Nurse-surgeons in the Australian public health system : A mixed-methods study

Background: Amidst the persistent global surgical crisis that leaves over five billion people worldwide without adequate surgical care, innovative solutions are imperative. Nurse-surgeons, or nurses undertaking surgery independently, have emerged as a promising innovation in the field of surgery, presenting a unique opportunity to address the surgical access gap.

Aim: To consolidate the data around the nurse-surgeon role, training, education, career prospects and experiences in the Australian public health system.

Methods: This explanatory sequential mixed-methods research involved two phases. The first phase was a non-experimental descriptive survey of 28 nurse-surgeons in Australia, including 22 females and six males. The survey questionnaire consisted of four sections: demographics; roles; training; and perceptions. Data collection methods encompassed email surveys sent to public hospitals, crowdsourcing, and snowball sampling. The results underwent descriptive analysis. The second phase involved semi-structured interviews of five nurse-surgeons using purposive sampling. Data analysis was conducted using an inductive approach, following Braun and Clarke's six phases of thematic analysis. Both phases adhered to ethical standards and consolidated criteria for reporting.

Results: Quantitative findings revealed that most of the nurse-surgeon participants held a master's degree and trained for an average of 2.27 years (95% CI [1.47, 3.07]). Training consisted of practical and theoretical components, along with rigorous competency assessments before independent practice. Nurse-surgeons faced challenges in the form of limited job opportunities, political resistance, and opposition from Australian medical societies, contributing to poor to average
employment prospects. However, the support from their colleagues—nurses, surgeons, and management—remained strong, despite occasional undercurrents of jealousy and resentment. Nurse-surgeons expressed high job satisfaction and a resolute intention to continue their practice. They emphasised the need for standardised training and practice to secure the future of their role. The qualitative findings showed consistently positive interactions with clinical supervisors marked by unwavering support throughout their training and into independent practice. In contrast, their interactions with nurses and physicians beyond their clinical supervisors were initially antagonistic, but with time, evolved positively as the value nurse-surgeons brought became increasingly evident. Qualitative analysis unveiled the crucial facilitators and barriers to nurse-surgeon integration within the Australian healthcare system, including raising awareness, fostering collaboration, creating a standardised national credentialing pathway, and addressing geographic, political, and financial challenges.

Conclusion: This mixed-methods research offered a comprehensive understanding of nurse-surgeons within the Australian public health system. Challenges and opportunities faced by nurse-surgeons have been highlighted, emphasising the need for standardised training and enhanced support. As the field of nurse-surgeon practice continues to evolve, our findings serve as a roadmap for evidence-based policies and practice, nurturing the growth and recognition of nurse-surgeons within the Australian surgical workforce and beyond. The urgency of a standardised national credentialing pathway to ensure the sustainability of this innovative role in addressing the global surgical crisis is underscored. Policymakers and stakeholders have a pivotal role to play in expanding surgical care, innovating surgical delivery, and closing the global healthcare access gap by addressing the identified challenges and reinforcing support for nurse-surgeons considering their invaluable role within the healthcare system.

This work © 2024, Tenber Grota.