Surgical PA vs. RNFA?

[KristinWW]

I apologize if this question has already been posted, but what's the diff? I keep reading about how the Surgical PAs are battling the RNFAs for work. What's the story? Thank you!

[Chrislynn2003]

Well I am new to the OR, but what I see is that the PA's are doing a lot of the surgical procedure with the physician. One PA was left in the room by themselves for 15 minutes with no surgeon. I don't know if thats legal. In my hospital we only have one RNFA. And from what i hear, the RNFA is only acting as a circulator- That's ridiculous seeing as they are making more money and only acting as circulator. I don't know about in other facilities, but I hear an RNFA is able to assist the doctor in doing the surgery also, but maybe not to as great of an extent as a PA. I don't really know too much about this; I will have to inquire more about it or research it. I guess a PA might have higher status than RNFA, don't really know.

Christine

[flynrn]

PA's in surgical assisting are not any different than RNFAS and that Certification stuff is just a way to make more money. The PA used to be mostly men, and of course, the "good ole boy" philosophy takes over with male surgeons. If you take the course as an RN and you have experience you could write a book for some PAs.

[stevierae]

I have worked with some really, really REALLY good PAs and even some techs who were trained as "surgical assistants" who literally knew the the operation better than the surgeon did. These are mostly people who were military corpsmen in Vietnam. I am sure there will be, or are now, equally qualified ex-corpsmen who trained during the Gulf war and the war in Iraq.

I've worked with some really good RNFAs, too.

Then again, I've also seen RNFAs, PAs and on the job trained surgical assistants who could barely tie knots, let alone suture.

When I went to OR school in the military (1975) part of our curriculum included learning to tie knots, suture, do digital blocks and infiltrate, and debride burns and wounds, do I&Ds, etc--and we got plenty of on the job practice so that everyone did it extremely well. We all also had to do independent duty in the ER. However, my colleagues and I could not hold a candle to those aforementioned ex-corpsmen who actually SERVED in Vietnam. To this day, I am impressed with the extent of their knowledge, especially in very complicated orthopedic procedures, such as spinal fusions and various total joint systems and IM roddings. These guys, in my opinion, are not paid nearly enough--I can think of a couple who have had to bail out the surgeon on more than one occasion.

[Circl8r]

Greetings: While I am not a RNFA, I am a CNOR, and president of my local AORN Chapter. AORN has published a position statement on RN's as first assistants which can be found at:

http://www.aorn.org/practice/rnfastate.htm

only a short portion is shared below, along with the certification board's (certboard.org) statement

AORN Official Statement on RN First Assistants:

"The RN First Assistant at surgery collaborates with the surgeon and the health care team in performing a safe operation with optimal outcomes for the patient. The RN First Assistant practices perioperative nursing and must have acquired the necessary knowledge, skills and judgement specific to clinical practice. The RN First Assistant practices in collaboration with and at the direction of the surgeon during the intraoperative phase of the perioperative experience. The RN First Assistant does not concurrently function as a scrub nurse.

CRNFA Certification is defined as the documented validation of the professional achievement of identified standards of practice by an individual Registered Nurse First Assistant providing care for patients before, during and after surgery.

Objectives of CRNFA certification include:

*recognizing the individual registered nurse first assistant who is proficient in practice,

*strengthening conscious use of theory in assessing, planning, implementing and evaluating patient care and

*enhancing professional growth through continued learning that results in broader knowledge and expanded skills.

Purposes of CRNFA certification include:

*demonstrating concern for accountability to the general public for nursing practice,

*enhancing quality patient care,

*identifying RNFAs who have demonstrated professional achievement in providing care for patients during surgical intervention,

*providing employing agencies with a means of identifying professional achievement of an individual RNFA and

identifying professional nurses practicing in an expanded role.

I personally nothing against PA's working in the first assist role, but believe that we as nurses should encourage and support the RN in the role of first assistant. Remember colleagues...

"EVERY patient needs and deserves a perioperative registered nurse"

:::edited for spelling:::

Donna

[Alnamvet]

New to this forum, and I feel that the differences in the First Assistants used in the OR are really not a matter of who is who, but what was the training received, and what hoops one had to go through to get their. As I see it, an RNFA has to go thru many obstacles (read: MONEY for certifications) and beaucoup time in the OR, before they can receive certification...but before that, they have to be a CNOR. An MD has it easier...have a license, and your buddy surgeon from med school can make you a first assist, and bill accordingly. Than you have the PA, who if he has completed a Surgical PA program (Cuyohoga Community College), can easily assume the role of First Assist. Now it gets tricky, since an RN with a CNOR cert, who elects to go to a ski resort for a week, and is willing to pay the exhorbitant cost of such an adventure, can qualify as a RNFA, so long as you keep the AORN happy with paying your dues. Now, you have Certified Surgical Assistants, or Surgical Assistants-Certified, or Certified Surgical Assists, who by virtue of their traing (one year of didactic and one year of clinicals: read ~2000 hours of clinicals), who are now being recognized by Congress as highly trained surgical assistants, who have the MOST training initially to qualify as First Assistants. AND, you now have several states licensing these professionals, and guess what...turf wars. AORN consultants states they never heard of them, PA's and NP's, as well as RNFA are pissed, and these guys have been around since the Vietnam war, and can bill and get reimbursed just like the surgeons. For my money, get your RN, go to a reputable university offering a surgical assistant program, and voila, you can be a First Assist working for the Dep't of Medicine (more money) as opposed to working for the Dep't of Nursing (read: Jealousy, low pay, no recognition). For more info on this well established, but little known/ignored profession, see the Eastern Virginia Medical School of Medicine home page...the surgical assistant program has been around since 1981, and this is the last year as a certificate program. In 2005, it will be a Masters program, and I can't wait to see the AORN get their petticoats in a lather.

BTW, I am a RN, and proud of it, but cannot stand the territorialism of the profession.

[Ferret]

Hi All,

I have been a circulating nurse for 4 years, and just completed my RN degree, and am allowed to scrub, just starting my postgrad perioperative course. Due to staffing shortages, I was asked to assist a surgeon recently (read - Human Retractor :chuckle ). WOW!

Not concentrating on the instruments and other scrub nurse role, I was able to focus on the operation, ask the surgeon lots of questions, and it was a great learning experience. I for one have only come across one RNFA, but she had a hell of a lot of hoops to jump through to get there, and thinks it is worth it.

If you have heaps of OR experience, it is a logical step to continue your career, honestly. You KNOW you know more about that operation than the new registrar attempting it, don't you? :roll

I'll be there one day:)