The role of nurses has grown considerably in the last decade in accordance with the rapid changes in technology, as well as political and socio-economic developments. The perioperative practitioners play a significant part in this all nursing profession. However, the role of perioperative nurses considerably changes in the operating theater for a variety of reasons. For instance, the diverse regulations and rules clearly explain the role of these nurses in the operating room. In addition, from the viewpoint of legal, moral, and professional perspective, the role of nursing within the perioperative landscape has come many challenges. The changing environment dealing with professional accountability and its effect on the scope of nursing practice has emerged.

According to Boss (2002), the changes in the nursing roles over the years have been influenced by several guiding codes; Code of Professional Conduct (UKCC 1992) and Code of Professional Conduct. These changes include the whole arena of developing roles in perioperative nursing which include working as advanced scrub practitioner (ASP). Dowling (1996) explains that these new functions of nurses deal with principles like meeting the needs of patients, giving an all rounded, complete care as well as developing needed skills. In addition, responsibility and accountability are essential skills are required in this field.

Nurses who serve as ASP have several issues to content with such as independence, professional accountability, and duty to care in addition to legal issues. Of late, nursing has developed into all the functional activities which arose as a result of the technological, socio-economical and political changes. The ASP is part of all this nursing activities since their roles always vary for several reasons in the operating theater. For instance, different regulations and rules always define the roles of the ASP nurses who operate within the theatre are generated differently. In the ethical, legal and professional perspectives, the ASP preoperative environments have many new challenges which must be addressed on a daily basis. The ever changing boundaries of professional responsibilities and their influence on the practice have emerged. The clinical and practice influence has influenced the academic, professional and academic development of the Scrub Theatre practitioners.

The Advanced Theatre Scrub Practitioners are personally accountable for their practice and must always work in a cooperative and collaborative manner with the healthcare professionals and other people who are involved in provision of care, respect and recognize their contributions to the care team. For the Advanced Theatre Scrub Practitioners to be successful in their careers, they must be effective and always work towards achieving a certain goal.

The Advanced Theatre Scrub Practitioners provide the nursing care to the patients in a perioperative environment and they also deal with the technical and instrumentation equipment that will be used during the whole process. Emotional labor is always very crucial for both the nurses and the ASP and it ahs been established to be very important in the nursing profession. In the Operating theatre, the ASP have to consider two major areas in their work which include one, to keep the surgeon dealing with the patient happy and the second, not to upset the surgeons. The second point is a big reminder that if the ASP can make the Surgeon jovial and happy, then they will be very sure that they will not upset the surgeons. It is highly recommended that the ASP maintains the emotional labor with the co-employees rather than the patients.

The roles of the healthcare professionals have changed considerably over the years and the nurses have been particularly affected. These changes have arose because of the code of professional conduct, the code of professional conduct and guidance. These changes have affected the whole area of the perioperative nursing such as the Advanced Scrub Practitioner who was formally known as the First Assistant.

The Advanced Theatre Practitioners always have many issues to contend with which includes the duty of care, autonomy and other legal and professional accountability. The development of the extended roles like the Advanced Scrub Practitioner has also created dangers that the nursing profession could end up in a very bad state of confusion. Nurses therefore have to be aware that accepting the roles of the ASP issues which include underpinning education of practice and development and the high standards of care that the patients require and deserve are considered in the requirements of the governing bodies and the healthcare management.

The roles of the ASP therefore must be undertaken by a very competent and qualified practitioner who should have received the renown training of this role and aware that the care of the patient is paramount before anything else. Therefore, the role of the ASP gives the nurse who acts in this capacity a chance to provide a very holistic care to each and every patient. The PCC Act of 2003 therefore clearly states that the duties of the ASP do not at any cost involve any surgical interventions.

The role of the ASP doesn’t require extended practice but instead the role is already established into the theater nurse role and as such, it doesn’t require any specific training. The roles of the ASP therefore require some specific training competencies and needs and that this role should be clearly states in the contract employment and job description of the people who undertake this practice.

The NMC (2004) in their code of professional conduct didn’t have any objection for the practitioners to develop the scope of their practice but instead requested that the ASP concerned be competent for the jobs and always be mindful of the professional and personal accountabilities that they bear for their actions. As such, there are several points in the code of NMC which refer to autonomy when considering the professional practice of the ASP. The ASP should be able to support and protect the health of the individual patients and the clients. Another role was that the ASPs were professionally accountable for their actions and therefore they should be responsible and answerable for their omissions and actions regardless of any directions they get from the other professionals. Another point was that the practitioners should able to realize their strengths and weaknesses so that they can be able to protect the patients who are under their care.

The specific duties and specifications of the Advanced Scrub Practitioner will therefore include but are not limited to:

Performing skin preparation prior to surgery of the patients.

Draping.

Performing tissue and skin retraction.

Handling of the tissues and manipulation of the organs so that they can be prepared for exposure or access.

Handling the instruments which will be used in the surgery.

Enhancing the communication channels between the ward, the theatre and the patient and even performs preoperative assessment and offer postoperative care evaluation for the patients.

They are responsible for the application of indirect electrocautery under the supervision of the superiors.

They are responsible for the use and maintaining of the specialized surgery equipment in their areas of working.

They are required to perform the male and female characterization and also cut off the ties and sutures.

The ASPs should assist with haemostasis so that to secure and maintain a very clear operating field.

They are responsible for holding the camera so that there is invasive access surgery to the patients.

The ASP should assist in positioning the patients and also conduct a tissue viability assessment.

They should handle the tissues and manipulate the organs for access or exposure.

It is therefore important to note and be aware that the role of the ASP is extended which requires validated training and those they are obliged for the maintenance of the high standards while bearing in mind the protection and support of the patients in a professional and accountable manner. On the other side, it is also worthy noting that although the use of technology can help in the optimum care of the patients, there should be a very strong need for interaction between the surgical patients and the perioperative practitioners.