Orthopedic FNP Texas

  1. 0
    Hello all

    I'm currently in the FNP program at Texas Tech, due to graduate in August and trying to figure out what to do afterwards. My background is ICU for 2 years and Ortho for the last 3 years. I always thought I would go to Family Practice when done with my FNP but, as I am nearing completion of my program, Ortho surgeons I work with are asking me about potentially joining their respective practices. While I love the idea of staying in Ortho, I am unsure of what my role, as an FNP, would be.

    I realize seeing patients in clinic- injuries, pre-op, and post-op would be a big part of it so the surgeon could be in the OR where he makes his big $$$. But the surgeons I work with employ PAs and don't seem to think there is a difference between the two. I see PAs assist in the OR frequently, but as an FNP, the only way I could do that is with an RNFA, correct?

    Also, they could not ask me to round or deal with anything inpatient, correct? I really wish Tech offered a course on this type of issue as I am months away from graduation and am unclear of my scope in this field. Anyone who has a clue about how this works in Texas, please advise.

    Thanks
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  4. 14 Comments so far...

  5. 0
    Quote from littlebelle1293
    Hello all

    I'm currently in the FNP program at Texas Tech, due to graduate in August and trying to figure out what to do afterwards. My background is ICU for 2 years and Ortho for the last 3 years. I always thought I would go to Family Practice when done with my FNP but, as I am nearing completion of my program, Ortho surgeons I work with are asking me about potentially joining their respective practices. While I love the idea of staying in Ortho, I am unsure of what my role, as an FNP, would be.

    I realize seeing patients in clinic- injuries, pre-op, and post-op would be a big part of it so the surgeon could be in the OR where he makes his big $$$. But the surgeons I work with employ PAs and don't seem to think there is a difference between the two. I see PAs assist in the OR frequently, but as an FNP, the only way I could do that is with an RNFA, correct?

    Also, they could not ask me to round or deal with anything inpatient, correct? I really wish Tech offered a course on this type of issue as I am months away from graduation and am unclear of my scope in this field. Anyone who has a clue about how this works in Texas, please advise.

    Thanks
    Two problems. First you are correct you would need an RNFA to work in the OR:
    Q: What requirements need to be met for advanced practice nurses who want to first assist and be reimbursed for their services?
    A: HB 1718, passed in the 79th Regular Legislative Session (2005), amended the Nursing Practice Act to include Section 301.353. This section defines a nurse first assist as an individual who:

    • Is licensed to practice as a RN,
    • Has completed a nurse first assistant educational program approved or recognized by an organization recognized by the board, and
    • Is either (1) certified in perioperative nursing (CNOR) OR (2) recognized by the board as an advanced practice nurse and qualified by education, training or experience to perform the tasks involved in perioperative nursing.


    Second problem:
    APN Scope of Practice

    You are an FNP trying to work in an acute care specialty.

    Talk to the BON but in all likelihood you would need to get a post graduate ACNP (and a ANCP-P if they see patients under 13) to work there.
  6. 0
    Actually, as an Advance Practice Nurse you do not need RNFA to assist. CMS automatically recognizes APRN's (NP's etc.) to assist. The issue is often that NP programs do not include a surgical rotation. The other issue is the facility credentialing. The previous poster was referring to RN's. Look at NIFA. They have a program specifically for NP's to get the necessary skills to First Assist. It includes an online didactic portion then a six day intensive hands-on session. They have payment plans available and your practice will most likely reimburse you once you're set with them. Check it out and go for it. Orthos are usually great to work with.
  7. 0
    Quote from bsnanat2
    Actually, as an Advance Practice Nurse you do not need RNFA to assist. CMS automatically recognizes APRN's (NP's etc.) to assist. The issue is often that NP programs do not include a surgical rotation. The other issue is the facility credentialing. The previous poster was referring to RN's. Look at NIFA. They have a program specifically for NP's to get the necessary skills to First Assist. It includes an online didactic portion then a six day intensive hands-on session. They have payment plans available and your practice will most likely reimburse you once you're set with them. Check it out and go for it. Orthos are usually great to work with.
    Read the quote above. Texas requires RNFA course and either a CNOR or NP. CMS is completely different. On the other hand its relatively easy (although expensive) to get the RNFA training. The inpatient role is going to be a different problem.
  8. 0
    Thanks for the replies. Yes, I thought I could not see inpatients I just wanted to be sure. I have no interest in rounding in the hospital, that is the main reason I went for FNP instead of ACNP. Also, I liked the ability to see across the lifespan not just >13yrs.

    So when it come to the RNFA. I have glanced at the NIFA site and have seen the RNFA course they have specifically for NPs. My understanding from the Texas BON was that I could take this course or some other course designed to teach first assisting to nurses, would likely need to prove my newly acquired skills to facilities for credentialing, but would not need to sit for the CNOR or any other additional certification- that proof of course completion and ability to prove my skills in order to cover my back side would suffice. Is this correct?

    Further, if the surgeon just wanted me in clinic, no OR, no hospitals, no additional education or certification would be required. Again, correct? While I would like to eventually be a certified ONP (orthopedic NP) I can't sit for that exam until I've got 2,000 hours as an NP working in orthopedics. Thanks for the guidance.
  9. 0
    Quote from littlebelle1293
    Thanks for the replies. Yes, I thought I could not see inpatients I just wanted to be sure. I have no interest in rounding in the hospital, that is the main reason I went for FNP instead of ACNP. Also, I liked the ability to see across the lifespan not just >13yrs.

    So when it come to the RNFA. I have glanced at the NIFA site and have seen the RNFA course they have specifically for NPs. My understanding from the Texas BON was that I could take this course or some other course designed to teach first assisting to nurses, would likely need to prove my newly acquired skills to facilities for credentialing, but would not need to sit for the CNOR or any other additional certification- that proof of course completion and ability to prove my skills in order to cover my back side would suffice. Is this correct?

    Further, if the surgeon just wanted me in clinic, no OR, no hospitals, no additional education or certification would be required. Again, correct? While I would like to eventually be a certified ONP (orthopedic NP) I can't sit for that exam until I've got 2,000 hours as an NP working in orthopedics. Thanks for the guidance.
    ONP isn't a recognized certification. You can look at the Texas BON to see what they recognize. As far as working in the clinic you could conceivably do that, however you would have to worry about possible BON action if someone complained.
  10. 1
    I'm a surgical NP, and I completed the fast track NIFA course. I'm already a CNOR, so I didn't have to take the 6 day course. Since you don't have OR experience, they'll tell you to take the full course. There's some videos you'll have to watch, attend the workshop, and then it's pretty much the same coursework that everyone takes. You don't need OR experience or CNOR since you're an APN. After you finish the course requirements and the 120 hours of Ortho cases, you'll get your certificate and you're good to go.

    We have a FNP that's currently getting her hours for RNFA. She works in the general surgery clinic an sees all ages. She also sees new consults in the ER, and does pre-ops and post-ops. The only thing she doesn't do is inpt management.
    littlebelle1293 likes this.
  11. 0
    Thanks so much kguill, that is very helpful and was exactly what I was understanding based on what I've read. I've spoken to a peer who runs an OR for some of the Orthopods I work with and she has offered to give me training in the OR for the last semester of my FNP program. While I know I won't reach some high # of OR hours and would still want to take the full NIFA course, I'm at least looking to get my feet wet.
  12. 0
    I see FNP's round in hospitals in the part of Texas where I'm at.
    It's not that uncommon.

    Best of luck.
  13. 0
    Thanks TX RN,
    I too have seen the same thing in Austin hospitals. While I don't feel that I would be prepared to see inpatients based on Texas Tech's FNP program, there are others who have better experiences or additional education that could give them that ability.

    Core0, I can't seem to understand why an FNP working in the clinic setting only (no inpatient no OR) of an orthopedic practice would be working outside of their scope. FNPs in primary care clinics see patients with orthopedic complaints, and have completed instruction on medical management of those disorders, giving joint injections, splinting, etc... Could you clear this up for me a bit? Is this because it is a Surgical practice?


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