We have three 'areas ' of work - all requiring very different skills. Staff (nurses &/or ODP's) may work as:

Anaesthetic Assistants work with the Anaesthetists, to care for patients in the anaesthetic room and theatre. They also provide this care in other areas of the hospital i.e. Accident & Emergency Resuscitation, Cardiac Arrest calls, MRI & Neurology X-Ray. They require knowledge in pharmacology, specialist anaesthetic equipment, care of the critically ill patient and advanced resuscitation procedures.

Scrub Staff work within the Operating Theatre, with the surgeons, as a member of the 'scrub team' and also act as a circulating assistant during cases. They take responsibility for the care being given to the patient during surgery. They require in-depth knowledge of anatomy, surgical procedures including the instrumentation required and must have the ability to respond appropriately to emergency situations i.e. on-table cardiac arrest, ruptured Aortic Aneurysm etc.

Recovery Staff provide one-to-one care as the patient recovers in the immediate post operative period. They also require in-depth knowledge of pharmacology, particularly the action of Anaesthetic drugs and methods for effective pain control. They require an understanding of the surgical procedures undertaken to ensure appropriate care is provided for the patient, including anticipation of possible anaesthetic or surgical post-operative complications particularly in the critically ill   patient. Advanced resuscitation skills are also needed.

When a new member of staff starts work, in the Department, they are asked if they have a preference as to which 'area' they would like to work in and as far as possible we try to accommodate their request. A newly qualified nurse /ODP will enter our preceptorship programme and there is a specific programme for the area they have chosen to work in.

This framework was formed in response to an identified need for a flexible workforce who could respond to the ever changing demands of the service. Also, through using this framework the staff are given the opportunity to refresh and develop skills and competencies in other 'areas which gives them the opportunity to experience greater job satisfaction and increased motivation. This can help with the Recruitment & Retention of staff in a speciality for which is historically very difficult to recruit. The competency booklets were put together by the Professional Development Co-ordinator and experts from each 'area' - which were G Grades and Senior Operating Department Practitioners. They were then shown to other grades of staff before they became an approved working document.

This framework enables an experienced, competent theatre practitioner i.e. a specialist in one of the areas of theatre work, to move from novice practitioner to competent practitioner in an identified second area of theatre work with the support and guidance of an expert assessor. The assessor is expected to be the expert in the identified clinical area e.g. Senior Operating Department Practitioner or nurse Grade G or F I MTO equivalent.

The concept of 'Novice-Competent- Expert' practitioner is described by Herman and Kenyan (1987) in the DACUM model of competency based rotational education cited by Fearon (1998) in diagrammatic format.

Grade 0  Cannot perform this activity satisfactorily to participate in the clinical environment

Grade 1  Can perform this activity but not without supervision and some assistance

Grade 2  Can perform the activity satisfactorily but requires some assistance and supervision.

Grade 3  Can perform this activity satisfactorily without assistance and/or supervision

Grade 4  Can perform this activity satisfactorily without assistance and/or supervision with more than acceptable speed and quality of work

Grade 5  Can perform this activity satisfactorily with more than acceptable speed and quality of work and with initiative and adaptability to special problem situations.

Expert

Grade 6  Can perform this activity with more than acceptable speed and quality, with initiative and adaptability and can lead others in performing this activity.

The assessment framework is based on the NVQ Level 3 ODP framework. It is competency based and the experienced theatre staff are familiar with the terminology and documentation as they are already acting as Work Based Assessors for the ODP trainees - there was no need to reinvent the wheel! There are four stages of review built into the assessment process:

• Self assessment
• Self and peer assessment using attitude scales
• Peer Assessment
• Validation of process

These mechanisms ensure the novice practitioner's suitability and potential to achieve competency of the given skill at every stage of the process. The process is envisaged to be a partnership between the individual and the assessor. Learning needs and assessment are identified and addressed together.

Staff member completes a self-assessment to determine how up to date his/her knowledge may

2.Introduction to clinical area

Identify the clinical expert for particular area i.e. assessor.  Working with the assessor for a given period of time i.e. 1 week.

3.  Initial assessment

Assessor to complete initial assessment over the introductory period (point 2).

Staff member to complete second self-assessment at the end of the introductory period. 

Analysis of the two assessment forms from the assessor and staff member to determine learning needs.

4.  Supported work in the clinical area

Depending on the learning needs to be met this time is negotiable, days to weeks, to a level of competent practitioner.

5.  Skills assessment

This is undertaken throughout the period identified in point 4 or as a formal assessment. Assessment format would be a combination of observation, discussion and written to determine competency

6.  Skills Achieved

Documentation to be signed by staff member and assessor.

6a. Skills not Achieved

Staff member and assessor should establish further learning needs that are required

Discussion may involve the Theatre Co-ordinator to facilitate staff member requirements. Issues of concern are taken further to the theatre management by staff member and/or assessor. Further assessment takes place once staff

Member learning needs have been met i.e. point 4

7.  Assessment validated by theatre management

Assessment forms are signed by the manager validating the standard and process

Photocopied assessment forms go to the staff members personal files Original assessment forms are kept by the staff member for their personal portfolio

8.  Certification

Each assessment consists of performance criteria, range of practise and knowledge depth. The number of assessments depends upon the 'area' of work but the novice practitioner will have no more than eleven assessments to undertake.

It is very important that, after the Initial Assessment, the Novice Practitioner and Expert Assessor agree the expected completion date for the framework and both sign a Learning Contract. The progress of the practitioner needs to be monitored but three - four months should be sufficient time for completion. There is an 'Appeals Procedure' for Assessment. The novice practitioner may wish to appeal against the assessment process for any of the following reasons:

1. The result of an assessment.
2. The conduct of an assessment.
3. Access to assessment.

The assessor is the clinical expert practicing in the given area, which, together with the framework offers credibility to the skills the practitioner achieves.

The novice practitioner, at the end of the assessment process, will have up to date evidence of their clinical skills demonstrating their generic function within the operating department.

The framework has also become a useful tool for use by newly qualified staff who have joined the theatre team immediately following UKCC registration. As with any development programme it requires commitment and time from those involved and support from those around them.

Staff who are competent to work in more than one area offer a flexibility that can help us to provide a better service to our patients.

We plan to start work shortly on a further framework which will provide staff with the opportunity to take specialist skills and knowledge, in all three areas, further into a deeper dimension e.g. paediatric and neonatal anaesthetics. This will allow the progression of developing practitioners from competent to expert level and will be built into a higher-grade, professional development programme.