Mid Level practitioner best for surgery.

  1. Hello,
    I am a RN BSN who has worked in MS for 3 and a half years (CMSRN and whatnot) who also got into PICC nursing on the side about a year and a half in. It was at that point I discovered that I liked doing procedures more than anything else. As such, I have a large interest in doing some kind of surgery some day. I have always been more attracted to the technical aside of healthcare rather than the holistic and I want my next move to reflect that. I know the debate of PA vs NP will forever cause a general rabble rabble to break out, but I personally feel that because my goals are aligned to surgery/procedural side of healthcare that going for a PA-C is better despite the whole autonomy lobbying deal. Right now Im a travel nurse and my last rotation will hopefully set me up to start schooling wherever that may be. Also, I only just got out of the army nurse corp, so my experience with PAs has been pretty exclusively military. I know its different on the civy side.

    Top choices:

    Intervention Radiology
    Cardiac (Catheterizations)
    Orthopedics
    General

    as you can see, I prefer the minimally invasive side of house so if there is some kind of other surgical sub specialty you can recommend I'm all ears!
    •  
  2. Poll: PA??? NP??? Something else?!

    • PA

      73.91% 17
    • NP

      21.74% 5
    • Something else (explain please)

      4.35% 1
    23 Votes
  3. 13 Comments

  4. by   sauce
    If you are hard set on surgery usually the only way to do anything more than simple ID, sutures, assisting is to be a doctor. If this is out of the question all else aside surgeons are more likely to hire PAs than nps since they have more training in that aspect. But i don't know your life situation so the rest is up to you.
  5. by   Dranger
    For procedures I see PAs used way more often than NPs.
  6. by   Rose_Queen
    I work in the OR and have spent some time observing cath lab procedures.

    So, let's look at your top choices:

    Intervention Radiology
    I know of a PA who worked in this area, but not sure what she was allowed to do.
    Cardiac (Catheterizations)
    I have never seen a PA or NP involved in the cath itself. The cath is done by the cardiologist with cath lab techs handing up supplies. The only involvement of an NP or PA in cardiology is rounding on patients.
    Orthopedics
    Never seen an ortho NP in my OR. Have seen several PAs. They hold retractors, hold leg positions during joint replacements, and suture the incision closed. They also round on patients on the floors and see consults.
    General
    Nope, no NPs in the OR here either. They round on the post op patients on the floor and handle discharge orders for same day surgery patients. PAs, on the other hand, do work in the OR. They can suture, hold retractors, use the bovie, and fire a stapler as long as the surgeon has placed it.

    I would suggest researching the role of the first assistant in the OR and decide if it is for you. If you really want to be the one doing the procedures, then you're going to need to be an MD or DO.
  7. by   Alicia777
    Popular topic lately! I work as a surgical FNP RNFA in a specialty (I don't want to give everything away here on AN). I assist in General surgery occasionally and Ortho as well.
    My background was as an OR nurse for 10+ years before this position. I would say others are correct, mostly PAs are in the OR, but as you can see it's not out of the realm for an NP. Added bonus, the pay is great and I don't have to bill!
    I've never heard of an RN going for PA .. Why not try and beef up your experience in procedures as an RN and go ahead with NP? I would also suggest referring to your BON for laws regarding APNs and assisting because all states are not alike..
    Last edit by Alicia777 on Nov 2, '15
  8. by   MallysMama
    I second Alicia's comments!
    My hospital uses NPs in the OR almost as often as PAs (from what I've seen)...though they use residents even more (since its a teaching hospital). I know of one NP that has done cardiac caths too (before coming here). So- it may not be common, but it can be done!

    My suggestion is to find an NP program that will work with you and your goals. My program director is very supportive of my goal to work as a surgical NP- and is trying to make sure I have some quality OR rotations! All of my preceptors have been great about it too- so even if their specialty isn't surgery, they've all gotten me into the OR (from assisting with a vasectomy to just watching an LVAD). So, I'm a firm believer that the program you choose can be helpful or hurtful in your future career goals! And also that you get out of it what you put into it!
    Good luck with your decision!
  9. by   BostonFNP
    Honestly, if you want to do surgery than serious consider medical school. While NPs and PAs have a role surgically it is always an assist role. If that's what you want probably either would be ok with a lean towards PA.

    I honestly don't see a day in the US where NP or PA will be the primary in major surgery.

    And the term "mid-level", in my opinion, shouldn't be used at all, at least for NPs!
  10. by   zenman
    You can work in Kroger meat market and do all kinds of surgery. Don't have to worry about malpractice either.
  11. by   blancas56
    My goal is to become a Surgical NP as well. If you don't mind me asking what school do you attend and what route did you go such as FNP, ACNP, etc? Sorry for the late questions.
  12. by   blancas56
    Quote from MallysMama
    I second Alicia's comments!
    My hospital uses NPs in the OR almost as often as PAs (from what I've seen)...though they use residents even more (since its a teaching hospital). I know of one NP that has done cardiac caths too (before coming here). So- it may not be common, but it can be done!

    My suggestion is to find an NP program that will work with you and your goals. My program director is very supportive of my goal to work as a surgical NP- and is trying to make sure I have some quality OR rotations! All of my preceptors have been great about it too- so even if their specialty isn't surgery, they've all gotten me into the OR (from assisting with a vasectomy to just watching an LVAD). So, I'm a firm believer that the program you choose can be helpful or hurtful in your future career goals! And also that you get out of it what you put into it!
    Good luck with your decision!

    My goal is to become a Surgical NP as well. If you don't mind me asking what school do you attend and what route did you go FNP, ACNP, etc? Sorry for the late questions.
  13. by   MallysMama
    Quote from blancas56
    My goal is to become a Surgical NP as well. If you don't mind me asking what school do you attend and what route did you go FNP, ACNP, etc? Sorry for the late questions.
    OHSU and AGACNP.
    Feel free to send me a message if you have any questions!
  14. by   cayenne06
    I'm definitely much more used to seeing PAs in the OR than nurse practitioner- the only APRNs I see in the OR on any sort of regular basis are midwives and of course CRNAs. I disagree with the poster who said that the OP should just go back to medical school- you can definitely have a professionally satisfying career that involves surgery without being an MD. Yes, you won't be a surgeon and won't be leading an OR team, but being first assist in surgery is very hands on- you aren't standing there dutifully passing instruments.

    I think you should try to do some shadowing in each specialty. IR and cardiac cath are a very different type of surgery than, say orthopedics. I feel like NPs might be more common in IR, but I could be making that up. So if that is an interest, it might be an easier career switch to just go for your NP, who knows.

    I loved loved loved doing first assist for c/sections and repairing perineal lacerations when I worked inpatient- so interesting, and a definite sense of a job well done when everything is put back together how it's supposed to be, and everyone is safe. I do miss it sometimes, but I thoroughly enjoy doing office based procedures, some of which would be considered minor "surgery." So I get my itch scratched that way.
  15. by   PNW_NPstudent
    I'm finishing FNP school shortly and have been in IR as an RN for 5 years. NPs and PAs both do IR. I find that preference for one over the other seems to be regional. I will be doing a final clinical rotation in IR where I place HD caths, ports, do paras and thoras, liver bxs, etc, under an NP and a PA. In my facility, these have been performed independently by PAs and NPs (doc in house, but not in procedure room).

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