Quote from jer_sd
David is correct. I have privliges at two hospitals, one required proof of CNOR certification and completion of an accredited RNFA program for me to assist, the other just required proof of NP training.
Often NPs work pre-op and post op, not that much first assisting compared to PAs. There are jobs out there. What type of surgery interests you, what is the local job market like ect.
From the MD view point having a scut provider (NP or PA) see patients pre-op and post op allows for more surgical time which generates revenue for the physician. Billing for first assisting is hard, not all procedures will pay, and the range is 8-12% of the surgons fee.
I would recomend attending a RNFA program if you are really interested in the surgical aspect of a NP job. Good training and it will make you a better first assistant when compared to just learning the way one physician like you to assist.
The PA model is very different. PA's primarily pay for themselves with thier assist fee which is 13.6% of the surgeons fee and usually higher for private insurance. The key is for the surgeon to know which procedures are not reimbursed and not have the NPP scrub for those. Some Surgeons will eat that part if the PA being present allows the surgeon to do more surgeries. Pre-op and Post-op work is part of the global fee for service and is not reimbursed. The key here is the NPP is doing these unreimbursed items while the surgeon sees new consults which generate more surgery.
The problem with the RNFA is the requirements. There is a distance learning RNFA program (very expensive). The other requirements are:
You must have completed at least 2000 documented hours of practice as an RNFA, including pre-, intra-, and postoperative patient care. Pre- and postoperative patient care does not necessarily have to be connected to cases on which you've assisted.
- The 2000 hours may include practice in an RNFA internship or practicum but may not include attendance of classes, programs or seminars.
- 500 of these hours must have been within the two years immediately preceding application.
- The exam contains 70 percent intraoperative patient care and 30 percent pre- and postoperative patient care. Therefore, 600 of the 2000 hours required for eligibility may be pre- and postoperative patient care, and at least 1400 hours must be intraoperative practice.
- Written documentation of the 2000 hours of practice must accompany your application.
The hours can be pre, post or peri op. So in theory you could get a job, do the NIFA course, and then use your hours pre and post op to apply. The problem is that someone would have to do without the income from first assist fees during that time. Frankly this is why PA's tend to dominate the surgical fields. The UAB program would be the best bet or working in the OR for a year or two to get your RNFA would also be a way to go.
David Carpenter, PA-C