nurse practioners and surgery - page 2

HI, I have a few questions here. Do nurse practitioners do clinical rotations/training in surgery (like MDs,DOs and PAs)? If they dont, then do Dr.Nps do rotations in surgery? Thanks Nev... Read More

  1. by   no-recall
    In response to your question about NP in OR, well...there is RNFA (Registered Nurse First Assist). The RNFA helps the surgeon in surgery. Lately, the RNFA's that I have met are going back to school to get their NP because many surgeons are preferring to hire NP vs. PA to help them with patient follow-up. One surgeon tells me that with an NP, they have prescription authority along with the knowledge base of actual nursing--- that is needed for them to communicate to other nursing staff. They are also finding that NP's have better relation with the nursing staff. This is a very new field in advanced practice nursing. This was my option if I did not get in Anesthesia school (w/c I have). However, many surgeon colleagues of mine feel strongly over the value of RNFA with NP credentials. Many will be happy to mentor you if they know that you are an NP student (with OR background). To be an RNFA, check the AORN website. Just FYI, most first assist are scrub technician who went to school an additional 6 months to learn how to suture etc. They are technical people, non-degreed and have no licenses. No offense to any scrub tech reading this post....Surgeons still prefers PA or NP to assist them in surgery.
    Thanks.
  2. by   nev
    Thank you all very much

    I Still have about 3 more years to go.

    Nev
  3. by   nev
    I have one more questions,
    Are there any Nurse practitioners who work in surgery (like PAs)?

    Thanks
    Nev
  4. by   suzanne4
    Yes, there are....but their training again is completely different. The best way to work in surgery as an NP is to get OR training first, then go for the NP. But with an RNFA, you can do most of the same work in the OR, actually do the same, if not even more.
  5. by   nravey
    Quote from jeepgirl
    OMG I have a freakin migraine from reading all the CRAP on that thread. Those people are spouting the most spiteful, hateful, anti-nurse babble I have ever heard!!!! They even mentioned allnurses.com and referred others to come over here to see what "real" NP's want... to basically take their jobs.

    Do docs really think like this? I guess I have been lucky... overall, we have very nice docs where I work!

    Do they try to teach them this in med school?

    Do med schools teach them that we are trying to take their place? I'm sure they are! But I wouldn't want to be a dr for anything the way they are so greedy. Everyday for me I wonder if I'll have enough patient's (I own the practice in LA), will we collect enough money to pay the bills, will people pay on their accounts? In addition, I am in the middle of a small town where the doctors are trying to blackball me out of business and NP's in surrounding are are ostracizing me - one told me to give them my patients and close my office! I owe huge sums of money for buying this place and equipment that I thought I'd be able to do procedures on patients to pay for - only to find that our hands are tied at every corner by our board, by m/m and private insurance. The medical association has more money than we do and so fight us on every bill to get more privileges and exploit us so much by charging us huge fees for being our collaborative doc. I had no business course in nursing course and accounting should have been a priority. I have been cheated, had money stolen from me, and one big reason is private insurances still don't recognize us to pay us directly - not all but most.
    On the other hand, the patients are great and I love treating them and helping them - i have 65% medicaid with most being adults and no doctor in town will take new medicaid adults - so why should they fight me. Because how dare me, a woman, buy a doctor's practice and work here alone with a collaborator from another town coming the required number of times a month, right here in the middle of them. And having our hands tied with the collaborative agreement hurts us immensely. We need to get rid of that across the nation and give nursing back to nursing.
    It's frustrating at best.
    Nina
  6. by   AWDC
    Quote from nravey
    Do med schools teach them that we are trying to take their place? I'm sure they are! But I wouldn't want to be a dr for anything the way they are so greedy. Everyday for me I wonder if I'll have enough patient's (I own the practice in LA), will we collect enough money to pay the bills, will people pay on their accounts? In addition, I am in the middle of a small town where the doctors are trying to blackball me out of business and NP's in surrounding are are ostracizing me - one told me to give them my patients and close my office! I owe huge sums of money for buying this place and equipment that I thought I'd be able to do procedures on patients to pay for - only to find that our hands are tied at every corner by our board, by m/m and private insurance. The medical association has more money than we do and so fight us on every bill to get more privileges and exploit us so much by charging us huge fees for being our collaborative doc. I had no business course in nursing course and accounting should have been a priority. I have been cheated, had money stolen from me, and one big reason is private insurances still don't recognize us to pay us directly - not all but most.
    On the other hand, the patients are great and I love treating them and helping them - i have 65% medicaid with most being adults and no doctor in town will take new medicaid adults - so why should they fight me. Because how dare me, a woman, buy a doctor's practice and work here alone with a collaborator from another town coming the required number of times a month, right here in the middle of them. And having our hands tied with the collaborative agreement hurts us immensely. We need to get rid of that across the nation and give nursing back to nursing.
    It's frustrating at best.
    Nina
    We med students/doctors are just paranoid, that's all. The problem isn't that we're taught that NP's are trying to take us out. The problem is that there is no assurance from NP's about what they can or can't do. So when we see a NP "playing doctor," we become very wary. We're like "WTH?! Do they really have the knowledge base or the training?" And then we hear some NP's say what they really do is practice medicine. So again, we're like "WTH?!" I'm guessing what it boils down to is we don't trust NP's as a whole. Why? Probably because NP's didn't go to medical school nor residency. I think docs tend to trust the NP's they have worked with but tend not to trust the NP profession as a whole. We on the medicine side see it as not ideal for NP's to have increased scope of practice and independence without the same level of training that physicians have. Well, I didn't mean to say that the medical profession always has the right way of doing things, just trying to present a perspective. So just take it as that, a perspective... probably viewed as the wrong perspective on this forum. That's okay cause physicians and nurses come from two different paths with neither one really experiencing what it's like to be the other... except for those RNs or NPs having become physicians.
  7. by   RN4NICU
    Just a bit of advice for the OP (and anyone else, really):


    If you want to find out the reality of ANY kind of nursing (including advanced practice) DO NOT look for it on studentdoctor.net

    There is a lot more ranting and raving about nurses over there than there is factual informal. Some of it is paranoia, some is just plain ignorance. Whatever it is, unless they are nurses who are going to med school, they do not know nearly as much about nursing as they like to think that they do.
  8. by   elizabells
    Okay, had a looooong lecture today about the DrNP program, so here goes, from my notes:

    The name of the degree is Doctor of Nursing Practice. Columbia started it out of the belief that the current standard of MSN is not sufficient for truly advanced independent practice. (side note, please don't yell at me for any of this, absolutely none of it is my personal opinion, kay?) They felt that there was an educational void, given that there are research-related doctorates for nurses and not practice-based doctorates. MDs have doctorates, PTs have doctorates, lawyers have doctorates, but not nurses. Courses are given in pathophys, advanced assessment, advanced pharm, and a few others I didn't write down, plus mad clinical hours and case studies and a dissertation. The first class of doctorally-prepared NPs has just graduated, and the Dean's practice, CAPNA, has been the first to receive reimbursement at 100% of what physicians make, as opposed to 85%, which had been the max. The scope of practice will not change, only the level of education and hopefully reimbursement. It was not made clear whether an attempt would be made to standardize the scope of practice across states - apparently the AMA has a lot of influence over state legislatures, and the more powerful the state chapter of the AMA, the narrower the NP scope of practice.

    Okay, here's the part I reeeeeally don't want to get yelled at for: They have been in contact with the AACN to make the DrNP the standard for NPs by 2015. I believe they are still sussing out the method of "grandmothering" (yes, that's what she called it) in current NPs. This is an aspect of the drive to reduce the number of ADN nurses. Oh god, I hope I don't get kicked out of school for posting this. It's basically the trickle-down theory as applied to nursing education. She said change will come from the top, not the bottom. She cited a study by Aiken showing that morbidity and mortality rates had a direct correlation to the education level of the primary nursing provider. There's some sort of push to have ADNs relicensed as "technical nurses" with BSNs as "professional nurses", however, change in professional title is upsetting to those being renamed. Plus she said some things about ADN programs just teaching to the NCLEX.

    This is what we, as BSN students, are being taught about other nurses.

    Kay. Please no flaming. Just the messenger. Also, mods, if what I just did is totally inappropriate, please feel free to move or delete this post.
  9. by   nravey
    Won't shoot the messenger - that message has been out for a little while now and frankly I have too many other things to worry about than getting a DR.NP at this moment. As for the AD and BSN, that rumor has been making the rounds for a least the last 20 years, so don't hold your breath!
    Nina














    Quote from elizabells
    Okay, had a looooong lecture today about the DrNP program, so here goes, from my notes:

    The name of the degree is Doctor of Nursing Practice. Columbia started it out of the belief that the current standard of MSN is not sufficient for truly advanced independent practice. (side note, please don't yell at me for any of this, absolutely none of it is my personal opinion, kay?) They felt that there was an educational void, given that there are research-related doctorates for nurses and not practice-based doctorates. MDs have doctorates, PTs have doctorates, lawyers have doctorates, but not nurses. Courses are given in pathophys, advanced assessment, advanced pharm, and a few others I didn't write down, plus mad clinical hours and case studies and a dissertation. The first class of doctorally-prepared NPs has just graduated, and the Dean's practice, CAPNA, has been the first to receive reimbursement at 100% of what physicians make, as opposed to 85%, which had been the max. The scope of practice will not change, only the level of education and hopefully reimbursement. It was not made clear whether an attempt would be made to standardize the scope of practice across states - apparently the AMA has a lot of influence over state legislatures, and the more powerful the state chapter of the AMA, the narrower the NP scope of practice.

    Okay, here's the part I reeeeeally don't want to get yelled at for: They have been in contact with the AACN to make the DrNP the standard for NPs by 2015. I believe they are still sussing out the method of "grandmothering" (yes, that's what she called it) in current NPs. This is an aspect of the drive to reduce the number of ADN nurses. Oh god, I hope I don't get kicked out of school for posting this. It's basically the trickle-down theory as applied to nursing education. She said change will come from the top, not the bottom. She cited a study by Aiken showing that morbidity and mortality rates had a direct correlation to the education level of the primary nursing provider. There's some sort of push to have ADNs relicensed as "technical nurses" with BSNs as "professional nurses", however, change in professional title is upsetting to those being renamed. Plus she said some things about ADN programs just teaching to the NCLEX.

    This is what we, as BSN students, are being taught about other nurses.

    Kay. Please no flaming. Just the messenger. Also, mods, if what I just did is totally inappropriate, please feel free to move or delete this post.
  10. by   elkpark
    There's some sort of push to have ADNs relicensed as "technical nurses" with BSNs as "professional nurses", however, change in professional title is upsetting to those being renamed.
    I agree with nravey. That "push" has been underway since well before I entered nursing school >20 years ago (the discussion was old news then), and it ain't happened yet ... I predict the same trajectory for the debate about MSN vs. clinical doctorate (whichever of the six or seven names out there you like) for entry into advanced practice. But I could be wrong -- I often am ...
  11. by   candyndel
    NPs training and practice focus on providing primary health care to pts while making health promotion and illness prevention of utmost importance- thats what makes us a unique discipline. (Or so we think....)
    Both of which would be difficult to do in an OR! As several previous posters said, RNFAs or PAs are better suited/trained for scrub roles like those.

    Quote from nev
    I have one more questions,
    Are there any Nurse practitioners who work in surgery (like PAs)?

    Thanks
    Nev
  12. by   nev
    so how do RNFAs differ from PAs?
  13. by   candyndel
    Good question! Besides the obvious training differences (one is a nurse, one is not, one needs a Graduate degree, one does not) I have no idea. Maybe there is an OR forum that could help?

    Quote from nev
    so how do RNFAs differ from PAs?

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