ACNP/RNFA salary negotiations

Published

Specializes in APRN, ACNP-BC, CNOR, RNFA.

I will be completing a general/minimally invasive fellowship in May and without being too specific, can anyone tell me what is an acceptable salary for someone with less than 2 years experience? The surgeon that I work with says that he wants to keep me, so I would like to have a salary in mind when we have the conversation. My job duties are inpatient rounding, putting in lines, and assisting in surgery. Thanks in advance.

Up Vote Up Vote ×

Have no idea about the salary but just wanted to say it sounds like an awesome job.

Up Vote Up Vote ×
Specializes in APRN, ACNP-BC, CNOR, RNFA.
Have no idea about the salary but just wanted to say it sounds like an awesome job.

Thanks! I was lucky to land it, plus he's super nice and very easy to work with. Of course, none of that matters if I can't make a decent living.

Up Vote Up Vote ×
Specializes in Critical Care Transport.

I am an aspiring NP and your posotion sounds similar to something I am interested in attaining. Where did you complete graduate school and the first assist program?

While you are having some stress regarding this issue, it sounds to me as though the surgeon wants to keep you happy and on staff. There are a few different options you can take.

1. Wait for the conversation and when it is brought up put the ball in his court. Ask him what someone with your experience/skills would generally be paid. You would then know his ball park figure.

2. Research the market to the best of your ability as you are currently doing. Not knowing location, subspecialty if applicable, or market value makes it challenging.

In my experience combining both methods produces the best results during salary negotiations. If the figure is much too low you can move on to other prospects. If it is around your desired income you can negotiate. Good luck!!

Up Vote Up Vote ×
Specializes in APRN, ACNP-BC, CNOR, RNFA.
I am an aspiring NP and your posotion sounds similar to something I am interested in attaining. Where did you complete graduate school and the first assist program?

While you are having some stress regarding this issue, it sounds to me as though the surgeon wants to keep you happy and on staff. There are a few different options you can take.

1. Wait for the conversation and when it is brought up put the ball in his court. Ask him what someone with your experience/skills would generally be paid. You would then know his ball park figure.

2. Research the market to the best of your ability as you are currently doing. Not knowing location, subspecialty if applicable, or market value makes it challenging.

In my experience combining both methods produces the best results during salary negotiations. If the figure is much too low you can move on to other prospects. If it is around your desired income you can negotiate. Good luck!!

Thanks! I completed my ACNP locally at TWU Houston and I did the first assistant training through NIFA. I'm already a CNOR (certified nurse of the OR), so it was a fast track program. In Texas, NPs can assist in surgery, but if you want to bill for your services, then you must complete a RNFA program. Good Luck on your endeavors as well.

Up Vote Up Vote ×
Specializes in Anesthesia, Pain, Emergency Medicine.

Medscape Today

May 12, 2010

Can Registered Nurse First Assistants Be Reimbursed?

Medicare and most other insurance companies reimburses for first assist to NPs. RNFA is not required. Many advanced practice nurses are being reimbursed by Medicare, but what about Registered Nurse First Assistants? Are they being reimbursed?

Response from Carolyn Buppert, NP, JD Attorney, Law Office of Carolyn Buppert, PC, Bethesda, Maryland

A Registered Nurse First Assistant (RNFA) is a registered nurse who has completed a minimum of 2000 hours of first assisting a physician with surgery and related preoperative, intraoperative, and postoperative care, and who is certified as such by a recognized organization. Medicare does not reimburse RNFAs at this time.

Florida Medicaid reimburses RNFAs, and in some states, private payers are required by law to reimburse RNFAs. These states include Florida, Georgia, Kentucky, Louisiana, Maine, Minnesota, Rhode Island, Texas, Washington, and West Virginia. In other states, RNFAs are not reimbursed.

However, Medicare reimburses assistant-at-surgery services if the assistant is a nurse practitioner, physician assistant, or clinical nurse specialist; if the surgery is one for which an assistant is reasonable and medically necessary; and if the hospital is not a teaching hospital.

The conditions for coverage of assistant-at-surgery services in teaching hospitals are more restrictive than those in other settings because of the availability of residents who are qualified to perform this type of service. Medicaid and the commercial payers also usually reimburse assistant-at-surgery services when medically necessary and reasonable and when performed by a physician, advanced practice nurse, or physician assistant.

Some advanced practice nurses who want to assist at surgery complete an RNFA program and become certified as an RNFA. These clinicians generally are being reimbursed because they are advanced practice nurses.

Medicare calculates payment for assistant-at-surgery services according to the following formula: when the assistant is a physician, payment is the facility-specific Medicare Physician Fee Schedule amount multiplied by the assistant-at-surgery reduction percent (16%), minus deductible and coinsurance, multiplied by 115%. In the case of a physician assistant, nurse practitioner, or clinical nurse specialist, the amount paid for serving as an assistant-at-surgery is the lesser of the actual charge or 85% of the amount that would otherwise be recognized if a physician had served as the assistant-at-surgery. [1] Medicare's rules for billing for an assistant-at-surgery are found in the Medicare Claims Processing Manual, Chapter 12, section 20.4.3. [2]

Up Vote Up Vote ×
Specializes in Vents, Telemetry, Home Care, Home infusion.

RN - Surgical First Assistant Salary - Salary.com

[TABLE]

[TR]

[TD=align: left] The median expected salary for a typical Staff Nurse - RN - Surgical First Assistant in the United States is $82,943.[/TD]

[/TR]

[/TABLE]

The Average Registered Nurse First Assistant Salary | eHow.com

Potential

In some high-paying metropolitan areas, the top 10 percent of registered nurse first assistants earn more than $100,000 per year. These include Washington, D.C., where the median annual pay rateicon1.png for these health care professionals is $87,140; in Seattle, Washington, with a median annual salary of $89,000; in Honolulu, Hawaii, at $89,250; in Atlantic City, New Jersey, and Boston, Massachusetts, at $90,100; and in San Jose, California, at $96,910. The top 25 percent of registered nurse first assistants in San Jose earn more than $105,000 per year, and the top 10 percent more than $112,500 per year.
Up Vote Up Vote ×
Specializes in APRN, ACNP-BC, CNOR, RNFA.

Thanks for the responses everyone. I was looking for someone with less than 2 years experience who may have recently negotiated a salary. I've been told so many different ranges, I'm not sure what is reasonable to expect as a minimum salary. Since the RNFA without an advanced practice degree makes $82,000, is it reasonable for me to ask for $92,000?

Up Vote Up Vote ×
Specializes in Peds OR as RN, Peds ENT as NP.

I just wanted to subscribe to this thread to see how things turn out since I am an OR nurse and applying to NP school to do the same thing. Keep us informed!

Up Vote Up Vote ×

I have a very close friend who is interested in this very same type of NP role (I may be posting some of her questions here). Definitely keep us informed and good luck!

Up Vote Up Vote ×
Specializes in APRN, ACNP-BC, CNOR, RNFA.

Thanks everybody for the support and encouragement. I welcome any questions.

Up Vote Up Vote ×

Hello, I am not an NP but I stumbled across this thread while researching info about RNFA's. The AORN website has a salary survey from 2012; only 3.4% of the survey respondents were RNFA's so it was roughly 82 RNFA's that responded and they report an average salary of $82800. Unfortunately there isn't a breakdown of years of experience, type of degree. Also they show geographic spread and it was pretty limited. Maybe let the surgeon be the first to bring up salary. It sounds like a great position, best of luck to you and please do keep us updated!

http://www.aorn.org//uploadedFiles/Career_Center/2012%20salary%20survey.pdf

Up Vote Up Vote ×
+ Join the Discussion