Surgical assistants support the primary surgeon as a skilled second pair of hands providing continuous, competent and dedicated assistance under the direct supervision of the primary surgeon. The surgical assistant works collaboratively with other members of the surgical team, including the primary surgeon, scrub nurse, anaesthetist, and other healthcare professionals, to deliver the best possible patient outcomes.

Summary of RACS position

The Royal Australasian College of Surgeons (RACS) supports the use of surgical assistants who are appropriately credentialed, working within their scope of practice and are supervised, monitored and appraised.  The primary surgeon should decide if a surgical assistant is necessary.  Surgical assistants should be a qualified surgeon, a resident in an approved surgical education program, medical practitioner or a qualified specialist nurse in certain circumstances.  RACS supports the use of Perioperative Nurse Surgical Assistants (PNSA) or Registered Nurse First Surgical Assistants (RNFSA) in settings where surgeons or resident assistants may be unavailable or where it may be difficult to achieve continuity of care, for instance in rural and remote areas.  The use of PNSA/RNFSA should not impede the ability of surgical trainees to gain access to training in the operating theatre.

Requirements and expectations of surgical assistants

The role of the surgical assistant may include:

  • Supporting the work of the surgeon before, during and post operation by:
    1. Providing adequate exposure
    2. Maintaining a clear operative field of view
    3. Supporting and protecting body tissues
    4. Assisting as directed by the primary surgeon
  • Working closely alongside the primary surgeon, applying understanding of the operative steps and processes and demonstrating additional operative skills and experience where required
  • Providing advice and discussing issues with the primary surgeon, drawing on considerable knowledge and experience with pathology, operative procedure and surgical techniques

Surgical assistants should be:

  • Registered, appropriately credentialed and covered by sufficient medical indemnity insurance
  • Understand their role to support and facilitate the safe and efficient performance of an operation by the primary surgeon
  • Follow instruction and direction from the primary surgeon and work within their scope of practice and training
  • Demonstrate a clear understanding of the purpose, nature and technical requirements of the operation
  • Have required knowledge of the anatomy of the operative region and anticipated pathology
  • Demonstrate a thorough understanding of general operating theatre behaviour and any specific requirements relevant to the theatre suite in use
  • Be proficient in the use of required surgical instruments for the operation
  • Adhere to surgical hygiene and safety procedures including aseptic techniques
  • Demonstrate compliance with continuing professional development (CPD)

Use of surgical assistants

The decision to request a surgical assistant is the responsibility of the primary surgeon. The decision to use a surgical assistant should be made in advance, allowing sufficient time for both the surgical assistant and surgical team to prepare. Several resources provide guidance on the use of a surgical assistants, including Physicians as Assistants at Surgery produced by the American College of Surgeons.


Use of nurse surgical assistants

Where surgical assistants may otherwise be unavailable, for instance in rural and remote areas, a primary surgeon may wish to consider the use of a PNSA or RNFSA. PNSAs and RNFSAs are registered nurses who undertake an advanced practice nursing role as a surgical assistant in surgery. The following requirements for PNSAs and RNFSAs have been endorsed by RACS as minimum entry requirements:

  • Appropriate qualifications (i.e. PNSA course offered by La Trobe University or RNFSA at Auckland University), credentialing, and indemnity insurance
  • Access to a surgeon mentor
  • Formalised oversight and participation in ongoing competency based CPD within the appropriate scope of practice (RACS can review the CPD framework and provide advice)