How long before NPs will be able to do surgery solo?

Jengirl18 · Apr 16, 2006

I agree with TopherSRN. And for NPs to be able to assist in surgery, I think Gross Anatomy should be implemented into the course schedules (like physician assistant school.) Please correct me if I am wrong about this, but I have looked at several NP curriculums, and I havent seen any so far. Gross anatomy is a lot different than undergrad nursing anatomy (unless they were privileged to have cadavers to work on.)

brownrice · Apr 16, 2006

Jengirl:

I feel this way too. I took two semesters of regional anatomy with cadaver lab dissection, as I could not see myself working as a primary care provider without having a better knowledge of human anatomy. It has helped me understand things so much better.

platon20 · Apr 17, 2006

a RNFA is a far cry from a surgeon. 1 yr experience and another week of classes + a test does not equal medical school + surgery residency.

Yes, and CRNA training is not equal to med school + 5 year anesthesiology residency.

So why is it again that CRNAs are allowed to do anything an anesthesiologist can do, with ZERO supervision?

Oh yeah thats right its because despite the training differences that CRNAs are JUST AS EFFECTIVE AS DELIVERING GAS as doctors who went thru a much longer training program.

RN + NP training is not the same as 4 years of med school + 3 year family practice residency. So why is it again that FNPs can do anything that a family practice MD can do, including setting up their own practice with ZERO supervision?

Oh yeah, thats right its because studies show that FNPs are just as good as family practice MDs and that FNPs can script meds just as well.

So your argument about training program lenghts being different is irrelevant.

According to your "doctors training program is longer than nurses training" logic, then CRNAs NEVER should be allowed to run gas solo. Yet they do it routinely.

No they can't because they haven't had the advanced A/P and that silly surgical residency.

Oh please, the physiology involved in delivering gas is JUST AS COMPLEX IF NOT MORESO THAN SURGERY. Yet CRNAs do fine with their "limited" physiology training that they get in CRNA programs compared to MDAs.

I dont recall CRNAs going thru gas residency, do you? I must have missed that.

Writing scripts and performing surgery are two different things.

Yes they are 2 different things, but in both cases, nurses with special RNFA training CAN do teh simple surgery cases solo. I already told you, at my rural hospital the MD surgeons give the RNFAs tremendous scope of practice and we do just as well as the surgeons.

Sorry, but surgeons do run the show whether your ego recognizes it or not. Nurses are subordinates (professionally) to physicians. Without the surgeon RNFAs and S.A.s wouldn't have jobs.

Wrong again. Nurses are NOT subordinates to doctors, and every state nursing board in the nation has that enshrined in their regulations.

As far as nurses performing 'bread & butter' surgeries, even those can go wrong in more ways than one and would necessitate the advanced training an actual surgeon has. If you want to play surgeon then I'd suggest going back to medical school and actually investing the 10+ years required. Because if you intend on waiting around for nurses to be anything more that FAs then you will be sorely diasppointed.

Those same arguments apply to scripting meds. Lots of meds cause serious side effects and drug interactions that can be fatal. Yet NPs do just fine scripting them anyways.

You are repeating the same mumbo jumbo that MDs have used to try and hold down nurses for years. Thank god that finally the state legislatures are calling them on their BS and allowing nursing to exercise the scope of practice that we deserve.

Corvette Guy · Apr 17, 2006

platon20 - "Yes, and CRNA training is not equal to med school + 5 year anesthesiology residency. So why is it again that CRNAs are allowed to do anything an anesthesiologist can do, with ZERO supervision?"

Sir, I respectfully post... your wrong! CRNAs [civilian type] are required [does not always happen] to have the Anesthesiologist with them upon intubation, and if possible during extubation.

BTW, I will paraphrase a previous post of mine on this thread. Would you please consider narrowing down your Thread regards to NPs doing certain of surgical procedures, or do you suggest they be allowed to solo on cardiac bypasses, acoustic neuromas, and other such complex procedures?

n_g · Apr 17, 2006

platon20,

There's more to being a surgeon than performing procedures. Surgeons have to also properly diagnose the condition and know which surgery is right, if it is necessary at all. It takes a lot of training and experience to be able to do that. Are you suggesting that you would feel comfortable doing those things? As an independent healthcare provider, you should be able to make your own diagnoses and treatment plans. You risk significant liability if you misdiagnose and perform the wrong or unnecessary surgery. There are also anatomical differences between people, as you may or may not know. Some people have anatomies that exactly correspond to what they show in the anatomy books, while other people have truly bizarre ones. If you encountered such a body, would you know what to do? What if you cut a nerve that you thought was a vessel? Sorry, can't undo a cut nerve. Even senior residents see new things, so a fresh nursing graduate even with 1 year of apprenticeship has barely seen anything at all! Residency training is necessary for surgery because as you are seeing new things an experienced surgeon is there to guide you along. Would you want to be the first case that the solo nurse has seen? What if no surgeons were nearby to ask for guidance? While doing surgery may seem all mechanical to you, there is a lot of medicine behind it. Tiger Woods sure makes golf look easy, but do you know how many hours he puts into training? All doctors including surgeons have to understand

anatomy, biochemistry, physiology, pathology, pharmacology, etc. Not all of your patients will be healthy 22 year olds who come to you with a pimple. They may have hypertension, diabetes, weakened immune systems, be on a multiple drugs regimen, etc. If you don't take into account their full medical history, you can kill the patient, if not during surgery then by what you do post-operatively. As someone said earlier, surgery is different than writing scripts or giving anesthesia because it can go to hell in a handbasket in a hurry. What if you accidently cut a vessel and the patient starts to bleed profusely? Would you know how to get yourself out of trouble? If you had as much training as a surgeon, you probably would know how to avoid problems in the first place and what to do if you find yourself in a tricky situation. It goes without saying that you risk significant liability if something goes wrong and you are at fault. It comes with the territory in surgery. While you may have had great experience working at your hospital, we have to be careful before we take one person's experience and make it a state or national policy. You may feel confident about your surgical abilities because at a small rural hospital you don't see the sickest patients and strangest cases. They mostly come to large academic centers because the higher quality of care they get there. Most of your cases are probably very routine. Would you be able to handle cases that were more challenging? If we made this policy change, I assume that it would affect any setting, from large hospitals to outpatient centers. Would you want someone who is fresh out of nursing school doing solo surgery on you because they have set up their own practice? I wouldn't. I wouldn't want some med school grad going solo doing it either. I want a board-certified surgeon who has been doing his job for a long time and has a proven track record. Nurses and residents can do surgery because they are under the supervision of a surgeon. If a problem occurs, the surgeon immediately steps in. If we allowed nurses to perform solo surgery, I fear that would be the beginning of a slippery slope that leads to nurses wanting to do more and more types of procedures, not just the minor ones, that they are ill-trained to do. Moreover, I would argue that the definition of what is considered "minor" surgeries would be fluid as nurses every year would undoubtedly try to increase the number of covered procedures. Again, this opens up the possibility of complications, patient endangerment, and increased liability as solo nurses try to take on surgeries that are outside of their comfort zone.

I have no problem with nurses becoming solo surgeons. It's called medical school + residency.

andrew39 · Apr 17, 2006

Yes, and CRNA training is not equal to med school + 5 year anesthesiology residency.
So why is it again that CRNAs are allowed to do anything an anesthesiologist can do, with ZERO supervision?
Oh yeah thats right its because despite the training differences that CRNAs are JUST AS EFFECTIVE AS DELIVERING GAS as doctors who went thru a much longer training program.

CRNA supervision differs from state to state. In most states, CRNAs do perform under the supervision of the surgeon.

First of all, if this did go through, I doubt most, if any, hospitals would actually allow nurses to provide surgery. Just like many ACNPs don't see ICU patients and many CRNAs don't provide anesthesia during open heart cases. Those patients are within their scope of practice, but hospitals don't let them participate in those surgeries. I think it would be much easier to convince a jury to find against a hospital in a civil suit if a nurse was doing surgery rather than a doctor.

If you want to do surgery independently, why don't you go to medical school? Nurses will always have a more narrow scope of practice when compared to doctors.

n_g · Apr 17, 2006

The MD surgeons at my hospital routinely let their NPs do most of the surgery while they do on the 15 minutes that are most critical.

I wouldn't call cutting through fascia and suturing the most critical aspects of a surgery which I'm sure you're as good as anybody. Even at large academic hospitals, residents or PA's would usually perform this task. As you say, it's those 15 minutes that determine the success or failure of the surgery, life or death of the patient. And why nurses and residents can't do solo surgery.

caroladybelle, BSN, RN · Apr 17, 2006

Sorry, but surgeons do run the show whether your ego recognizes it or not. Nurses are subordinates (professionally) to physicians. Without the surgeon RNFAs and S.A.s wouldn't have jobs.
As far as nurses performing 'bread & butter' surgeries, even those can go wrong in more ways than one and would necessitate the advanced training an actual surgeon has. If you want to play surgeon then I'd suggest going back to medical school and actually investing the 10+ years required.

While I agree with much of your post, you are quite incorrect in your statement that nurses are subordinates.

Nursing is in a collaboration with Medicine, just as pharmacy, OT or PT. A nurse is only subordinate to an MD if he hires him/her for a private practice and the MD oversees the nurse as an employer.

Please remember that though MDs write the medical plan of care, Nursing formulates the nursing plan of care - we are separate, and subordinate to our nursing supervisors not the MDs.

As far as my personal opinion, nurses have no business performing surgery and really have I have no problem with the NPs not writing scripts, without supervision by an MD.

Nursing should control its own practice. Medicine should control its own practice. They should not be dabbling in each others' practice, and there would be fewer arguments over "subordinate" issues when there should be collaboration.

Quite frankly, Nursing has enough problems to handle with creating newer ones.

platon20 · Apr 17, 2006

nurse god

you keep bringing up the same stuff that I already addressed. I'm talking simple bread and butter surgeries here, not double transplants. Stuff like appys, lap choles, hernia repairs, lymph node dissections

All of those things are READILY DONE IN RURAL HOSPITALS AND NOT ONLY AT LARGE ACADEMIC CENTERS. We see those cases every single day and the RNFAs can handle them just as well as the MDs

Complications can arise from ANYTHING YOU DO MEDICALLY, whether its scripting tPA for acute stroke or doing a lap chole. Nurses have been proven to be able to handle complications arising from medication, with extra training for RNFAs the same is true for the bread/butter surgeries that I mentioned above.

As for your comment that if you want to do surgery, then you should go to med school, thats the same kind of red herring BS argument that doctors used against nurses for decades: "if you want to script medicine, then go to med school. if you want independent practice go to med school. if you want to deliver gas, go to med school" Nurses have shown time and time again that you DO NOT NEED MED SCHOOL FOR THAT, and the same is true for simple surgery.

Everybody thinks I'm trying to argue that RNFAs are good enough to REPLACE ALL surgeons, and thats NOT what I said. Please read my posts. I simply said that its quite reasonable for RNFAs to get an extra couple of years of training and be able to handle many routine bread/butter surgeries solo.

platon20 · Apr 17, 2006

Sir, I respectfully post... your wrong! CRNAs [civilian type] are required [does not always happen] to have the Anesthesiologist with them upon intubation, and if possible during extubation.

Depends on the state. In my state, CRNAs are virtually 100% independent from MDAs. They run intubations, extubations, and the gas all the way thru surgery from beginning to end, with no MDA. Hell the MDA is not even required to be in teh same HOSPITAL as the CRNA doing the procedure. And we have safety data in our state from several large studies showing that our success and complication rate is EXACTLY THE SAME as MDAs.

BTW, I will paraphrase a previous post of mine on this thread. Would you please consider narrowing down your Thread regards to NPs doing certain of surgical procedures, or do you suggest they be allowed to solo on cardiac bypasses, acoustic neuromas, and other such complex procedures?

I already addressed this is my other posts. Again, I'm talking about bread/butter GENERAL SURGICAL procedures, not the stuff that advanced surgical subspecialists deal with. No transplants, CABG, or brain surgery. Things I'm thinking of are hernias, lap choles, appys, lymph node dissection, etc

n_g · Apr 17, 2006

platon20,

I posed specific questions in my post. Don't try to brush them aside by saying that it's all been covered. I think I raised good points that the general public would be concerned about.

Corvette Guy · Apr 17, 2006

Depends on the state. In my state, CRNAs are virtually 100% independent from MDAs. They run intubations, extubations, and the gas all the way thru surgery from beginning to end, with no MDA. Hell the MDA is not even required to be in teh same HOSPITAL as the CRNA doing the procedure. And we have safety data in our state from several large studies showing that our success and complication rate is EXACTLY THE SAME as MDAs.
I already addressed this is my other posts. Again, I'm talking about bread/butter GENERAL SURGICAL procedures, not the stuff that advanced surgical subspecialists deal with. No transplants, CABG, or brain surgery. Things I'm thinking of are hernias, lap choles, appys, lymph node dissection, etc

I've seen first hand lap chole turn into a major open chole w/intraop complications. IMHO, you still need to narrow down your bread-n-butter NP type surgical procedures.

IMHO, your not even using the term General Surgical procedures [btw, don't yell at me] correctly. General Surgeons perform open exploratory laps and I've seen such turn very complex.

BTW, which state do you practice where the civilian CRNAs go solo to the point of no Anesthesilologist in the OR Dept. or, much less in the hospital? :uhoh21: