaching medical, physician assistants and nursing students.

What are the benefits of working as an ACP-SCP?

The benefit of working as ACP-SCP is the privilege to work with a diverse group of people. I also appreciate the autonomy of working as an ACP-SCP. I am thankful for the confidence of my consultant surgeons with my abilities. They trust my judgement and management plans for their patients. I can book patients for investigations and surgery under their names. I also get to attend training and conferences related to my role sponsored by the Trust.

What are the challenges of an ACP-SCP?

As a team of ACP’s we’ve encountered many challenges during the pandemic. The ACP’s with ITU background were redeployed back to ITU and some of us with theatre background went to theatre to assist the consultant surgeon on-call in emergency theatres. As junior doctors were redeployed to ITU and respiratory wards, we as a team stepped up and were also assigned in the medical rota. We helped the medical team to manage/assess emergency surgical patients in SAU, as the SAU became the surgical emergency unit.

How would you convince other nurses to consider a role as an ACP-SCP?

The SCP role is limited to nurses/AHP with theatre background while the ACP can be from any other medical background. My colleagues were from ITU, Enhanced Care Unit, A&E, Surgical Assessment Unit, PACU, capacity manager but previously from the recovery unit, and Outreach.

I have never dreamt of working as an ACP-SCP. I just tried to be the best in what I do. And if your seniors see that you are passionate in the way you work they will trust you and they will create opportunities and push you to be the best practitioner that you can be.

Most importantly, I brought with me the most important transferable skill possible: a learning–oriented growth mindset. I am always passionate about learning and how to acquire new skills and knowledge. I also never expected this role to be easy. Hence, I have appreciated the value of failure, not giving up and keep going as I go through this career journey.

Opportunity is always there, it is up to you to grab and push yourself to achieve and be the best. I encourage you to apply and try new roles and challenges, as there is no boundary or limit to what you can do.


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