ABSTRACT
AIM: To identify the roles of nurse-surgeons in the provision of surgical care. DESIGN: Scoping review. METHODS: This scoping review adhered to the JBI guideline for scoping reviews and EQUATOR Network's PRISMA-ScR checklist. Searches were performed from May 2022 to July 2022 using a combination of MeSH headings, keywords and filters via database and hand searching based on the eligibility criteria. Keywords included nurse-surgeon, nurse endoscopist, nurse hysteroscopist and nurse cystoscopist. Data sources were CINAHL, Cochrane, Google Scholar, PubMed and Scopus. Descriptive analysis was used to report the findings. RESULTS: Ninety-six included records indicated nurse-surgeon practice in 26 countries. Forty-one nurse-surgeon titles were found, the majority of which were types of nurse practitioner. A total of 5,684,198 surgeries were performed by nurse-surgeons varying from laparotomies to biopsies. Nine records reported that nurse-surgeons perform surgeries safely and on par with physicians with zero to minimal complications. Nineteen records reported improved surgical care efficiency by nurse-surgeons in terms of patient access to surgery, waiting times, surgery times, patient show rates, patient education, physician workload and junior physicians' training. Seven records reported high patient satisfaction. Nurse-surgeons were cost-effective according to five records. Thirteen records recommended the standardization of nurse-surgeon practice. CONCLUSION: Nurse-surgeons performed millions of surgeries worldwide assisting in easing the global surgical burden. This review identified the roles and benefits nurse-surgeons play in global surgical care. Research gaps on nurse-surgeon roles were discovered including the ambiguity in nurse-surgeon titles and the need to regulate nurse-surgeon practice. IMPACT: This research addressed the clinical safety, quality, contribution to timely surgical access and cost efficiency of nurse-surgeon performed surgeries, as well as the need to standardize nurse-surgeon practice and use a more consistent nurse-surgeon title to ensure role identification and monitoring.
ABSTRACT
Background: Nurse-surgeons have been performing surgeries for decades. Yet, their impact on perioperative clinical outcomes has not been explored in detail. Objective: To investigate the impact of nurse-surgeons on patient-centred outcomes. Design: Systematic review. Method: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram and checklist for systematic reviews were used as the screening and reporting guideline. CINAHL, Cochrane Library, MEDLINE, and PubMed databases were searched for articles that fit the review's eligibility criteria. A combination of Medical Subject Headings, keywords and filters for each database were used. Following screening and full text review, the Mixed Methods Appraisal Tool was used for quality assessment and the Grading of Recommendations, Assessment, Development and Evaluations framework for certainty and confidence assessment. Narrative synthesis was used to report the findings due to the design heterogeneity of the included studies. Results: Forty-eight (n = 48) patient-centred outcomes were identified from 25 included studies. These outcomes were grouped into four categories: patient satisfaction and experience; waiting list; perioperative complications; and quality of surgical care. Patient satisfaction and experience was rated high to very high in 16 studies; none reported patient dissatisfaction. Waiting lists improved in eight studies. Perioperative complications were none to very low in nine studies. Mortality rates in the nurse-surgeon group were better than the physician group in three studies. The quality of care in the performance of surgeries by nurse-surgeons was either similar or better than physicians in ten studies. Conclusions: Nurse-surgeons performed safe, satisfactory, and high-quality surgeries with minimal perioperative complications similar to physicians. The use of nurse-surgeons has significantly reduced waiting lists regardless of surgical speciality. Policies around nurse-surgeon practice needs to be developed at national and international levels to streamline the delivery of much needed surgical services amidst the coronavirus pandemic in the areas of cancer diagnostic surgeries, emergency surgeries, minor surgeries, and remote and rural health.
ABSTRACT
Background: The role of nurse-surgeons has recently emerged to meet patient and health system surgical demands. However, methods of nurse-surgeon training and education requirements are unclear. Objective: To identify and describe the current methods of nurse-surgeon training and education worldwide. Design: Systematic review. Method: An electronic search was conducted using Cumulative Index to Nursing and Allied Health, Cochrane Library, Medical Literature Analysis and Retrieval System Online, Public Medical Literature Analysis and Retrieval System Online, and Google Scholar databases. Key words included nurse-surgeon, training, education, and perioperative. Following screening for inclusion, a mixed methods critical appraisal tool was used to ascertain methodological rigour and the Grading of Recommendations, Assessment, Development and Evaluations framework to assess confidence in the evidence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram and checklist for reporting systematic reviews were used. Results: A total of 18 studies was included in this review. Current methods of nurse-surgeon training were identified as surgical speciality specific (n = 18). Most training courses were at least one year in length (n = 4) with a theoretical component (n = 15). All studies included a practical requirement (n = 18), which was generally supervised by a physician (n = 16). A competency assessment was required by 15 programmes, with nine (9) using a formative assessment approach. The evidence available for this review is low in quality and certainty. Conclusions: Current methods of nurse-surgeon training have been identified to be specific to speciality areas. Overall, training has required nurse-surgeons to undergo andragogical education in theory, supervision in practice by a surgeon and assessment of competency. An implication for practice is a streamlined nursing pathway to surgical residency training which would improve global surgical health outcomes and retain young perioperative nurses.
