first assistant, do u have them?

shodobe · Sep 26, 2003

Don't have them and DON'T NEED THEM! There are RNFAs in this country but we still don't have a need for them. Why have someone that doesn't do anything more than you already do. I just don't suture. Doesn't mean I can't, but by nursing practices I am not allowed. This was just another specialty pushed through by a few many years ago to justify the things they were doing illegally, against their nursing practices. I personally can't see the need for them or why nurses who have many years experience, 10 years or more can't sit for the exam. First they make you go through a course, this is fine and a good refresher. Then you have to have a BSN to be certified, this is BS and another conspiracy brought on by the BSN fanatics who think the only good nurse is one with a BSN behind your name. I wouldn't work with a person who went through a 16 week course and have them doing things that wern't appropriate, would you? Just ranting, this is only my own opinion and really doesn't hold water against I'm sure people who have alot of stats to back them up. Mike

POPRN · Sep 27, 2003

we don't have SA's where I work. Some of the surgeons have their own RNFA's But in lower East Tn. they use them all the time. they are paid MORE than the Techs. they also have CSRFA and one heart surgeon has his own RNFA. I agree that a 16 week course isn't enough time to learn what one needs to know. But I think they SA's can bill insurance for their time.

shodobe · Sep 27, 2003

Most RNFAs work for private surgeons because they can only bill most of the time through their employer. I know that many years ago when RNFAs were just coming into the picture, Medicare and Medical would not give billing numbers to these individuals. Today it is a little easier but still requires a magician to get reimbursement. All of the heart surgeons that I know only use PAs because then they can use them for a wider variety of post-op follow-ups. I know that RNFAs have a whole different opinion of themselves and probably have better answers to this question. I have yet met one that practices on their own. Mike

carcha · Sep 28, 2003

do any of u feel the patients should be made aware that someone with little more experience then a new student nurse may be performing surgical procedures, ie suturing on them, and at the operating table who is responsible for their actions?

Sarah, RNBScN · Sep 28, 2003

Check this out for comparison re: RNFA schooling and you be the judge.

http://www.bcit.ca

This is Canadian and in the US, you are required to have further training than the Canadian program. It doesn't make sense to me. Furthermore, I don't see the need for RNFA's. We already do the same job when the surgeon doesn't have a GP to assist them, they utilize nursing services. We do not have tech in the OR, they are all RN's and we also don't have PA's. I don't think they have them in Ontario at all. I could be mistaken though.

Just my 2 cents.

shodobe · Sep 28, 2003

Sarah, I totally agree with you. We already do the job why give it a special name. I find that you have a nurse just a few years into OR nursing then suddenly they go to a program to learn things they will learn just by staying in OR nursing. They then set for a cert exam and voila! they are supposedly a better OR nurse. Mike

acuteobrn · Sep 28, 2003

For Shodobe and Sarah:

I noticed that you mentioned that you already do the same job and don't see the need for RNFAs, PAs just curious to know if you all are suturing. From what I know that is the big difference. They are also paid directly through insurance billing. I looked into this when I was a surgical tech and was thinking at one point of going down that path because I love surgery. I find that there are some hospitals and surgeons that have large volume and use these guys with special training to avoid needing another surgeon lose time in the OR that he could be doing a case with. I think this is becoming big d/t the large cut that the insurance companies and HMOs are making in physician and hospital reimbursement. Also don't these guys go to school for more than a few weeks. RNFAs and CSTFAs are required a few years of basic OR experience before school and then have so many clocked hours to become competent and take some sort of standard test. Our hospital does use physicians from foreign countries as staff SAs I have no clue how they verify their experince but most are very good and catch some things that the surgeons don't, this is in L/D but we have quite a high c/s rate due to our population. I think that our hospital highers these guys in hopes of them becoming board cert. here in the states and taking and attending position so that they can bring in more pts, ie more revenue. It all seems to come down to the money factor here.

I am interested in what your thoughts are on my post as I am not posting this to anger anyone, just what my understandings are, glad to be corrected if I am not understanding correctly...

cwazycwissyRN, RN · Sep 28, 2003

CRNFA we have a few at our hospital. We have a certified first assist scrub tech too. The docs have told me the insurance pays different amounts for different titles. There are FAs' out there too.(no certification). The docs told me they get minimal reinburstments for asisting another doc. One got paid 62 cents (accually recieved a check for it) for assisting on a case that lasted over 2 hours. Kinda poor wages. Lots of titles, insurance payment bite, life in the or.

shodobe · Sep 28, 2003

I have 26 years experience and , yes I have sutured in the past before I was told that this was a no-no. I don't see the problem if you have the knowledge. This being the only big point goes back to the answer above of why would you go through all this just to make 62 cents! The "credentialing" of FAs is just another underhanded approach by the hospitals to save money. The problem also is RNs let this happen! They should have put their foot down years ago and said if your going to hire anybody to do this , hire us and not just RNFAs. I have seen the so-called "competence" these RNFAs are supposed to have after so many hours and quite frankley I am not impressed. Now I have seen some ORTs that are very good and they usually have many years experience and can leave these FAs in their dust when it comes to assisting. I guess the problem is where I work we, the RNs, do it all. When it comes to assisting the surgeon will usually ask for one of the more experienced RNs to help them. I guess it still comes down to the suturing part which any of the RNs I work with could do. Many years ago I had applied for a RNFA program, but was turned down because where I work would not allow me to do my hours there even though I had 6 surgeons state they would be my proctors. I gave up on that idea and over the years I still can't see the need. Sorry for the ranting! Mike

acuteobrn · Sep 29, 2003

Mike, I can totally appreciate where you are comming from. I was a surg tech for 3 years and loved it, I have first assisted in emergency cases, before we could get anyone else to get there and had no problem as I was in the OR every day observing technique, alot of the surgeons were happy to teach as well. A few taught me how to do the knots and the different types of ways of running sutures, of course couldn't do them on a pt. I don't blam you for being fed up with underexperienced and undereducated employees being hired by the facility to do a job you could do w/ your eyes closed. But it all seems to come down to the almighty dollar. IF they are highered by the hospital, they don't make much I can tell you that...and reimbersment from insurance companies, doesn't sound like they are out buying a BMW at $0.31/h. It seems to come down to not just the OR but all areas of the hospital, like hiring several techs and nursing students to cove the floor w just a few nurses. And the RN title = the responsiblity of those practicing under us...

Hard times I agree...but thats why we are here on this website, so we can rant and get it out of our systems and go back to work, day after day...Hang in there Mike!

Sarah, RNBScN · Sep 29, 2003

acuteobrn,

Firstly, I am speaking about an area where I am employed. We have GP who assist surgeon when there are no surgical residents. When there aren't any GP's, it is the RN's who assist. We do not get paid anymore or less for doing that. Actually, if we nurses were smart and stood our ground, we would say "no". It isn't part of our scope of practice to "assist" the surgeon only in a circulator or scrub role as per our hospital's policy.

Secondly, I am in Ontario, Canada. I can't relate or comment on US guidelines. I do know though when I researched RNFA and compared the US to Canada, the US program superceded the Canadian one by far.

Thirdly, we have a RN who has completed her RNFA and she will be paid differently from her peers. THIS has opened up a whole can of worms. One being that she can't maintain 2 positions in the hospital and get paid by two different parties. That isn't in our collective agreement. Secondly, she may have her RNFA, but won't be CRNFA. She isn't going to go and write her exam which she has to do in the US to be a full fledged CRNFA. "It's too expensive." That is like going to school to become a nurse and not write your provincial or NCLEX exam. ???? Thirdly, every nursing specialty should be paid more than???? This is an issue that is surfaced and myself being in the union, was approached by OR staff members to investigate for them and that is what I have been doing.

Lastly, I am just stating my 2 cents worth and enjoy others replies. That is what keeps me coming back to this BB. It's great!

Also, acuteobrn I found it interesting that your c/s are done on your floor. All of our c/s go to our OR. I should mention we are a small hospital with a population of 50 thousand BUT serve a large catchment area in Ontario.

Hope you all keep sharing.

Shodobe: I will keep you posted if your interested in the outcome.

Take care,

Sarah