CARDIOTHORACIC SURGERY WORKFORCE PLANNING SURVEY

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CARDIOTHORACIC SURGERY WORKFORCE PLANNING SURVEY

• Tara Bartley
• Nursing Representative,
• Society for Cardiothoracic Surgery

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RESULTS

• Returns 52
• No. of Cases
• CARDIAC 550-1950
• mean 1024
• THORACIC 10-700
• mean 346

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Current Service ProvisionSurgical

• Critical Care
• Surgeon Lead 23
• Intensivist Lead 25
• Joint Leadership 52
• Are pure Surgeon Led Units at a
• disadvantages with EWTD MMC?

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One Approach Doesnt Suit All
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Current Service ProvisionSurgical

• Nos. of tiers 2 for 24/7 BUT several units have
  moved to 1 tier at night
• What impact does this have for cover of ITU,
  theatres ED?
• Comments associated with
• Level of knowledge
• Personnel for an open chest
• The role of Senior nurses

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Who Is The Best Person To Treat The Patient?
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Current Service ProvisionSurgical

• Nos. of Trainees 3-15
• mean 7.0
• Nos. of Staff grades 0-5
• mean 1.7
• All provided 24hr cover
• (x1 unit had two SHO)
• Nos. of Junior Anaesthetists 0-14 mean 6
• Majority provided 24hr
  cover BUT were reliant upon Hospital at night
  joint cover to make up any deficit. 75
• 60 worked a Partial
  shift system 40 total shift system
• Nos. of Junior Drs 0-10
• Mean 5
• Majority provided 24hr
  cover BUT were drawn from other specialities
  (cardiology, neurology, hospital at night) 72
• 64 worked a Partial
  shift system 36 partial shift system

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Current Service ProvisionSurgical Care
Practitioners

• Nos. of unit with SCPs 66
• Nos 0-8
• mean 4
• Qualifications
• 64 SA qualification
• 7 Trainees
• 14 mixture of trained untrained
• 14 untrained (x1 unit training
  scrub nurses to flex as SCPs)

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Current Service ProvisionSurgical Care
Practitioners

• Areas in which SCPs worked
• Theatres 100
• Clinic 42
• Ward 35
• Critical Care 14
• All received supervision
• Administration Support
• 50 didnt receive any administrative time
• 42 received office time
• 7 received both secretarial support and
  office time.

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Current Service ProvisionSurgical Care
Practitioners

• SCP Banding
• Band 7 50
• Band 6 14
• Pending outcome 7
• Dont know 28
• Work Pattern
• Weekdays 92
• Weekends 35
• Nights 14
• What are the implications of this work pattern
  for service
• delivery?

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Current Service ProvisionSurgical Care
Practitioners

• Skills
• Leadership 42
• Decision making 42
• Autonomy 42
• Career Pathway
• Yes 25
• No 75
• Is the SCP role moving to one of education for
  junior Drs?
• Future plans call for increase in nos. but the
  majority think there
• isnt a career plan. What are the implications?

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Current Service ProvisionNurse Practitioners

• Nos. of NPs 1-25 4
• Nos. of units with Nurses Practitioners
• Yes 85 No 15
• Cardiac 15
• Thoracic 15
• Both 70
• Work Pattern
• Weekdays 100
• Weekend 38
• Nights 15
• What are the implications of this work pattern
  for service
• delivery?

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Current Service ProvisionNurse Practitioners

• Area of work
• Pre admission clinic 92
• Critical Care 7
• Ward 64
• Rehab 50
• Other 28 Clinic, admission/discharge
  planning
• Issues around
• The title Nurse Practitioner
• Is it primarily a Clinical Role?
• Registration with NMC

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Current Service ProvisionNurse Practitioners

• Qualifications
• Specialist Practice Actual 76 (Desired
  69)
• ANP 53 (30)
• Undergraduate 30 (53)
• Postgraduate 7 (46)
• Professional development 61 (69)
• Experience 78 (61)
• Other 46 (prescribing, Health assessment,
  MSC)
• Supervision
• By Nurses 76
• By Doctors 38
• None 24

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Current Service ProvisionNurse Practitioners

• Banding
• Band 6 42
• Band 7 78
• Band 8a 14
• Nurse Consultant 14 (X1 pure X1
  outreach)
• Administration support
• secretarial 25
• office time 57
• none 21

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Current Service ProvisionNurse Practitioners

• Skills
• Leadership 83
• Decision making 100
• Autonomy 83 (nurse consultant also said
  yes)
• Career pathway
• Yes 27
• No 73
• Future plans call for increase in nos. but the
  majority think there
• isnt a career plan. What are the implications?

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Current Service ProvisionCritical Care
Practitioners

• Number of units with CCP Yes18 No 81
• Nos. 1-11
• Work Pattern
• Weekdays 100
• Weekends 66
• Nights 66
• Qualifications
• Specialist Practice 100
• ANP 66
• Undergraduate 100
• Postgraduate 7 (38)
• Professional development 66
• Experience 100

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Current Service ProvisionCritical Care
Practitioners

• Supervision yes 66 No 34
• Banding
• Band 7 66
• Band 8a 33
• Administration Support
• Secretarial 33
• Office time 66
• None 34

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Current Service ProvisionCritical Care
Practitioners

• Skills
• Leadership 100
• Clinical decision making 100
• Autonomy 66
• Career pathway
• Yes 34 No 66
• Future plans call for increase in nos. but the
  majority think there
• isnt a career plan. What are the implications?
• x2 units had a Nurse Consultant one was pure
• Cardiothoracic one worked with outreach

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Future Service Provision

• Currently 92 of units felt they worked
  collaboratively
• Desired change
• Increased nos. SCPs, NPs CCPs
• Review the role of the Anaesthetist, and
  Staff Grades hospital at night
• Consultant lead
• Issues concerned the role of the Consultant,
  Nurse
• prescribing, health assessment o/e. Questions
• raised about looking towards a competency based
• service delivery

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Future Service Provision

• Units that were reacting to change 85
• Units that were currently planning 68
• Units that had no plans 15
• A reduction in Drs Hrs was resulting in a desire
  to increase cover from nurses, SCPs, staff
  grades (at SHO reg level), anaesthetists and
  hospital at night for 24/7 service provision
  encompass clinics
• BUT there were issues around education funding.
• Thus some units had firm plans but were unsure
  how
• to actualise them.

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Future Service Provision

• Provision should be driven
• National 95
• Trusts 24
• Both 6
• (14 units had no plans)
• The drive should come Nationally in terms of the
  lead, who what when the authority behind. So who
  do you expect to take the lead? If it is
  Government there will be calls for finance, if it
  is SCTS what will be their role. Other thoughts?
• NB. One comment was that there were four
  countries to be accommodated.

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Future Service Provision

• Planned provision
• 84 of units had average of 4 NPs. Increased
  nos. 1-7 the mean 4 more.
• 60 increase NPs SAs
• 10 Didnt know
• 5 not looked into it
• 5 no vacancies
• 5 funding issues.
• 5 were recruiting
• 5 were looking in to issues around
  education
• 5 no comment
• Comments about funding and vacancy freezing were
  highlighted
• as hurdles. Suggestions were to train a minimal
  no. but they would have
• to be good or train all nurses to expand their
  roles.

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Future Service Provision

• Issues
• Regulation 69
• Accountability 69
• Governance 69
• Demand/supply of staff 7.6
• EWTD 7.6
• Dont know 23
• 95 felt nurses would still nurse, 28 felt that
  this would be reduced BUT delivery should be
  Patient Centred
• Other comments called for a National framework
  and yet the
• NNP has been disbanded, there was a need for NMC
  guidance
• particularly with medical and nursing roles
  blurring. Two optimist views
• felt all issues can be over come.

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Future Service Provision

• Hours to be worked by nurses
• Weekday 66
• Weekend 47
• Nights 42
• Dont know 23
• Training Issues for nurses
• Resources 23
• Personnel 28
• Education 14
• Governance 14
• Resistance 9.5
• Dont know 19
• Issues raised were releasing staff, mx of open
  chests, mx
• haemodynamics, Standards
• Its a nightmare of
  bureaucracy

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Future Service Provision

• Finance
• Deanery 19
• Trust 90
• Unknown 23
• No Answer 28
• Obstacles
• Consent 33
• Prescribing 25
• Vicarious liability 33
• Manpower 75
• Conflict 33
• Barriers 50
• New Roles 41
• Education 58
• Finance 100
• No Answer 38
• Call for National Guidance

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Conclusion

• We are bewildered, there are many variables and
  the root of it all is funding

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TARA BARTLEY

• NURSING REPRESENTATIVE FOR THE SOCIETY FOR
  CARDIOTHORACIC SURGERY
• tara.bartley_at_ntlworld.com