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

Specialties NP

Published

Fellow NPs, I think this is coming soon. I know many NPs who are first assists right now. They do 95% of the surgery while the MD does the other 5%

However, the NPs I know are well trained to where they could easily do the other 5% of the surgery that the MD does currently

I think its time for our PAC and lobbying organizations to get behind this effort. Doing surgery has been part of nursing practice for a long time now, its time for the world to recognize that we NPs are surgeons too and we can do it just as well as the MDs, if not better.

We need to move on this issue.

Specializes in Anesthesia.
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.

Hey everybody! I snuck on over here from the CRNA board and I hope that maybe I can clear a few things up. CRNAs are NOT required to be supervised by an MD in many states and are considered licensed independent practitioners. The decision is mainly up to the state itself to decide and each state can "opt-out" of the medical supervision of CRNAs by MDs. In addition, CRNAs are "allowed to do anything an anesthesiologist can do" because we have been around much longer than the profession of anesthesiology. Short history lesson (I know everyone loves history ;) ).....nurses were the first health care professionals trained to administer anesthesia (way back in the 1800's) because it was the job that nobody wanted during surgery. So nurses stepped up to the plate and were trained specifically for the delivery of anesthesia to patients. It wasn't until AFTER WWII that the profession of anesthesiology really took off and MDAs began accusing nurses of "illegally practicing medicine." However, nearly every case that has gone before the courts has been ruled in the favor of the CRNA profession. And it is true that there are no studies that show that there is any difference in outcomes between delivery of anesthesia by MDs and delivery of anesthesia by CRNAs.

Sorry for the interruption......now back to the original topic.....:)

Tracie

I am not saying that NP's should or shouldn't be doing solo surgery, but I do agree that training for this has to be extensive enough to cover all possibilities because some "MINOR" surgeries are not so minor. During infertility work I had a simple lap, "Just take a couple of days off, we'll go in and do some scraping and get this show on the road". I believed him, why not, right.? "Just 4 little punctures and we'll be done", but they cut a few abdominal arteries...just little ones...there's so many of them I don't see how it doesn't happen more often. And of course in the lap you are tilted head down, so I'm bleeding into my chest cavity and they aren't even aware of it until my vitals start crashing cause they're in my abdomen, and now they have to stop the initial surgery to rush to repair this bleeding mess, have to tell my husband that I've lost alot of blood and they don't know what is going to happen and suddenly I'm an emergency situation. This was a surgeon, an infertility expert, had done this many, many times.....but. Any way the outcome was that I lost 2 leiters of blood, left the hospital with a hemoglobin of 4 and a hematocrit of 13 and I lost 3 months of work couldn't walk on my own for a few weeks. For a simple breadand butter procedure. So to me nothing is so simple that just anyone can do it. I want to know that who ever is cutting me or puncturing me can clean up the mess that may be made even if they're doing their very best.

OMG nurse_god is obviously a troll from SDN, look at his/her Hx.

The only thread he has started is 'Have you ever dated a doctor'

ddduuuhhhh.

What is SDN?

Its a forum for student doctors - some members are a little ignorant to other health care proffessions - and a little rude and immature, some are very into advance practice nurse bagging. 'Doctors are the kings/queens of the health care world' sort of thing...

I am an RNFA (certified). I have harvested vein. Harvested radial arteries. Assisted in plastics removing parts of breast for reductions. Sure there are lots of procedures I could perform solo BUT for what I am paid I would not accept the liability. I did a procedure by myself once but it was because the MD told me to start the case and then he had an emergency and could not get back. It was a minor case. I would not willingly do this unless I got a lot of compensation. I think the premium is probably more than 3 times what I am paid as a first assistant. BTW the majority of the first assistants here are not even RN's they are scrub techs that just took a written test and paid their $300 dollars.

OMG nurse_god is obviously a troll from SDN, look at his/her Hx.

The only thread he has started is 'Have you ever dated a doctor'

ddduuuhhhh.

Lol, I guess sticking up for patient safety stigmatizes a person. Call me a patient advocate. We need to have policies that are in the interest of the public, not our own careers. Just from the anecdotal evidence people have posted, I think that it's clear that even "minor" surgeries can become serious really fast. I can't predict what the state regulators will do, but I would hope that they think through carefully the implications of any changes. If protections are weakened, people will always look for loopholes to bypass them completely. If that was you or your loved one on the operating room table, who would you want to be leading the surgery? Nuff said.

Lol, I guess sticking up for patient safety stigmatizes a person. We need to have policies that are in the interest of the public, not our own careers. Just from the anecdotal evidence people have posted, I think that it's clear that even "minor" surgeries can become serious really fast. I can't control what the state regulators do, but just imagine if that was you as the patient. Who would you entrust your life to?

Well if I read this thread correctly we are all in agreement that if an advanced practice nurse would ever do selective surgeries solo they would need further education and training. If a nurse has the appropriate training/experience I would trust them to operate on me.

But I may be brain washed after completing two NP programs and a RNFA program.;)

The issue is developing the training program to ensure that the surgical nurse practitioner is qualified.

The current RNFA programs woudl need major revamping, they are very technical in nature but do not have sufficient patient assesment, pharmacology, and differential diagnosis. How about acute care NP, plus RNFA, plus an additional 2-3 years "clinical residency". I feel that would be an extremly safe provider. The only problem is who is going to be the preceptor for the first students? I don't think that an organized medical school would support this "nurse resident role".

No doubt that they would need additional training. But after the changes, I bet that it ends up looking not much different if person had gone to medical school and then residency. I don't see a bridging program on the horizon either.

Well if I read this thread correctly we are all in agreement that if an advanced practice nurse would ever do selective surgeries solo they would need further education and training. If a nurse has the appropriate training/experience I would trust them to operate on me.

But I may be brain washed after completing two NP programs and a RNFA program.;)

The issue is developing the training program to ensure that the surgical nurse practitioner is qualified.

The current RNFA programs woudl need major revamping, they are very technical in nature but do not have sufficient patient assesment, pharmacology, and differential diagnosis. How about acute care NP, plus RNFA, plus an additional 2-3 years "clinical residency". I feel that would be an extremly safe provider. The only problem is who is going to be the preceptor for the first students? I don't think that an organized medical school would support this "nurse resident role".

There IS a training program that would ensure that NPs are qualified to perform surgery independently; it's called "medical school & surgical residency."

Sorry, but that really is not an option. I am an ACNP and a RNFA for CVS and my guys had 10 years of training and fellowship before independent practice. N ot only would I not want the responsiblity but the malpractice costs would kill me.

bigdogu :uhoh3:

10 years f on the job training is great I am sure you are an expert at your job and excell at your field. But that woudl be different than if a nurse were to actually be in a residency or fellowship with structured educational outcomes and a gradual increase in responsibility and role under guidance of an experienced provider.

Lets face it Nurses are not a replacement for a MD or DO. All health providers are increasing scope of practice with time podiatrists now can work on the knee not just foot and ankle. Physical therapists can now work as a point of entry health care provider rather than needing an order in some states. Optomistrists can now perscribe meds....

I am not a fan of nurses replacing physicians in the health care system but hypothetically we could still increase our role and responsibility, which might even include some surgical procedures. I am a huge fan of the team approach and this could fit nicely in an ideal world.

But there are issues with education, credentialing, reinbursement, and malpractice. All need to be cleared before this could ever happen.

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