APRN Required To Have First Assist

Specializes in OR, Trauma, OH, Vasc., Ortho, Gen.

I work in a busy level two trauma center's operating room and I am also in school to be an ARNP(finish in 17 months) My faciliting is enacting a rule they say was in a law passed in 2015 requiring ARNP's to have a first assist certification in order to assist in surgery.

Has any heard of this requirement for ARNP's

22 Answers

Interesting, since both RN's and NP's get exactly the same training in this role in school. (which is precisely none)

Sam

I think the reason NPs do not have the 2 years OR experience requirement is because, unlike RNs, their practice is not governed by AORN in anyway. NPs can and do first assist in the OR without completing an RNFA program (they are above the rules governing RNs so to speak), whereas RNs cannot practice in that role without further education.

State boards of Nursing allow NPs to essentially do whatever, whereas they require RNs to be formally trained... I don't agree with this at all, but... it's happening.

Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Whatever law this pertains to has to only be in effect in your state. Scope of practice and regulations surrounding the practice of NP's and RNFA's are different for each state. On a federal level, CMS, will reimburse NP's (and even CNS' in states that allow it) for assisting in surgery without going through RNFA training or certification.

There's no law (federal or state) I'm aware of that requires the NP to have the RNFA cert. There are, however, many hospital systems that are beginning to require it as a way to CYA.

Specializes in OR, Nursing Professional Development.
I was told it was a national Law. I live in Florida so I am trying to find the statute with no luck.

I have yet to find a truly national law regarding nursing. It's by and large left to individual states- hence why each state has its own BON, NPA, and license.

From all appearances, Florida sets the requirements for being utilized as a first assist, but doesn't appear to give nurse practitioners any specific more authorizations in this area. IMO, NP school doesn't prepare you for this role and as you are still an RN, you probably need to be trained as a first assist to work in this capacity.

Florida Laws and Rules | Wild Iris Medical Education

IMO, NP school doesn't prepare you for this role and as you are still an RN, you probably need to be trained as a first assist to work in this capacity.[/url]

I completely agree. Until you've been in this setting you really don't understand what goes into it. Learning the instruments, all the suturing techniques and the types of sutures themselves, asepsis, hemostasis, tissue handling, ANATOMY. NPs are not trained for this by nature of their NP programs.

Do yourself a favor and be formally trained for what you want to do. It will only help you in securing a job and performing well in that job.

Specializes in ED, OR, Oncology.

I'd say this is one of those areas where what you did as an RN plays a role. Long time OR nurse that scrubbed a lot, then went to NP school? That NP can probably take what she already knows, and as long as the surgeons they are working with are willing to do a little OJT, probably dont need to get formal training. An NP with no OR experience? Unless the surgeons the NP is to be assisting are interested in a considerable amount of OJT, a first assist class is probably a good idea. As I recall from my days as an OR nurse, doesn't AORN's first assist program require experience in the scrub role and CNOR cert? Are there other recognized first assist programs available?

As I recall from my days as an OR nurse, doesn't AORN's first assist program require experience in the scrub role and CNOR cert? Are there other recognized first assist programs available?

If you are an NP you do not need the experience requirement that an RN does.

Specializes in ED, OR, Oncology.
If you are an NP you do not need the experience requirement that an RN does.

Interesting, since both RN's and NP's get exactly the same training in this role in school. (which is precisely none)

Sam

Specializes in Adult Internal Medicine.

There are state laws to this effect.

Specializes in ED, OR, Oncology.

State boards of Nursing allow NPs to essentially do whatever, whereas they require RNs to be formally trained... I don't agree with this at all, but... it's happening.

This is a big flaw in the NP role it seems (based on what I've found through research, I haven't even started NP school yet, planning for next fall) There are NPs practicing in all sorts of roles that they aren't necessarily formally trained for. In many cases it ends up being fine, so there appears to be no reason to change. Examples like long time scrub nurse turned FNP assisting in surgery- probably will do a great job. Long time ER nurse turned FNP working fast track or even main ED with doc collaboration on critical cases- will probably get by. Neither is actually trained for the APRN position they are practicing in, but past experience makes it work. Swap their jobs compared to their experience, and neither is even remotely qualified without additional training such as first assist program or a post masters cert in acute care.

The increasing diversity of training for NPs is improving, but will really only work if we start sticking to where our training is. Some scenarios are not very well met yet- for instance, I want to work very rural acute care (ED or very rural clinics that see urgent care type stuff, but are also the first stop for traumas and critically ill patients). Planning on an FNP/AGACNP dual role, which gets close, but I will have a void in pediatric acute care. By the nature of these facilities, I have to be able to see peds, and the FNP gives some background for that, but it would be nice if there were some all ages acute care programs (recognizing that it would have to be more focused on urgent care/ED, and not mean you are necessarily ready to work as an intensivist for all ages).

The downside of specializing NP education to better prepare people for how they intend to practice, is that you lose some of the wide array of options we enjoy in the RN role without significant additional training other than OTJ.

Sam

Some scenarios are not very well met yet- for instance, I want to work very rural acute care (ED or very rural clinics that see urgent care type stuff, but are also the first stop for traumas and critically ill patients). Planning on an FNP/AGACNP dual role, which gets close, but I will have a void in pediatric acute care. By the nature of these facilities, I have to be able to see peds, and the FNP gives some background for that, but it would be nice if there were some all ages acute care programs (recognizing that it would have to be more focused on urgent care/ED, and not mean you are necessarily ready to work as an intensivist for all ages).

Sam

I had a professor that was dual certified AG-ACNP/AC-PNP and he worked in a rural ED.

I agree with you though. There should be an all ages ACNP. FNPs are not trained to work in many of the environments where they can be found. NP programs are trying to expand their specialty programs to make up for this, even so, it's still an issue.

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