First Assistant Nurse as an Independent Contractor

[nightingale, RN]

I found this article of interest and hope you do too:

http://healthcare.monster.com/qanda/fazzino08161999/

Job Q&A

by Kerry Eielson

[ More Job Q&A's ]

Dolores Fazzino, RN, MSN, FNP, RNFA, is the founder of Carmel Valley First Assistants, which started in May 1996. She has sole proprietorship.

Monster.com: What kind of education have you had?

Dolores Fazzino: I graduated in 1981 with a bachelor's degree from Widener University, in Chester, Pennsylvania. In 1999 I got my master's in family practice from California State University, Dominguez Hills campus, in Carson, California.

Mc: What did you do after your bachelor's degree?

DF: I went to UCLA for the registered nurse first-assistant training. I found my own internship with some surgeons in town and completed a one-year program in June 1995.

Mc: What kind of nursing have you done?

DF: After my BA I had a very diversified background. I did everything from medical research, orthopedics and pediatrics to intensive care. You just get through it and eventually find what you want to do. For the last 13 years it has been OR for me.

Mc: And what areas of nursing did you think you would never do?

DF: ICU and OR. I was scared to death. It was something that I didn't know a lot about. There was a lot of mystery behind it. Your fears start to escalate. I really took my job seriously. I feel that you shouldn't go into something that's over your head.

Mc: How do you deal with those fears?

DF: Try different things as your confidence builds. Some say it's better to jump into the frying pan, but I think that if it naturally evolves, it's better, and isn't as bad as you think. With time, your comfort and confidence levels develop. The only thing to do is to be patient and you'll get there. There are a lot of learning curves.

Mc: Why did you think of setting up your own business?

DF: I got the idea about five years ago because of the fact that I like vacations. I want to take a vacation when I want to. So I thought why not become an independent contractor. I feel so spoiled now; I got a taste of freedom and I never want to go back.

Mc: How did you set it up?

DF: I worked for seven years with the VA system. I tried to implement a staff role for myself, but it's a training hospital and the emphasis is on training the physicians, not forming new roles. As soon as I got my degree, I worked per diem for doctors in the area and did a little marketing for about a year. I was good at what I was doing, so doctors trusted me. I had credibility and I had the education. I bring something to the OR, and surgeons trust me and listen to me.

Mc: So what did you do?

DF: I knew that if I could get two surgeons to believe in me I'd be set. If it's something that surgeons want, they'll help make it happen. It all came from personal relationships. I found people who I worked with during the year that I worked per diem and they went to their HMOs. Now I am contracted with their HMO.

Mc: Is it harder to do this as a woman?

DF: In negotiating contracts, you have to go in really sure of yourself if you are a woman and a nurse. You have to go with your instincts about whether or not you want to work with someone. They are usually right, but you have to be sure because it's your name on that report if things go wrong -- which means you go down with it. You have to be very careful about who you work with. You have to be very selective. If you are trying to do something with the utmost integrity, it's more important than the amount of money you'll be making.

Mc: Do you have associates?

DF: I am the only one right now. I had a group, but I prefer to be the sole proprietor. You don't have to worry about anyone other than yourself.

Mc: How did you make the transition?

DF: I did it gradually, dropped one per diem at a time. After two-and-a-half years, I was no longer working per diem. I only did per diem in the first place to make contacts.

Mc: What do first assistants do?

DF: We help drape the patient. We stand across from the surgeon and use instruments and do some of the cutting and tying. There are standardized procedures. You have to go through committees to get approved. You pay your dues. A lot of times we do counseling with patients. We talk to them before and after surgery and even during treatment. It's like seeing a familiar face.

Mc: What's the best way to deal with patients?

DF: I do something a little different. I am really interested in Eastern medicine and integrated healing. It's mind, body and spirit. Surgery is just treating the body. I'm going to work with patients on energy work. I'll be doing energy work with them before and after surgery.

Mc: What is energy work?

DF: Shiatsu, prianic healing and therapeutic touch. I believe in energy fields. There are seven that line up from the top of the head to the spinal column. Each one deals with a different part of the body. Some people can see colors or can sense it; can touch someone and see where the dip is.

Mc: Can you give us an example?

DF: If someone's gallbladder is being operated on, I will scan his body to see where the defect is in his aura. There are cracks in a person's aura before things manifest themselves physically. By doing this work I can energize the area. It allows the area to balance out; to make sure the energy is flowing in a balanced fashion. I'm just the instrument. It all comes from a higher source when you are going into a meditative state.

Mc: What do people think of this sort of treatment?

DF: It's not for everybody, but I know there are people who will want to avail themselves of this type of treatment, so I want to be able to give it to them.

Mc: Why do you think this sort of treatment is needed?

DF: Because the patient is getting the best of both Eastern and Western healing modalities. Also, you see less of a need for pain medication, so the patient is back on his or her feet more quickly.

Mc: What's the best example you can think of its effectiveness?

DF: There is one case that comes to mind: a woman in her early forties with a benign slow-growing tumor in the brain. It was very tricky stuff. The surgery lasted for 11 hours. Her brain started to swell up. I'm a firm believer that you can talk to tissue. I had talked to her before surgery to get to the energy below the neck. During the surgery, I gave her a drug to decrease swelling. I started to talk to her telepathically. I said "Tell your brain that you're okay. Tell it to calm down. Take the fluid someplace else." The doctors thought it was the Manatol that took away the swelling, but it takes much longer than that to work. After the surgery she was wide-awake, waving. She did really well. The doctor thought it would be difficult for her to wake up. I have to be careful about how I present this and put it out there. The thing is, this stuff happens and it's out there, but it's hard to explain.

Mc: Have you had training in Eastern medicine?

DF: I taught myself. I've known how to do this since I was a little girl. It's very individualized.

Mc: Are doctors receptive?

DF: The female ones are more so. Some of the male doctors are, but others think it's a load of baloney. It only takes a couple of people to believe in it and it'll become word of mouth.

Mc: How have you kept current?

DF: The master's really helped. Also, there's the Association of Operating Room Nurses, perioperative nurses, seminars and the American Holistic Nurses Organization.

Mc: What advice would you give other nurses?

DF: In order to maneuver your way in a fluctuating system you need to find a niche. Becoming a nurse is just the foundation. There's a lot more you can do with it. Believing in yourself is sometimes hard to do. You can't throw in the towel. I think communication is important and if you have dreams, pursue them. You'll only regret it later. Some people are so stuck where they're at. They should be proactive.

[SICU Queen]

Very interesting article, but I could see myself telling one of our hospital neurosurgeons that I talked to a patient's brain tissue to make the swelling go down... I'd get my butt laughed right out of the ICU :)

This woman's got a great idea though...