Can the NP assist in surgery?

[Alisabeth, BSN, MSN, DNP]

Yes, nurse practitioners can first assist in surgery. I am a Family Nurse Practitioner, and I specialize in neurosurgery. I was an operating room nurse for several years and knew how to scrub and assist. I do not have my RNFA, which I will probably work towards in the future. Some hospitals where you will either work or have privileges require you to have your RNFA. I am at an HCA hospital, and they do not.

[CRF250Xpert]

RNFA is an excellent idea if surgery is your goal. Without it, you will eventually have your BON asking you when exactly it was during your curriculum and clinical as an NP student that you learned to do surgery.

They might not take, "Well, one of the surgeons showed me how to XYZ" as an acceptable answer. Ask yourself, would you want your mom to get a CABG with a NP who gives that kind of answer?

I knew an NP who was the ct surgeon's right hand. She was involved in everything from A to Z and would harvest grafts, close, help anastomose, etc. I wondered where she got that kind of training that the plaintiff's lawyer wouldn't find objectionable, but I always think like that since I guard my license closely. Some folks are reckless and feel invincible once an MD takes them under the wing.

I try to remember it's my license, and (as lovely as he is) my MD won't be there when the lawsuits start flying. Before I went to grad school, I was trained to do chest tubes, cut down trach, cut down groin lines, etc. will you ever see me to any of that anywhere? No way. if it's not on your syllabus – use caution and remember whose lawyer you'll have to answer to.

[CRF250Xpert]

Alisabeth said:

I am a Family Nurse Practitioner, and I specialize in neurosurgery. I do not have my RNFA.

I do not doubt your skill or ability, and maybe you have a ton of certifications and 1,000 CME in neurosurgery, but when did you learn to do neurosurgery? Your BON might look more favorable if you had all the credentials to go with the experience. Right or wrong, I always have the plaintiff's lawyer in mind. You do know that with the first bad outcome, the surgeon will blame you, and the BON will throw you under the bus.

[Alisabeth, BSN, MSN, DNP]

I chose to specialize in neurosurgery as a registered nurse in the operating room. When I went back for my master's and doctorate, I had my advanced clinical rotations in neurosurgery and neurology.

Yes, I do have a lot of certifications and have attended a lot of courses for my specialization. These are not required but are something I enjoy doing.

I'm sure it varies by state, but in Florida, before you even begin practicing as a nurse practitioner. You and the physician you work with must provide BON with specific details of what you will be doing in your position and specialty. They have to approve this before you can begin working. So I do not have to be worried about being "thrown under the bus" to the BON. They have already approved every clinical skill/procedure/first assisting I do in my position. The surgeon also must sign this letter that he supervises everything I do and is responsible for me. This is Florida-specific.

As I stated in my previous post, the RNFA is something I will probably work towards in the future. Yes, I know it does look more favorable to have your RNFA when you are in surgery.

For now, I practice per my state laws and hospital regulations, which do not require you to have your RNFA.

[frUABgrad]

CCRNDiva said:

UAB has a combined Acute Care NP/RNFA program. I think you are required to have OR experience, though.

I graduate on Saturday from UAB's ACNP/RNFA program. No OR experience is required; you get plenty of that during your clinical rotations.

[CRF250Xpert]

cassowary said:

I am so interested in your profession and I am burning to know more!

I'm excited that you are so excited about school. Unfortunately, you must know that you will learn how to be a FNP in FNP school - not become a neurosurgeon. You should look into another specialty besides FNP if doing surgery is your goal. When your grad from an FNP school, you are all set to see all Family Medicine patients in a clinical setting - it's what FNP school prepares you for. Please get the appropriate education for whatever your end game is. FNP doesn't sound like your best option.

ACNP w/ RNFA is probably what you should look for. As a FNP, I see everything from birth to death, from rash to CHF. I don't do surgery - I'm not a surgeon. I was trained to see Family Medicine Clinic patients. Make sense? If you want to tell a mom her 13 y/o daughter's belly pain and nausea are related to her being pregnant, then run off because you got paged for an emergent hemispherectomy - you are confused about what APRNs do for a living.

[nomadcrna, DNP, CRNA, NP]

God, FNPs are in ORs all over the country. This post makes no sense at all.

At my last hospital, an FNP was with one ortho surgeon, PA with the other, and the neurosurgeon had an FNP as the first assistant.

The surgeon can't blame the FNP, LOL.

CRF250Xpert said:

I do not doubt your skill or ability, and maybe you have a ton of certifications and 1,000 CME in neurosurgery, but when did you learn to do neurosurgery? Your BON might look more favorable if you had all the credentials to go with the experience. Right or wrong, I always have the plaintiff's lawyer in mind. You do know that with the first bad outcome, the surgeon will blame you, and the BON will throw you under the bus.

[nomadcrna, DNP, CRNA, NP]

Get your FNP; EVERY PA/FNP has to be trained by the surgeon, Period. The ortho surgeon I talked to about six months ago (doing anesthesia) said it takes about two years before the FNP/PA can function the way he likes. The FNP curriculum is a starting point. Finding a surgery-type position without experience will be more challenging, but it can be done. An ortho surgeon in Butte, Montana, has been looking for an FNP/PA for over a year. He will train you if you are bright and good with your hands. It would be most helpful to have suturing experience and such already.

For another view from the one below. I do minor surgery all the time. I I&D abscess, remove moles, small lesions, and such.

In the past two weeks, I I&D a buttocks abscess labial abscess and removed a lesion from a tongue. I even do prenatal visits and pap smears. Not my favorite.

Today I admitted a patient with severe pneumonia and splinted and referred a distal humerus fracture on an 8yo.

YOU can learn what you want and do the practice you want. Move to a state that lets you function at your total capacity and take courses to document your training.

The problem with doing the ACNP/FA is that you cant work on kids. That limits you significantly.

CRF250Xpert said:

I'm excited that you are so excited about school. Unfortunately, you must know that you will learn how to be a FNP in FNP school - not become a neurosurgeon. You should look into another specialty besides FNP if doing surgery is your goal. When your grad from an FNP school, you are all set to see all Family Medicine patients in a clinical setting - it's what FNP school prepares you for. Please get the appropriate education for whatever your end game is. FNP doesn't sound like your best option.

ACNP w/ RNFA is probably what you should look for. As a FNP, I see everything from birth to death, from rash to CHF. I don't do surgery - I'm not a surgeon. I was trained to see Family Medicine Clinic patients. Make sense? If you want to tell a mom her 13 y/o daughter's belly pain and nausea are related to her being pregnant, then run off because you got paged for an emergent hemispherectomy - you are confused about what APRNs do for a living.

[LJames13]

Becoming a FNP/RNFA has been my dream job for years!! I am applying to an FNP program with the plan of working in the OR with a surgeon and doing this once I have graduated. These posts have been constructive. Do any of you live in North Carolina? Thanks for all the great advice; keep it coming!!

[bsnanat2]

CRF250Xpert is a little off base.

Medicaid allows all Advance Practice Nurses to file and be paid as First Assist, even if they are not RNFA or ACNP. Remember that the term is "assist." Family Practice physicians function in all areas of the hospital and medicine, so why not FNPs? This is an excellent example of nurses getting in the way of nurses. Forget about the trouble MDs make for NPs; the turf-protecting attitude of NPs has led to many certifications and constant calls of being "unqualified" by other NPs. If someone is a professional, they know what they are capable of doing and what they are not. As long as NPs like CRF250Xpert cry "foul," the profession will never be what it could be. PAs are not "certified" and are limited to working in niche areas. They may choose to but can easily change without other PAs crying. They change, get the on-the-job specifics (and continuing ED), and move on to their new career. If someone practices in an area, they are not qualified for; it will bear itself out soon enough. Like PAs, in the state of Georgia (with only a couple of exceptions), professional engineers are licensed as such and are free to practice in whatever area of engineering they choose because everyone's license says "P.E." It is understood that professionalism will prevent one from going outside of their area of expertise.

Many NP certifications could go away, and the public would be better served by NP programs that prepare advanced practice nurses so that they could specialize afterward, according to wherever they find work, but that is for another thread. It just doesn't seem wise to put up such roadblocks to your profession's success.

[Alisabeth, BSN, MSN, DNP]

cassowary said:

Hello, Alisabeth; thanks for replying! Your reply has been the most helpful for me so far!

If you don't mind, please tell me your duties as the FNP assisting neurosurgery. What procedures do you do while assisting? I'm a bit confused, but how did you learn how to assist since you have not completed an RNFA program (if you can't tell already, do I know anything about NP school and what they instruct regarding surgery)? And what do you do as the FNP specializing in neurosurgery outside the operating room (such as before and after surgery)? I am so interested in your profession, and I am burning to know more!

Again, thanks for being so great, Alisabeth!

Sorry for the delayed response. I was an operating room nurse before returning for my master's and doctorate. I specialized in neurosurgery as an OR nurse, where I mainly learned how to assist. There is scrubbed and circulated, and learn first to help. Except I could not open or close the incision as an RN. In my master's and doctorate clinical, I chose surgical clinical and my other rotations in family/peds/OB/etc. My program did not offer them, but I asked specifically for surgery, and my school was very accommodating. I also gained first assistance/scrubbing in these clinics and learned to close and open incisions and assist with the surgery. In neurosurgery, we mainly do complex spine procedures, brain tumors, shunts, drainage of SDH, and trauma. Before surgery, I round in pre-op and see the patients, answer last-minute questions, give post-op education, pull and review films/labs, and check off on the H&P. I round on post-op patients after surgery and do discharges. We also have many surgical consults that come in daily. I will do the consult and physical exam, review films, and present this information to the surgeon. I also have clinic patients which I see independently and with my surgeon. I work very alone in my practice. I love it and think I have the most fantastic job in the world.

[Trauma NP/PA]

Yes and No. I have a PA and an NP. I worked as a Trauma PA as my first job, they allow PAs to operate right after school, but an NP needs a surgical cert. My second job at another hospital allowed me to be a Trauma NP and operate without any particular cert. It depends on the hospital.