In the next health crisis, hospitals will have to do without the support of OR staff

Problems arise in and around operating rooms because surgical assistants and nurse anesthetists are not allowed to perform some medical treatments. So-called ‘reserved actions’, such as pricking IVs, applying a bladder catheter, administering medication independently or suturing the skin, may only be performed by healthcare professionals who have a certain title.

Despite this, operating room staff now often perform these tasks, thereby breaking the law. Ministers Ernst Kuipers (Public Health, Welfare and Sport) and Conny Helder (Long-term care) do not want to change the rules.

As a result, operating assistants and anesthetists without prior nursing training, and there are many of them, can no longer be deployed independently. That was the conclusion of the Taskforce in January that research did to the deployment of healthcare professionals during corona crises.

against the law

In our work we carry out so-called reserved actions without supervision. Healthcare professionals may only perform this type of action independently if they are included in the Individual Healthcare Professions Act (BIG). And our professions are not.

When surgical assistants and anesthetists perform reserved procedures, there is rarely a surgeon or anesthetist in the operating room. There is also no other registered healthcare professional who directly supervises. And according to the National Health Care Institute, the advisory body to the minister, that is precisely the case. But the Zorginstituut bases its conclusions on information from all kinds of adjacent professional groups, except ours.

During the corona crisis, the hospitals were overcrowded and we worked in other departments, for example in the IC, emergency room or nursing ward. Here we also performed reserved actions, just like we do in the operating room. But because this is not allowed by law – and after recently decision According to the minister, this will remain so – many of us will no longer perform reserved actions outside the operating room in the next crisis.

screaming deficit

This makes the deployment of operating assistants and anesthetists less flexible. And that is worrying, because there is already a crying shortage of healthcare personnel – also in our professions.

Patients are the victims of this state of affairs for several reasons. Firstly, we are already with far too few colleagues, so fewer operations are being performed than necessary. When someone is finally operated on, they are not well protected. After all, the vast majority of our profession is well-educated and meets all competencies. But there is no legal quality control.

An operating assistant or nurse anesthetist who makes a mistake does not have to answer to the disciplinary court like a nurse, as prescribed by the BIG Act. Also, mistakes are not learned and an OR employee who has made a mistake can easily return to work in another hospital.

Unfortunately, there are examples where wreckers went to work in the next hospital after discharge. We now see, which was also the practice in the event of personnel shortages, that people without full training work in the OR. This compromises quality and safety.

We believe that the Minister of Health, Welfare and Sport is not doing enough to recognize us as specialized nurses. The minister considers us competent, but does not recognize us – because of an old flaw in the regulations. Our professions find their basis in nursing. We have called on the health ministers several times to recognize us. We got zero on the bill.

Necessary help

Minister Kuipers states in one of his letters to the House of Representatives that there should be an additional training program for surgical assistants who currently do not have a nursing diploma, enabling them to develop into nurses. But no additional training is required at all. Anesthesiologists and operating assistants already possess the essential nursing competencies. This became clear when we assisted in wards outside the operating theaters during the corona crisis.

Not only do we think that inclusion in the BIG Act is indeed important and that this is also necessary to deploy us for any assistance outside the operating room, several consultancies and bodies also indicate this in their reports.

Much has been written in recent years about the role and future of our professions. In many cases, the National Association of Operational Assistants and the Dutch Association of Anesthesiologists work together because the positions of our professions are virtually the same. We have a common interest and that is a safe operating room, where recognized healthcare professionals work transparently.