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Exclusive: 'Ad hoc' use of their skills sparking 'frustation' among surgical nurses


Nurses who train to be specialists in keyhole surgery are often not deployed to the best of their ability, causing many to leave the health service, according to a leading nurse in the field.

Mary Akangbe, who is a specialist practitioner in minimally invasive surgery at King’s College Hospital in London, said nurses were being deterred from doing specialist qualifications because they feared their skills would not be used.

“We have to go back to the drawing board and see how nurses can be encouraged, rewarded and positioned”

Mary Akangbe

She was recently the lead nurse for minimally invasive surgery during a ground-breaking operation by surgeons at King’s College Hospital NHS Foundation Trust to repair the spine of an unborn child with spina bifida.

She said the operation, which also saw her work alongside other specialist nurses with expertise in neurosurgery and anaesthesia, was an example of the vital role nurses could play in cutting-edge surgical procedures.

However, Ms Akangbe maintained specialist nurses were generally under used.

She delivers training on minimally invasive – or laparascopic – surgery to nurses and doctors all around the country, as well as practising in theatre three days a week.

“When I first started only the lead surgeon had the privilege of looking down the scope”

Mary Akangbe

She told Nursing Times that trusts tended to deploy nurse surgical assistants on an “ad hoc” basis, rather than as regular members of surgical teams.

“The problem with nurse surgical assistants is that some trusts don’t embrace them and only use them ad hoc, which not good for gaining experience,” she said.

“There are many nurses who could get to that level, but they are discouraged because it is not attractive enough,” she said. “When they do get to that stage, they are not really able to practise so frustration kicks in.”

She said nurses with these skills often ended up leaving the NHS to work for agencies or in the private sector where nurse surgical assistants – also known as assistant scrub practitioners – were used more widely.

“To make it more attractive, we have to go back to the drawing board and see how nurses can be encouraged, rewarded and positioned,” she said.

Having qualified as a nurse in Nigeria in 1981, she came to work in the UK in 1990 where she worked in theatres during the early days of the pioneering field of keyhole surgery.

“The success of the operation opens the doors to other similar cases in future and gave us a real sense of fulfilment”

Mary Akangbe

Ms Akangbe has seen the type of equipment and techniques used come on in leaps and bounds over the years.

“Everything was manual and now it is automated,” she said. “When I first started only the lead surgeon had the privilege of looking down the scope.”

Now surgeons increasingly use sophisticated robots to carry out delicate procedures under their direction and the time taken to carry out surgery is vastly reduced.

“We have moved on from spending 12 to 15 hours on a procedure to now doing the same procedure in four, five hours,” said Ms Akangbe.

She said the fact procedures used to take so long was one reason why nurses and doctors “shied away” from the field in the early days.

But now an increasing number of specialities were using laparascopic techniques and one of her roles was helping to train teams new to the field.

She has also been involved in piloting virtual reality training for nursing and medical students due to be rolled out at King’s.

Ms Akangbe said she was “thrilled” to be part of the team that carried out the operation on baby Jaxson Sharp who was diagnosed with spina bifida at a routine 20-week scan.

“Their skills and contributions are invaluable and I’d like to see more nurses take the lead”

Mary Akangbe

She said the procedure to repair Jaxson’s spine 27 weeks into the pregnancy, which involved the use of tiny surgical tools or “micro instruments”, had been meticulously planned by the multi-disciplinary team.

“It involved modifying techniques and equipment used for other innovative procedures,” she said. “The success of the operation opens the doors to other similar cases in future and gave us a real sense of fulfilment as a team.

“We were thrilled to have been able to offer this corrective surgery early on, which will hopefully help prevent severe long-term health problems,” she said.

Ms Akangbe has just been appointed a mentor for Digital Health London’s Accelerator programme aimed at speeding up the adoption of innovative technology.

She said she would like to see nurses more involved in the ongoing drive to develop keyhole surgery techniques in both elective and emergency care.

“Their skills and contributions are invaluable and I’d like to see more nurses take the lead,” she said.

This included getting more nurses involved in work around the National Emergency Laparotomy Audit (NELA), which also covers emergency laparoscopies, and was set up in a bid to improve outcomes for some of the most vulnerable surgical patients.

Her call comes after a special report in Nursing Times highlighted the key difference nurses could make in this area and the need to develop new nursing roles.

Ms Akangbe is the founder and chief executive of a firm called Zenith Global Health, which provides a worldwide platform for sharing best practice in healthcare and runs annual awards to celebrate excellence.

She said one of the reasons she set up the company was because she felt healthcare professionals, including nurses, deserved more recognition because “their commitment and ground-breaking work often unnoticed”.

“We do need to get better at supporting nurses from the moment they step into nursing”

Mary Akangbe

In particular, Ms Akangbe, who has been involved in developing induction and retention schemes for UK and overseas nurses, highlighted the need to improve support for nurses of all backgrounds in order to boost retention rates.

“We do need to get better at supporting nurses from the moment they step into nursing – we need to give them confidence, reassurance and showcase positivity,” she said.

This included providing opportunities for ongoing learning and career development so nurses did not get “stuck”.

“The worst thing is when you hear a nurse say: ‘I am only here to pay the mortgage,” she said. “I am only here to survive and make money’.

“When they get to that stage there is hardly anything you can do to move them out of it,” said Ms Akangbe.

She added: “There are a lot of intelligent, highly-driven nurses out there but sometimes they get stuck and this is a stumbling block we need to address.”

She has set up a Facebook group called “Not just a nurse” aimed at inspiring and encouraging nurses and is planning on staging the first of what she hopes will become an annual gathering next year.

Keyhole surgery

Mary Akangbe

Mary Akangbe, founder and president of Zenith Global Health


Readers' comments (3)

  • Gosh, what an inspiring article. Apart from its obvious message about surgical nursing; which stands, in its own right, I take from it, the wider point that we need a workforce of Registered Nurses who are up to date, know what they are doing and can work both assertively and coleagiately, in teams and alone, to deliver evidence-based person-focussed care and treatment; no matter the field or specialism.
    CPD encouragement from (and audit by) local leaders & senior managers, and respect from Executives about the work all nurse do is the essential ingredient.
    One way or another, in due course, there will be renewed investment in as they say "Real Terms". Executive Nurses will need to have their arguments, plans & strategies, well mustered and understood in the nursing workforce, if we are to apply the lessons from this article.

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  • Fantastic article, but confused by the titles used in this piece? Non-medical surgical assistant recognised titles are currently: Surgical First Assistant - single degree academic module qualification.
    Surgical Care Practitioner - Masters degree undertaken at a Royal College of Surgeons accredited University. Both draw candidates from theatre nurses or Operating department practitioners across the U.K. Providing continuity of patient care within Perioperative surgical care team led by consultant surgeons.
    More info : /

    Adrian Jones | Immediate Past President
    Association for Perioperative Practice
    Orthopaedic SCP - Norfolk & Norwich University Hospital

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  • Frustation? Is this journal produced by children who cannot spell? Or by journalists who cannot be bothered to proofread their work? Disgraceful. There are two other typos I can't be bothered to list here. A thought just occurred to me; Is a frustation some kind of lobster or prawn creature that thwarted nurses metamorphose into? I might be halfway there. Clack clack.

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