From novice to expert: Exploring surgical First Assistants and the conceptual integration of their role in robotic surgery
Main Article Content
Abstract
Competing demands and pressures in health services in the United Kingdom have led to the creation of specialist roles in nursing. One such role is that of Surgical First Assistant (SFA). SFAs are specialist nurses or operating department practitioners who work in operating theatre departments and provide clinical assistance to surgeons and the wider clinical team. In this article, Benner’s novice to expert framework is adopted to examine the progression and abilities of SFAs at different stages. A case study is also used to examine a nurse specialist’s transition into the SFA role.
This article conceptualises the development and training needs of a SFA in an era where robotic surgery is enhancing practice in many specialities. Each SFAs journey is unique depending on their experiences and encounters within their operating theatre environment, and this may influence their progress and skill development which can affect their ability to maintain an expert level in practice. This paper suggests that through the development of a formalised and specialist robotics training pathway, SFAs may have scope for further practice development in this area.
Article Details
Issue
Section

This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under CC BY 4.0
References
Aveling, E-L., Stone, J., Sundt, T., Wright, C., Gino, F., Singer, S. (2018). Factors influencing team behaviors in surgery: A qualitative study to inform teamwork interventions. The Annals of Thoracic Surgery, 106(1), 115-120. doi: 10.1016/j.athoracsur.2017.12.045
Albani, J. M. (2007). The role of robotics in surgery: A review. Mo Med, 104(2), 166-172. doi: 10.1016/j.apnr.2007.03.005
Bobay, K., Gentile, D., Hagle, M. E. (2009). The relationship of nurses’ professional characteristics to levels of clinical nursing expertise. Applied Nursing Research, 22 (1), 48-53. doi: 10.1016/j.apnr.2007.03.005
Benner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), 402-407.
Benner, P., Tanner, C. A., Chesla, C. A. (2009). Expertise in nursing practice: Caring, clinical judgment, and ethics (2nd ed.). Springer Publishing Company.
Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice. Prentice Hall.
British Medical Association. (2025). NHS backlog data analysis. https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/nhs-backlog-data-analysis
Brian, R., Oh, D., Ifuku, K., Sarin, A., O’Sullivan, P., Chern, H. (2023). Experience matters for robotic assistance: an analysis of case data. Journal of Robotic Surgery, 17(1), 2421-2426. doi: 10.1007/s11701-023-01677-w
Brykczynski, K. A. (2017). Caring, clinical wisdom, and ethics in nursing practice. In M. R. Alligood (Ed.), Nursing theorists and their work (8th ed., pp. 120-146). Elsevier.
Buckingham, N. (2025, Nov 4). NHS workforce in a nutshell. Kings Fund. https://www.kingsfund.org.uk/insight-and-analysis/data-and-charts/nhs-workforce-nutshell
Carpenter, B. T., Sundaram, C. P. (2017). Training the next generation of surgeons in robotic surgery. Robot Surgery, 21(4), 39-44. doi: 10.2147/RSRR.S70552
Clinical Services Journal. (2025). Perioperative care collaborative re-established under AfPP leadership to tackle urgent SFA role concerns. https://www.clinicalservicesjournal.com/story/48812/perioperative-care-collaborative-re-established-under-afpp-leadership-to-tackle-urgent-sfa-role-concerns
de Kok, E., Schoonhoven, L., Lalleman, P., Weggelaar, A. (2023). Understanding rebel nurse leadership-as-practice: Challenging and changing the status quo in hospitals. Nurse Inquiry, 30(4). doi: 10.1111/nin.12577
Denton, A. (2021). Implementing a surgical first assistant role into that of a clinical nurse specialist at an orthopaedic specialist hospital. British Journal of Nursing, 30(20). doi: 10.12968/bjon.2021.30.20.1178
Davis, A., Maisano, P. (2016). Patricia Benner: Novice to expert – A concept whose time has come (again). Oklahoma Nurse, 61(3), 13-15.
Gentile, D. L. (2012). Applying the novice-to-expert model to infusion nursing. Journal of Infusion Nursing, 35(2), 101-107. doi: 10.1097/nan.0b013e3182424336
Gallagher, A. G., Traynor, O. (2008). Simulation in surgery: Opportunity or threat? Irish Journal of Medical Science, 117(4), 283-287.doi: 10.1007/s11845-008-0204-5
Gill, A., Randell, R. (2016). Robotic surgery and its impact on teamwork in the operating theatre. Journal of Perioperative Practice, 26(3), 42-25. doi: 10.1177/175045891602600303
Gohery, P., Meaney, T. (2013). Nurses’ role transition from the clinical ward environment to the critical care environment. Intensive and Critical Care Nursing, 29(6), 321-328. doi: 10.1016/j.iccn.2013.06.002
Gulati, V., Simpson, A. I., Uzoigwe, C., Jaggard, M., Gibbons, C., Gupte, C., Williams, A. (2016). Surgical care practitioners in orthopaedics: A current concepts review. Journal of the Royal Society of Medicine, 109(3), 109-118. doi: 10.1177/0141076816643334
Hall, S., Quick, J., Hall, A. G., Jones, A. P. (2015). Surgical assistance - who can help? Bulletin of the Royal College of Surgeons England, 96(7), 244-246.doi: 10.1308/rcsbull.2014.96.7.244
Hall, S., Quick, J., Hall, W. (2016). The perfect surgical assistant: Calm, confident, competent and courageous. Journal of Perioperative Practice, 26(9), 201-204. doi: 10.1177/175045891602600903
Haji, F., Rojas, D., Childs, R., de Ribaupierre, S., Dubrowski, A. (2015). Measuring cognitive load: performance, mental effort and simulation task complexity. Medical Education, 49(8). 815-827. doi: 10.1111/medu.12773
Hill, A. L., Scherer, M. D., Kiani, A., Vachharajani, N., Matson, S., Cullinan, D. R., Martens, G. R., Yu, J., Davidson, J. T., Wellen, J. R., Chapman, W. C., Doyle, M. B., Khan, A. S. (2023). The impact of a dedicated operating room team on robotic transplant program growth and fellowship training. Clinical Transplantation, 37(11), e15103. doi: 10.1111/ctr.15103
Kings Fund. (2024). Activity in the NHS. https://www.kingsfund.org.uk/insight-and-analysis/data-and-charts/NHS-activity-nutshell
Kurtović, B., Gulić, P., Čukljek, S., Sedić, B., Smrekar, M., Ledinski Fičko, S. (2024). The commitment to excellence: Understanding nurses’ perspectives on continuous professional development. Healthcare (Basel), 12(3), 379. doi: 10.3390/healthcare12030379
Lanfranco, A., Castellano, A., Desai, J., Meyers, W. (2004). Robotic surgery - A current perspective. Annals of Surgery, 239(1), 14-21. doi: 10.1097/01.sla.0000103020.19595.7d
Leggett, L. K., Muldoon, O., Howard, D. L., Kowalski, L. D. (2021). A comparison of surgical outcomes among robotic cases performed with an employed surgical assist versus a second surgeon as the assist. Journal of Robotic Surgery, 16(1), 229-233.doi: 10.1007/s11701-021-01230-7
Lone, P.A., Lone, T.A. (2016). A study on relation between self concept and academic achievement among secondary school students of Jammu district. Journal of Education and Practice. 7(31), 19-23. https://www.researchgate.net/publication/352777252_A_Study_on_Relation_between_Self_Concept_and_Academic_Achievement_among_Secondary_School_Students_of_Jammu_District
McHugh, M., Lake, E. (2010). Understanding clinical expertise: nurse education, experience, and the hospital context. Research in Nursing and Health. 33(4), 276-287. doi: 10.1002/nur.20388
Moller, L., Olsen, R. G., Jorgensen, L., Hertz, P., Peterson, J., Roder, A., Konge, L., Bjerrum, F. (2024). Training and education of operating room nurses in robotic-assisted surgery: A systematic review. Surgical Endoscopy, 38(12), 7024-7036. doi: 10.1007/s00464-024-11335-3
Narbona-Galvez, A., Garcia-Iglesias, J. J., Ayuso-Murillo, D., Fontan-Vinagre, G., Gomez-Salgado, J., Allande-Cusso, R., Fagundo-Rivera, J., Macias-Toronjo, I., Ruiz-Frutos, C. (2024). Stress in novice nurses in new work environments: A systematic review. Frontiers in Public Health, 12, Article 1463751. doi: 10.3389/fpubh.2024.1463751
National Health Service England (2025). Millions to benefit from NHS robot drive. https://www.england.nhs.uk/2025/06/millions-to-benefit-from-nhs-robot-drive/
National Health Service Confederation. (2023). Key statistics on the NHS. https://www.nhsconfed.org/articles/key-statistics-nhs
National Health Service England & Getting It Right First Time. (2025). Implementation of robotic-assisted surgery (RAS) in England (July 2025). NHS England/GIRFT. https://gettingitrightfirsttime.co.uk/wp-content/uploads/2025/07/FINAL_NHS-England-and-GIRFT-implementation-of-robotically-assisted-surgery-in-England_17-07-2025.pdf
National Health Service Scotland Academy. (2025). How NHSSA SFA accelerated programme is making a difference to individual practitioners’ career progression. NHS Scotland Academy. https://www.nes.scot.nhs.uk/media/dhwokikd/27-caroline-adam.pdf
Office for National Statistics. (2025). Population estimates for England and Wales: mid-2024. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/populationestimatesforenglandandwales/mid2024
Paradis, M., Hart, E., O’Brien, M. (2017). The sisters of mercy in the Crimean war: Lessons for the Catholic health care. Linacre Quarterly, 84(1), 29-43. doi: 10.1080/00243639.2016.1277
Perioperative Care Collaborative. (2018). Position statement - Surgical First Assistant. https://www.afpp.org.uk/wp-content/uploads/sfa-position-statement-final-april-2018.pdf
Royal College of Surgeons of England. (2025). Surgical first assistant. https://www.rcseng.ac.uk/careers-in-surgery/surgical-team-hub/surgical-team-roles/surgical-first-assistant/
Reed, S., Arbet, J., Staubli, L. (2021). Clinical nurse specialist in the United States registered with a national provider identifier. The International Journal for Advanced Nursing Practice. 35(3),119-128. https://journals.lww.com/cns-journal/abstract/2021/05000/clinical_nurse_specialists_in_the_united_states.7.aspx
Schmidt, H. G., Norman, G. R., Boshuizen, H. P. A. (1990). A cognitive perspective on medical expertise: Theory and implications. Academic Medicine, 65(10), 611-621. https://pubmed.ncbi.nlm.nih.gov/2261032/
Titzer, J. L., Shirey, M. R., Hauck, S. (2014). A nurse manager succession planning model with associated empirical outcomes. Journal of Nursing Administration, 44(1), 37-46. doi: 10.1097/nna.0000000000000019
Tsuzuki, Y., Hirata, T., Tsuzuki, S., Tamakoshi, A. (2022). Does the experience of the first assistant affect organ injuries in laparoscopic hysterectomy for benign diseases? Archives of Gynecology and Obstetrics, 307(2), 453-458.doi: 10.1007/s00404-022-06745-4
Urban, R., Barnes, D. (2020). Transition to Practice: The lived experience of new hraduate nurses in early solo flight. Journal of Nursing Professional Development, 36(2), 74-81. doi: 10.1097/nnd.0000000000000608
Wah, J. N. K. (2025). The rise of robotics and AI-assisted surgery in modern healthcare. Journal of Robotic Surgery, 19(1), 311. doi: 10.1007/s11701-025-02485-0
Wilkinson, E., Aruparayil, N., Gnanaraj, J., Jayne, D. (2020). Barriers and facilitators of laparoscopic surgical training in rural North-East India: A qualitative study. International Journal of Surgery: Global Health, 3, e29. doi: 10.1097/GH9.0000000000000029