Surgical nurse assistants in cardiac surgery: a UK trainee's perspective.

In the United Kingdom, the main role of the cardiac surgical nurse assistant (SNA) is to harvest the vascular conduit, a role traditionally held by the cardiothoracic Senior House Officer (SHO). This overlap in roles may deprive the cardiothoracic SHO of the chance to harvest an intact long saphenous vein (LSV) which provides an important training exercise in careful tissue handling, haemostasis and wound closure, skills all essential for a surgeon in training. Alex et al. [1] have shown that the use of SNAs does not adversely affect outcomes. This is interesting but of greater importance is their impact on surgical training. The authors have not addressed this. We performed a telephone questionnaire survey of all cardiothoracic SHOs in accredited training posts in England and Wales between 20 and 30 July 2002 (unpublished data). The SHOs were asked to provide data on the number of operative procedures performed over the previous 6 months as recorded in the Royal College of Surgeons logbook. One hundred and ten SHOs were included in the survey and divided into two groups. The SNA group ðn 1⁄4 58Þ comprised SHOs who worked with SNAs, while the nonSNA group ðn 1⁄4 52Þ did not. The two groups were similar with regards to cardiac surgery experience and possession of the diploma of membership of the Royal College of Surgeons (MRCS) or equivalent post-graduate qualification. The median number (interquartile range) of LSV dissected free in the non-SNA group was 30 (14.3–71.3) compared to 15 (3.6–35) in the SNA group ðP 1⁄4 0:001Þ: In the non-SNA group, the median number (interquartile range) of cases in which the SHO initiated cardiopulmonary bypass was 1 (1–2) compared to 10 (2–25) for those in the SNA group ðP 1⁄4 0:004Þ: 37/58 (64%) of SHOs who worked with SNA found their presence beneficial and in some cases it allowed them to perform other more advanced aspects of the operation such as median sternotomy, initiation of cardiopulmonary bypass and sternal closure. The presence of the SNA seems to alter the nature of surgical training for SHOs. The impact of this on the quality of surgical training needs to be investigated further.