Can NP do surgery? What to do? Help!

Published

Hello everyone!

I have a some questions about nursing and surgery. I'm sure many people have already asked this and I have found several helpful threads, but each have different answers. This is kind of long, but please read and help me!

I'm a pre-nursing student about to begging nursing school in Tennessee and eventually plan on getting my masters or doctorate to become a NP. I love surgery and would love to assist through the operation, maybe first assist? I also love pediatrics, so maybe pediatric surgery? I've been trying to do some research on how to do this and what steps I need to take in order to be in surgery. I can't seem to get a straight answer. One minute I found an article that says yes I can all that I'm wanting to do then I find another that says no. I'm not in nursing school just yet and want to make sure I'm on the right path before I start. I don't understand all the abbreviations and such sometimes used and it just gets awfully confusing. From what I've seen on some of the discussions everyone is saying to be an OR nurse first then become an NP with First Assist training.

Ideal Situation:

Become a nurse, work for a year or two, then go back and get my masters or doctorate. THEN I would love to work in surgery, assist through the procedure, help with pre-op and post-op. I don't want to just hand someone tools or get them dressed for surgery, I actually want to help operate.

(please let me know if this is even possible or if I'm a complete idiot)

So I guess my questions are...

1. Can a NP do all the things I listed above?

-I shadowed a surgeon in my hometown and the nurse anesthetist working that procedure told me it is possible and a lot of it depends on the hospital and the surgeon. But she said she has a friend who works as a NP that first assists on cardio surgery. He apparently operates alongside the surgeon, does pre-op, post-op and rounds(which sounds great!).

2. What would I specialize in as an RN before getting my masters or doctorate?

3. What would I specialize in when becoming a NP?

-one post suggested that specialized in Acute Care w/ a First Assist is the way to go, but read that it limits and you cannot work on children which won't work for me since I've always known I need to work with kids no matter what. Another person on here said to do Family Nurse Practitioner w/ First Assist. They said they work in neurosurgery, assist during the procedure, pre-op/pos-op, rounds, and see patients alone or with a doctor in a clinic setting and allow you to see a variety of people of all ages.

4. Do you have to be a NP to first assist?

Please help me with these questions! I know it's a lot, but I don't know were to begin. If what I'm wanting to do is unachievable, please let me know because I would probably need to look into becoming a PA before I commit to nursing school. I always thought NP was the smarter route since I could have my own practice if I ever wanted to.

*If you do answer, for clarity sake, can you number your answers to match the questions asked? Not to be OCD, just gets confusing reading all these other forums. Would also appreciate if no one turns this into a debate of hierarchy. Seems like a lot of these forums turn into people peeing on other's territory and getting their panties in a wad! I just need help for my future, plain and simple.*

Up Vote Up Vote ×
Specializes in IMCU, Oncology.

My NP has told me she does basic procedures and I had an NP sew stitches on my son in the ER.

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I don't want to just hand someone tools or get them dressed for surgery, I actually want to help operate.

(please let me know if this is even possible or if I'm a complete idiot)

If you really want hands on surgery...become a PA
Up Vote Up Vote ×
Specializes in Hospitalist Medicine.

If you REALLY want to do surgery, why not go to med school and become a surgeon? Seems to be the surest route to performing surgery :)

Up Vote Up Vote ×

Med school is not an option for me due to personal and financial issues.

Up Vote Up Vote ×
Specializes in Adult Internal Medicine.

1. Can a NP do all the things I listed above?

NPs can and do participate as first assists on major surgeries; these jobs are fairly rare and you need to find a surgeon willing to train you. More NPs work in the pre and post-op roles. If you want to be strictly surgery, then many would say a PA education is more suited to that role. But you will not be the primary surgeon in any case. Many NPs do ambulatory surgical procedures but it sounds like you are talking about major surgery.

As for pediatric surgery, that's a lofty goal. Most major pediatric surgery centers will have house staff and fellows assisting.

2. What would I specialize in as an RN before getting my masters or doctorate?

You would want as much operating room experience as possible, both circulating and scrub. You would also ideally have an RN First Assist certification and experience. This all takes time.

3. What would I specialize in when becoming a NP?

Your NP track many not make much of a difference as you are talking about a very specialized role. Given you are a ways off from graduate school, you should take a look at the consensus model for NPs as it is the future. You would want an ACNP for intraoperative work for the future I would think.

4. Do you have to be a NP to first assist?

No. RN's first assist. Surgical techs assist. PAs assist.

Ok, your direct questions are answered. Now for a few pieces of unsolicited advice:

You are talking about a lot of school and an lot of effort to reach your "ideal" job. Honestly if you want to do specialized surgery as an assist then you don't need to be an NP, you may find the road easier for you as a PA. You mention owning your own practice, but if you are doing major surgery, you will never own your own practice or be the primary surgeon as an NP or a PA.

From a prior BA/BS degree you are looking at this timetable:

ACNP = 4-6 years plus gaining experience as either an RN or NP before landing a job in surgery assisting.

RN-FA = 2-4 years of school plus experience.

PA = 3-4 years of school.

Pediatric Surgeon (MD/DO) = 10 years of school/residency/fellowship.

You are looking at, conservatively, $75,000-300,000 worth of education.

Up Vote Up Vote ×

Thanks so much for your reply, it was very insightful! Especially the breakdown of schooling and cost. Right now I'm in the process of applying for nursing school (2 year program BSN/RN) and would start in the fall. So I really would like to stick with nursing at this point. I'm really just trying to get a feel for what my options are. Do you mind explaining what all an ACNP would typically do and as well as a first assist?

I like surgery, but I don't want to limit myself to that only, which is why I mentioned having my own practice. Maybe it would help if I list what I like and dislike and based off that, suggest what type of nurse and NP would fit that criteria best.

Like: surgery, the OR, pre-op, post-op, rounds, assisting in surgery(but not performing it on my own by any means), being in a hospital setting, kids(resilient!), interesting cases, variety, clinical work (but not clinical alone), labs/films

Dislike: slow paced clinic settings

I worked as a nurse tech in a pediatric clinic and it just got very boring at times. Not undermining pediatric nurses by any means, it was just very slow paced.

Thank you!

Up Vote Up Vote ×
Specializes in Adult Internal Medicine.

There are very few NPs that have "slow" or "boring" jobs regardless of what area they work in; at the provider level the more patients you see the more money you make so most stay quite busy while "on the clock".

I don't want to speak for my ACNP colleagues, and perhaps they could answer you better, but most that I know work in urgent care, ED, Hospitalist, and Intensivist positions, though they are not limited to that necessarily.

I also have several FNP colleagues that work in these settings, including one that works on the trauma surgery team. She doesn't do much in the OR (she can assist but normally does not) but she manages most of the post-op course, rounds, and does clinic follow-up after discharge.

First assists scrub with the primary surgeon and provide support retracting, cauterizing, closing, etc. Again, an experienced FA may be able to provide you better explanations.

PNPs work both inpatient and outpatient. NNPs work mostly in NICUs.

I spend 75% of my time in a busy outpatient internal medicine office managing some chronically sick patients as well as well visits. I also do I&Ds, aspirations, steroid injections, suturing, etc. The other 25% if the time I spend in the hospital rounding on patients from my panel that are hospitalized.

I am never bored.

You sound like an ACNP is best for you. If you want to have your own clinic someday then you can do a post-masters in PCNP.

Up Vote Up Vote ×

Have you considered the role of ER ACNP? If your looking for variety and a fast pace, this might be your calling. Also, you will see patients of varying ages and medical conditions.

Up Vote Up Vote ×
Specializes in Neonatal Nurse Practitioner.

1. Can a NP do all the things I listed above?

I work with NPs who worked with surgeons. Their responsibilities ranged from holding, clamping, irrigating for the surgeon like third and fourth hands to finishing a surgery after the critical part was done. I've never heard of an NP or PA performing a surgery in an OR by themselves.

2. What would I specialize in as an RN before getting my masters or doctorate?

Almost anything is fine. Critical care is a hot spot that exposes you to a lot.

3. What would I specialize in when becoming a NP?

-one post suggested that specialized in Acute Care w/ a First Assist is the way to go, but read that it limits and you cannot work on children which won't work for me since I've always known I need to work with kids no matter what. Another person on here said to do Family Nurse Practitioner w/ First Assist. They said they work in neurosurgery, assist during the procedure, pre-op/pos-op, rounds, and see patients alone or with a doctor in a clinic setting and allow you to see a variety of people of all ages.

That sounds like a good plan.

4. Do you have to be a NP to first assist?

No. You can be a RN First Assist. Finding surgeons to work with is very networking based from what I've heard.

Up Vote Up Vote ×
Specializes in Child & Adolescent Psych.

I heard that you can first assist as an RN, but you don't get paid as much as if you were FAing as an NP? Something to do with how it's billed... does this make sense to anyone?

Up Vote Up Vote ×

So what did you end up doing?

Up Vote Up Vote ×
+ Join the Discussion