Scott Lister, Nurse Consultant at Apex Health Associates, interviews Paula Mason about her role as physicans’ assistant and her expert witness work
SCOTT: Paula, can you tell us about your current clinical role?
PAULA: I currently work as a Physicians’ Assistant (Anaesthesia) in a large teaching hospital based in Manchester, and, I am also a qualified nurse. My clinical background has been predominantly in the operating theatre environment and I have worked in scrub, anaesthetics and recovery in both the NHS and private sector.
My present role is very similar to that of an Advanced Practitioner but with a high medical understanding of the delivery and complexities of anaesthesia. My typical day includes assessing patients for their anaesthetic, which varies from those who are essentially fit and well to those who have multiple co-morbidities, for both elective and emergency/trauma surgery. I will discuss the different options that may be available in regard to the anaesthetic technique, ensuring the risks and benefits are explained to enable informed consent providing patients have the capacity to do so.
Perhaps one of the most important aspects of my role is to prepare, check and manage a safe environment for the patient but at the same time, anticipate and plan for the unexpected. My role is all-encompassing when it comes to patient care whilst they are in the operating theatres. I not only take into account the maintenance of their vital signs, depth of anaesthesia or analgesia: I also have to be aware of the inadvertent problems that can arise, for example potential pressure damage from the patients position during their clinical procedure, fluid shifts and their safe transfer around the department.
Of course my nursing background means I understand about theatre standards and policies, the safety frameworks that have been implemented recently such as the WHO checklist, and the responsibilities of the theatre team.
SCOTT: Your role is relatively new within the UK, How many practitioners are doing it?
PAULA: The role has been around in the USA and parts of Europe for many years, however it was introduced to the UK just over 10 years ago as a result of a predicted shortfall in the number of doctors with the change in the EWTD. PA(A)s are trained locally in trusts who have a need for them. To date, there are around 150 qualified PA(A)s with a number in training. It is still a developing role.
SCOTT: How long have you been doing it?
PAULA: I have been working as a PA(A) for 8 years now at Salford Royal Foundation Trust. I have however been a Registered Nurse since 1997 with experience of Accident and Emergency, scrub, anaesthetics and recovery nursing as well as working in medical sales and medical information for a couple of years.
SCOTT: What did your training involve for this role?
PAULA: My experience as a scrub/anaesthetic/recovery nurse gave me a significant head start before I started my PA(A) training. I already had the underpinning knowledge of the operating theatre environment, the policies and procedures that need to be followed to ensure patient safety and the demands that are commonplace in theatres. The course is very much clinically based working alongside a Consultant Anaesthetist learning practical skills such as cannulation, advanced airway techniques, arterial and central line placement. We were however constantly assessed with eight official modules, two MCQ exams at the University of Birmingham and one OCSE exam which took place at the Royal College of Anaesthetists in London.
SCOTT: What do you enjoy about your current role?
PAULA: The main aspect that I enjoy about my role is the fact that every patient is unique and the way that anaesthesia is conducted is different. I have always said that in this role, I learn something every day and that is what keeps me interested. My job is very much patient orientated with their wellbeing at the forefront. There are so many elements to the job that I have to take into consideration, such as anaesthetic technique, analgesia, safe positioning or safe drug delivery while also planning for the expected and anticipating the unexpected are fundamental.
SCOTT: As an expert witness, what are your areas of expertise?
PAULA: I consider my expertise to be within the operating theatres. As a result of my clinical experience, I know how the theatre team dynamics work which means I also know how things don’t always go to plan. I have an excellent understanding of the risks and hazards that are always present in theatres.
SCOTT: Why do you do expert witness work?
PAULA: I have recently completed a Masters in Healthcare Law at the University of Salford. I always had an interest in medical law and ethics. I know that everyone strives to do their best but realistically things don’t always go to plan and standards can slip. Determining if an accident or error could have been prevented requires knowledge of the circumstance, an understanding of why things didn’t go to plan and whether the incident may have been prevented.