First Assist question! David C. I need help!

[BrandiannRN]

Okay, maybe you guys will know this. David you seem to know everything so I figured you might be able to help.

I'm currently in FNP school and have 3 semesters left. I work at an orthopedic hospital and was offered a position with a surgeon recently. He wants me to be his "RN first assist" until I graduate. Will I have to take more school for this? I know Oklahoma doesn't have an RNFA program so I'm confused at the training I would need. He seems to believe he could train me. Now here in Oklahoma its dominated by PAs so I didn't want him to be confusing NP rules with PA rules. I have read everything on the board of nursing and can't find anything.

Thanks in advance for any tips you may have!

Brandi

[JDCitizen]

I am reading this with some interest since it probably can be linked to procedures NPs can do in the hospital. So now it's really as clear as mud. What happened to protocols? Doctor signs it and agrees to it and the state accepts it but the hospital can still say no under JACO regulations?

[core0]

That is if a NP wanted to get certified as a CRNFA they would need to meet the minimum requirements similar to a RN only just without the CNOR.

But if a NP wanted to function as a first assistant they would be able to do so after completing a RNFA program with 160 hours of patient contact. Then if they want to keep accruing hours for extra certification they could do so and work upto a CRNFA if wanted. But they can bill first assisting based upon NP credentials no need to go through a RNFA program.

Now a BSN is not requried, this is the first time any BA/BS will meet certification requirements.

I do agree that if a NP wants to first assist they should have a structured education to support it. Nurse midwives have a nice protocol on obtaining 1st assist skill set. Just training a NP on the job would leave a lot to be desired.

Jeremy

You are correct on the bachelors requirement. I was looking at the original proposed certification requirements. As far as RNFA vs. CRNFA it depends on the hospital. From a Medicare standpoint there is no requirement outside of the NP license. I have seen hospitals require CRNFA for all RNs (including NPs) to first assist which is a much more difficult hurdle to overcome.

David Carpenter, PA-C

[core0]

I am reading this with some interest since it probably can be linked to procedures NPs can do in the hospital. So now it's really as clear as mud. What happened to protocols? Doctor signs it and agrees to it and the state accepts it but the hospital can still say no under JACO regulations?

Its not under JC regulations. A hospital has the right to decide which providers have which privileges pretty much without oversight. The only real rule is they cannot use privileging to deny providers entry when they meet the basic qualifications. You see this among physicians all the time. For example GI fellows are required to have 500+ endoscopies to graduate, while the FPs think that 50 is enough. If GI is running the department they can require 500 endoscopies to become credentialled.

The states job is to protect the public and follow state law. The hospital credentialing committees job is to protect the public and the hospital. Different requirements, different regulations.

David Carpenter, PA-C

[Jo Dirt]

When my husband had his total nephrectomy this past spring it was just the surgeon and his first assist, Jim. I'll admit, we were nervous. At first, we were like this is such a major surgery and he's just going to have one nurse help him?

The morning of the surgery we met Jim and this made us feel a lot more confident. He was so knowledgeable and professional.

I just wish they could have done an operation on his disposition.

[JDCitizen]

Its not under JC regulations. A hospital has the right to decide which providers have which privileges pretty much without oversight. The only real rule is they cannot use privileging to deny providers entry when they meet the basic qualifications. You see this among physicians all the time. For example GI fellows are required to have 500+ endoscopies to graduate, while the FPs think that 50 is enough. If GI is running the department they can require 500 endoscopies to become credentialled.

The states job is to protect the public and follow state law. The hospital credentialing committees job is to protect the public and the hospital. Different requirements, different regulations.

David Carpenter, PA-C

Thanks; I must have just misconstrued some of the previous posts...