Advanced Practice Practitioners In The Operating Room

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The term Advanced Practice Provider ("APP") has usually been limited to advanced practice registered nurses in a medical context. I believe recent trends and the efficacy of care is starting to really contemplate what that term can mean in surgical care. Nurses that go on to pursue advanced degrees such as an Acute Care Nurse Practitioner ("ACNP") bring years of high-stakes critical care knowledge and a level of independence that can only be accretive to the performance of a surgical team. As they progress in their abilities to manage the critically ill, why should that stop at the O.R. doors?

I firmly believe that in the next 5 - 10 years we are going to see something that already has momentum start to really take effect, and that is the use of APRNs, ACNPs, and other advanced-level nurses take a larger role in the Operating Room as first assists. I think it is very exciting that UAB is offering an ACNP program with an RNFA certification. I work with some wonderful surgical PA's, but there is a gap between the model in which they've been taught and the nursing model + nursing experience.

There are tremendous synergies that can be obtained by having someone like an ACNP be involved in the full lifecycle of acute care surgery - from consult to pre-op to first-assist to recovery. I think a lot of institutions are starting to see that...and patients want it. Continuity of care is often discussed as important for patients to follow. Well, I think it's equally important that healthcare professionals reciprocate that continuity.

Historically, NPs haven't really pursued intraoperative roles, and I think many want to [I acknowledge some do not]. So, I think it's time that they receive the appropriate training to become valuable members of the intraoperative surgical team. I think they bring a wealth of knowledge to very complex cases and can take what they see on the table and help calibrate the recovery off of what they see...not off of an operative dictation or chart.

There's an amazing article about an ACNP / RNFA named Trisha Hutton who is living this new reality as a Cardiothoracic Surgery First Assist and I think her interview provides an invaluable backdrop as to why this is not about 'personal interest', rather, 'in the best interest of the patient.' It has truly inspired me to reach further, explore more possibilities, and take pride in the experience of nursing that cannot be taught. We are the lucky few who have been in the trenches working as partners with residents, fellows and attendings before and after surgery, so why should we be left out of the middle part - "during surgery". As a teenage cardiac surgery patient, I got to know my advanced practitioner nurse very well - she was the glue of my care. When I asked if she would be able to help me in the Operating Room, she said, "no, there are plenty of amazing hands in there to heal you." And she was right, but is that right? Being a patient and now working on a cardiac surgery team, I understand the value of these amazing nurses who can do everything, but aren't often given the opportunity to prove just that.

The debate between going to nursing school and eventually becoming an NP versus going to PA school is often debated. But, they shouldn't be. Nursing is a very special and unique experience, and we need to show others why that experience is valuable in ALL aspects of care...including in the Operating Room. PAs may be able to assist in surgery, but can they care for post surgery acute care patients after? Would it be beneficial if there was a practitioner that had the aperture to bridge the two? I think undoubtedly the answer is, 'yes it would be.'

Advancing a profession is not about crossing lines of proficiency. Advancing a profession is educating others about the value of proficiency that inherently exists.

Advanced Practice Practitioners In The Operating Room

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