PA, NP, or RNFA in the OR?

MierKat · Jun 17, 2017

I'm not an expert but to address this question: What is the difference between a PA specified in surgery and an NP specified in surgery? Is there one? How does an NP specialize in surgery? Has anyone met an NP that is a first assist, or do you mostly see PAs in that position?

I think that this varies by region of the country so you should talk to people locally or in the area that you want to live after school. Find surgeons, NPs and PAs to ask and get a lot of opinions. Perhaps volunteer at a local hospital if you need to meet more providers. My basic understanding is that more PAs participate in surgery but that may not be correct in all areas, all hospitals.

BSN2FNP1 · Jun 17, 2017

So... this is something I've also done a LOT of research on lately as well. My background: I was an LPN for 1 year while obtaining my RN and I've been an RN for 5 years. 2 years med/surg/peds and SCU and 3 years in the OR. I LOVE THE OR! I work primarily in general surgery and robotics doing anything from a robotic assisted lobectomy to mastectomy. I circulate and scrub in the OR, but primarily circulate. I have applied to start a FNP program this Fall. I came to this decision because I my prior nursing background, BUT from my experience I also see more PAs working in surgery compared to NPs. I personally know 3 PAs that work for surgeons and 0 NPs. My goal is to work for a surgeon when I'm done with school and do both pre-op, assist, and post op work. If you have not become a nurse already I would do PA if I were you. I am choosing NP because I am already a nurse, have a family and cannot quit my job to do PA, and I'm hoping my prior experience as an OR nurse will put me ahead of both PAs and NPs with no prior surgical experience. The reason why I think surgeons choose PAs over NPs is because surgery is part of their clinical training. The job market where I am located seems to want NPs over PAs and I work in a state that has full NP practice autonomy. I am hoping my vast networking with surgeons in my RN experience will give me an in when looking for jobs after school. As far as RNFAs I have not met a single one. The hospital where I work at the assists are RNs and are hired by the surgeon and work both in the clinic and in the OR solely with the one provider. My understanding is that if you are an NP in surgery you should have your RNFA. I do not have this currently. I am in the process of sitting for my CNOR and do . not plan to do RNFA until after I have completed my FNP. Hope this helps!

LadyIce · Jun 19, 2017

I am a former OR scrub nurse/circulator. I am also an advanced practice first assist. I am board certified as an adult acute CNS and I am back in school for adult-geri acute NP. I attended NIFA for the APRNFA program. I am continually working on my technique to be the best. The nice thing for the surgeon is, while I am closing, he or she can be doing something else. I can write post op orders and also round on the post op patient. This may vary depending on what state you are in. But, if you want to learn about the OR, then perioperative nursing with AORN standards is ideal.

BSN2FNP1 · Jun 19, 2017

That's amazing! How did you decide to do AGACNP? I was conflicted between the 2 because my end goal is to continue to work in surgery after FNP, but I felt like committing to AGACNP would limit me because the majority of surgeons I work with do care for children.

Dodongo, APRN, NP · Jun 20, 2017

As an NP you really need to also be a RNFA. I am currently in ACNP school and will start the RNFA program this fall, and finish the NP program in 2019. Older NPs were (very rarely) given OTJ training as first assists in the OR. Now, you will be hard pressed to find this situation. As PAs are trained in school, and NPs do not gain surgical training in their programs, surgeons prefer to hire PAs on their surgical teams. There is one school - UAB - that has a combined ACNP + RNFA. Otherwise, you need to complete them separately, as I am doing.

Also, check the area in which you live before you decide to complete an FNP vs ACNP if your goal is to be RNFA and work as an operative first assist. My area prefers (greatly) to hire ACNPs for acute care positions (and OR falls into this). FNPs are generally not trained to work inpatient, let alone in a surgical specialty. Many states are beginning to control the scope of practice of NPs and you don't want to educate yourself into a corner.

Working in the OR is a more convoluted path as a NP compared to a PA, but absolutely doable and I'd like to see more NPs pursuing it.

Dodongo, APRN, NP · Jun 20, 2017

That's amazing! How did you decide to do AGACNP? I was conflicted between the 2 because my end goal is to continue to work in surgery after FNP, but I felt like committing to AGACNP would limit me because the majority of surgeons I work with do care for children.

In my area all pediatric cases go to the local children's hospital. So unless you work there, you are only going to see ages 13 and up. It was a no brainer for me to pick ACNP. I only want to work inpatient - ICU or a surgical specialty, and I certainly do not want to work in pediatrics.

Your best bet might be to complete an FNP (if you think you have to do pediatric cases) and a post master's ACNP (to make you more appealing in the inpatient setting).

BSN2FNP1 · Jun 20, 2017

This is great information! Are you attending UAB or how are you doing your RNFA? I am much more interested in inpatient care and the thought of working primary care makes me want to die a little (sorry being a big dramatic), but in my area I rarely see job posting for ACNP in my area. What type of surgery do you typically do? It's so amazing seeing someone doing the exact thing I am aspiring to do because I was starting to worry I should pursue PA instead.

Dodongo, APRN, NP · Jun 21, 2017

This is great information! Are you attending UAB or how are you doing your RNFA? I am much more interested in inpatient care and the thought of working primary care makes me want to die a little (sorry being a big dramatic), but in my area I rarely see job posting for ACNP in my area. What type of surgery do you typically do? It's so amazing seeing someone doing the exact thing I am aspiring to do because I was starting to worry I should pursue PA instead.

I am attending an ACNP program and RNFA program separately. You can PM me for more details if you would like.

I, too, cannot stand the idea of working in a clinic or primary care role. I need to be in the hospital, and, even more than that, I need to be doing something a bit faster paced in the hospital - ICU, OR, etc.

My area is pretty big on ACNPs as we have a large university with a good program. The larger academic institutions staff all their ICUs with ACNPs and prefer them for hospitalist teams and other inpatient services. I think, as ACNPs are a newer specialty, they will eventually spread to smaller systems and eclipse FNPs as the preferred inpatient provider - just as PNPs are preferred for peds, WHNPs are preferred in OB, etc.

Surgery, and specifically first assisting in the OR, can be achieved as an NP, but is a little more involved on the part of the student as compared to PA. I want to, at some point, approach the local university and suggest it start an ACNP/RNFA combined program like what UAB offers.

BSN2FNP1 · Jun 21, 2017

You are very knowledgeable about this subject! I can't private message on here I guess? I just did a quick job search again to see what the job market was really showing and I did find a general surgery job located an hr away from me (dream job!) and it only stated "qualified nurse practitioner" with no degree/education requirement stated. Even the hospitalist jobs don't state ACNP. I don't understand why PAs go through school and don't have to have specific certifications for patient population, but NPs do.. I just want to make the right choice and that appears to be FNP. I currently do minimal assisting (last was assisting a urologist with a broken member lol), but the NIFA RNFA program looks very educational. That would be a great proposal to make about combining the two programs.

Dodongo, APRN, NP · Jun 22, 2017

You are very knowledgeable about this subject! I can't private message on here I guess? I just did a quick job search again to see what the job market was really showing and I did find a general surgery job located an hr away from me (dream job!) and it only stated "qualified nurse practitioner" with no degree/education requirement stated. Even the hospitalist jobs don't state ACNP. I don't understand why PAs go through school and don't have to have specific certifications for patient population, but NPs do.. I just want to make the right choice and that appears to be FNP. I currently do minimal assisting (last was assisting a urologist with a broken member lol), but the NIFA RNFA program looks very educational. That would be a great proposal to make about combining the two programs.

AH, maybe you don't have enough posts or something.

Well, it's just the way NPs chose to structure their education I suppose. FNPs attempt to train a generalist, primary care provider similar to PAs, but PAs cover way more information in the same amount of time. I generally tell nurses, if they want to practice in primary care/family med they should go the PA route, but, if they want to specialize they should pick an NP specialty - acute care, women's health, peds, psych, etc. I'm just not a huge fan of FNP programs for the most part...

I almost signed up for the NIFA program but I eventually chose another program. The contacts I was emailing weren't great in giving me information on the program, and it didn't start at a great time to fit into my NP program. You can also try and find a brick and mortar program near you. I think you'll just get better communication from them in general (my experience anyways).

BSN2FNP1 · Jun 23, 2017

Can you tell me what your typical day looks like? Even though I would be more interested I think my best bet is going to complete my FNP and go back for AGACNP cert after, that way I will for sure be able find a job post graduation.