Surgery Opportunities as an NP

core0 · Mar 19, 2007

I just heard today that although you don't get training in surgery as an NP, you can actually receive post-NP training via certain hospitals you work in. Have any of you heard of such a thing? If so, let me know! Thanks! hehe.

OK nobody answered this so I'll take a shot. There is a FNP/RNFA program at UAB. Other than that you will need an RNFA or find one of the few hospitals left willing to credential you without OR experience. There may be places where the hospital may train you but I am not aware of any. NP's have the advantage that they can bill to assist in surgery. However, someone would have to eat your salary while they train you. All of the NP's around here that working in surgery have been doing it for some time. I don't remember any new NP's working in the OR.

David Carpenter, PA-C

jer_sd · Mar 19, 2007

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.

Jeremy

core0 · Mar 19, 2007

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.
Jeremy

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

jer_sd · Mar 21, 2007

Here is one quick clarification on RNFA programs that was not clear from David's post.

In order to enroll in a RNFA program you need to be an advanced practice nurse or have CNOR certification. Thr program will require a limited ammount of clinical hours and cases to graduate (probably close to 300 but they only count time with patients, waiting for cases does not count). When you graduate you may have the option of applying for first assisting privliges in some facilities. I have privliges in one hospital that required proof of RNFA program completion and CNOR certification in addition to my NP before obtaining 1st assist privliges. FOr CNOR certification you have to have 2 years of operative experience.

To be a CRNFA you must graduate from an approved RNFA program, have 2000 hours of first assisting experience as David explained, CNOR certification, and a BSN or MSN.

So if you want to work in a facility that only requires completion of a RNFA program for credentialing not a huge hurdle for NPs. If they will require a CRNFA or CNOR you are looking at a 2-3 year time frame fulltime to complete all requirements.

Medicare will pay for 1st assisting without documentation of training, the restrictions come form medical staff offices. And honestly if you did not learn it in your NP program you should take additional training. Holding a retractor can be easy to do but there is more to first assisting than just retracting or suturing.

Jeremy