ER vs OR?

Dodongo, APRN, NP · Jun 25, 2017

Both?

If you do not have 2 years of OR experience as a RN, you will have to wait until you graduate as a NP and pass your boards before you are able to attend the RNFA program. However, as a RN with 2 years of OR experience (also cath lab or IR) you can attend the RNFA program prior to, or during, your NP program. So, having the OR experience can expedite time spent in school - I entered my NP program with 6 credits so I was able to insert a RNFA program into the middle of my NP program. Although, one of the perks of doing it during or after your NP program, rather than before, is that the surgeon will train you as an advanced provider rather than a RN.

If you have to pick one or the other, then I vote OR, if for nothing more than streamlining your education.

Alexxoxox, BSN · Jun 27, 2017

Just bumping this thread.

Editorial Team / Admin · Jun 27, 2017

I'm going to be quite honest with you about how it is at my facility. In traumas, the assistant (NP or PA, there's a couple of each) don't do too dang much. Why? Because a second trauma surgeon has to come in from home when the first one's in the OR, and he/she might as well go ahead and scrub in with the first surgeon since he/she is already there.

Additionally, trauma surgeries don't happen all that often in every single trauma center- and when they do, they might not even involve the trauma surgeon and PA/NP at all. Ortho trauma? Call the orthopod. Head trauma? Call the neurosurgeon. Chest trauma? Well, they might crack the chest and stick a finger in the hole, but it's the cardiac surgeon that puts everything back together (if the patient lives that long). Abdominal traumas are surprisingly rare in my facility- we see a lot of ortho and a lot of head injuries. Even some of the abdominal injuries that used to come to the OR (splenic bleeding, liver bleeding) now go to interventional radiology for coil embolization instead of a big abdominal surgery- done by the radiologist, not the trauma surgeon.

The most common duties of the trauma NP/PA seems to be management in the trauma ICU or responding to the trauma bay. The actual surgical portion is a much smaller percentage.

Alexxoxox, BSN · Jun 27, 2017

I'm going to be quite honest with you about how it is at my facility. In traumas, the assistant (NP or PA, there's a couple of each) don't do too dang much. Why? Because a second trauma surgeon has to come in from home when the first one's in the OR, and he/she might as well go ahead and scrub in with the first surgeon since he/she is already there.
Additionally, trauma surgeries don't happen all that often in every single trauma center- and when they do, they might not even involve the trauma surgeon and PA/NP at all. Ortho trauma? Call the orthopod. Head trauma? Call the neurosurgeon. Chest trauma? Well, they might crack the chest and stick a finger in the hole, but it's the cardiac surgeon that puts everything back together (if the patient lives that long). Abdominal traumas are surprisingly rare in my facility- we see a lot of ortho and a lot of head injuries. Even some of the abdominal injuries that used to come to the OR (splenic bleeding, liver bleeding) now go to interventional radiology for coil embolization instead of a big abdominal surgery- done by the radiologist, not the trauma surgeon.
The most common duties of the trauma NP/PA seems to be management in the trauma ICU or responding to the trauma bay. The actual surgical portion is a much smaller percentage.

Thank you for this. It is very insightful. I have actually been going back between this and Cardiac Surgery APNP (first assist). Would a cardiac surgery APNP be more often assisting in surgery than a trauma surgery APNP?

Editorial Team / Admin · Jun 27, 2017

Thank you for this. It is very insightful. I have actually been going back between this and Cardiac Surgery APNP (first assist). Would a cardiac surgery APNP be more often assisting in surgery than a trauma surgery APNP?

They certainly are in my facility. They are permitted to do the actual vein harvest while the surgeon is working on opening the chest and freeing up the mammary artery for a CABG. Depending on when the surgeon is ready to start placing cannulas for cardiopulmonary bypass, they may assist with that or if they are still harvesting vein, one of the cardiac team members will assist with that portion. They help with grafting or valve replacement. They assist with coming off of cardiopulmonary bypass and removing the cannulas. They are responsible for suturing all layers with the exception of sternal wires (surgeon does those) when it comes to closing. Quick and simple, not all inclusive explanation of what they do in surgery. But, if the surgeons are in the OR, one of them is in each surgery as well.

They are also responsible for seeing patients in the office and rounding on patients who are in ICU or the post-op floor. They also cover during off hours for emergencies- there is no evening or night shift PA/NP- they take turns and if the pager goes off, in they come. They also deal with all pages from nurses caring for patients on their service line (unless a patient codes/is a rapid response/is a stat consult from a cardiologist) and either deal with it themselves or refer to the surgeon on call as necessary- there's many more PA/NPs than there are surgeons, which is why they use this setup. My facility also does not have any residents in the cardiac surgery service.

Alexxoxox, BSN · Jun 28, 2017

They certainly are in my facility. They are permitted to do the actual vein harvest while the surgeon is working on opening the chest and freeing up the mammary artery for a CABG. Depending on when the surgeon is ready to start placing cannulas for cardiopulmonary bypass, they may assist with that or if they are still harvesting vein, one of the cardiac team members will assist with that portion. They help with grafting or valve replacement. They assist with coming off of cardiopulmonary bypass and removing the cannulas. They are responsible for suturing all layers with the exception of sternal wires (surgeon does those) when it comes to closing. Quick and simple, not all inclusive explanation of what they do in surgery. But, if the surgeons are in the OR, one of them is in each surgery as well.
They are also responsible for seeing patients in the office and rounding on patients who are in ICU or the post-op floor. They also cover during off hours for emergencies- there is no evening or night shift PA/NP- they take turns and if the pager goes off, in they come. They also deal with all pages from nurses caring for patients on their service line (unless a patient codes/is a rapid response/is a stat consult from a cardiologist) and either deal with it themselves or refer to the surgeon on call as necessary- there's many more PA/NPs than there are surgeons, which is why they use this setup. My facility also does not have any residents in the cardiac surgery service.

This is wonderful, thank you! If you don't mind me as, what state do you live in? Also, if my goal is to become a cardiac surgical APNP, is getting a RN job in the OR the best place to start? Or would a CVICU be better?