FNP as a First Assist?

Specializes in Critical Care, Peri-Op, Aesthetics.

Is this possible? An FNP also functioning as a First Assist (ex: in an outpatient surgery center)?

Would this not be considered acute care or a role only for an acute care NP?

If an FNP can function as a first assist.. in what setting would this be possible?

Thanks!

14 Answers

Yes this is possible just as it is possible to work as a RNFA without any advanced practice credential. The problem with your question is the (incorrect) assumption that the RNFA is an advanced practice role. Any nurse who is appropriately credentialed as a first assistant can work in that capacity in any setting that will hire them. This is true regardless of any other credentials they may have. For instance, a PMHNP, NNP, CNS, or any other alphabet soup combo could work as an RNFA because doing so is under their RN license and not their APRN license.

Now, if you're thinking about NPs who both first assist and round/care for pts outside the OR (writing post-op orders, following up, etc...), then the most appropriate certification would be acute care. But there's no reason your APRN license would restrict your ability to work in a capacity that does not require such a license.

An RN can be a first assist. If the FNP has the certification already or goes out and gets that certification, what's the problem with an FNP working in that capacity? Now granted that person shouldn't be working in an acute care capacity, but they shouldn't be barred from working in whatever capacity their RN entitles them.

Specializes in Neonatal Nurse Practitioner.

My state strictly follows the consensus model. That seems to be the general direction a lot of states are going. To function as a FA, RNs (including APRNs) must be RNFA certified. A lot of RNFA programs will waive the OR experience requirement for NPs. FA is not covered in your NP education, and therefore, outside your scope unless you get formal training and education. On-the-job training is not acceptable in my state. Last year, they mandated that the NPs working as FAs produce RNFA certs.

This is a question for your BON. Only they can tell you. If they allow you to do it without the RNFA now, I would work on getting the RNFA cert in the meantime. It takes about a year, and should be fairly uncomplicated since you're already working with a surgeon. That way, you won't be up a creek without a paddle if/when they decide to change it. And if you move to a consensus state that requires it, you'll already be qualified.

I have worked with many NPs and PAs that are first assists in the OR. Both large hospitals and outpatient centers. They either work directly for a particular surgeon or cover the needs of the facility working with many surgeons.

Nowhere that I have worked would have allowed cystos to be done without an attending.

I am an ACNP and RNFA. I know of one FNP that works in the OR. She has simply been in that position for a long time. The chief of surgery and the chief of medicine for my hospital system are trying to get all inpatient NPs to be ACNP certified. They tried once before a couple years ago but the hospitalist physicians all signed a petition to prevent the loss of a big chunk of the work force. It will happen sooner or later though...

There was no assumption that the RNFA role is an advanced practice role. I know what the credential is and how the role works when an RN is certified to be a first-assist. I just didn't word the original question correctly and I think it confused many and rightly so, so I apologize for that.

My question was more in line with the latter part of your response, where you're doing cases in the OR (not only as a first-assist, but also doing cases ALONE without the surgeon in the OR for that procedure) and rounding in the hospital and seeing patients in a clinic. I've talked FNPs who do this in some states since I've posted this question, but I believe my state (Georgia) is requiring an acute care certification as an NP to be able to function in this way.

Thank you for your response!

Thank you for clarifying. You're right, in your OP you mentioned first assist which would be limited to what occurs in the OR (and is not an advanced practice role). For the other duties an NP might do in a surgical practice, clearly an ACNP is the appropriate credential. I think you have also identified the real issue which is that different states and even facilities have adapted to the Consensus Model at different rates. Eventually, things will even out but this will probably be at least a decade as people who have been working in APRN roles outside the Consensus Model retire and are replaced by those trained appropriately under the model.

Specializes in Neonatal Nurse Practitioner.
Thank you for clarifying. You're right, in your OP you mentioned first assist which would be limited to what occurs in the OR (and is not an advanced practice role). For the other duties an NP might do in a surgical practice, clearly an ACNP is the appropriate credential. I think you have also identified the real issue which is that different states and even facilities have adapted to the Consensus Model at different rates. Eventually, things will even out but this will probably be at least a decade as people who have been working in APRN roles outside the Consensus Model retire and are replaced by those trained appropriately under the model.

My state is experiencing a hard-stop on out-of-scope practices. They've been notifying NPs working in inappropriate areas that they must pursue the appropriate education or find a new job. An FNP working in an NICU was told this years ago (there was only one case like this that I'm aware of), last year they demanded that NPs have RNFA certs to assist in surgery, and more recently, the BON has been cracking down on FNPs working in acute care or psych roles.

My state is experiencing a hard-stop on out-of-scope practices. They've been notifying NPs working in inappropriate areas that they must pursue the appropriate education or find a new job. An FNP working in an NICU was told this years ago (there was only one case like this that I'm aware of), last year they demanded that NPs have RNFA certs to assist in surgery, and more recently, the BON has been cracking down on FNPs working in acute care or psych roles.

Some states, like yours, are much more aggressive at bringing practice in line with the Consensus Model. Others are very lassie-faire and rely on employers and collaborating physicans to sort out the details. This is why it's still best advice to earn the appropriate credentials whether it's required yet or not. 1) We own it to our pts and ourselves to undergo the appropriate training. 2) Providers who don't are putting themselves in a vulnerable position if their state decides to get with it, their employer beefs up their credentialing requirements, or if they end up named in a lawsuit. Nevertheless, some people will have to be dragged into the 21st century kicking and screaming.

Some states, like yours, are much more aggressive at bringing practice in line with the Consensus Model. Others are very lassie-faire and rely on employers and collaborating physicans to sort out the details. This is why it's still best advice to earn the appropriate credentials whether it's required yet or not. 1) We own it to our pts and ourselves to undergo the appropriate training. 2) Providers who don't are putting themselves in a vulnerable position if their state decides to get with it, their employer beefs up their credentialing requirements, or if they end up named in a lawsuit. Nevertheless, some people will have to be dragged into the 21st century kicking and screaming.

I wouldn't say those later states are laissez faire about the consensus model so much as haven't adopted it period. You either adopt it or you don't. Michigan for instance only sees a few classifications. NP, CNM, CRNA, and the recently recognized CNS. They don't go into any weeds and our bon doesn't regulate where specific NPs should or shouldn't work. My employer asked if I'd be willing to see our patients who are admitted and when I suggested it wouldn't be smart, he literally called and verified that he could use an fnp for that role if he so chooses. I still reinforced an unwillingness to work in that role and the issue hasn't been brought back up.

I wouldn't say those later states are laissez faire about the consensus model so much as haven't adopted it period. You either adopt it or you don't. Michigan for instance only sees a few classifications. NP, CNM, CRNA, and the recently recognized CNS. They don't go into any weeds and our bon doesn't regulate where specific NPs should or shouldn't work. My employer asked if I'd be willing to see our patients who are admitted and when I suggested it wouldn't be smart, he literally called and verified that he could use an fnp for that role if he so chooses. I still reinforced an unwillingness to work in that role and the issue hasn't been brought back up.

That's exactly what laissez-faire means: government leaves it to the market (in this case job market) to sort out the details. States like yours are relying on exactly the situation you described. Providers, employers, and collaborating physicians will sort out the details of who is qualified to treat whom. Other states (as a previous poster mentioned) have taken a very active approach which essentially enshrines the Consensus Model in state law. My particular state licenses NPs by specific specialty but doesn't place any explicit limits on their practice in relation to that specialty - so a sort of middle ground.

Specializes in Critical Care, Peri-Op, Aesthetics.
An RN can be a first assist. If the fnp has the certification already or goes out and gets that certification, what's the problem with an fnp working in that capacity? Now granted that person shouldn't be working in an acute care capacity, but they shouldn't be barred from working in whatever capacity their RN entitles them.

Yes, I knew an RN can be a RNFA.. but I have seen PA's and NP's doing procedures alone (kidney stone removal/stent placement, TURP's, etc.), with no surgeon present. I don't think an RN can do something to that capacity, as far as I know.

So I'm curious if the FNP would be able to work in this capacity..

Yes, I knew an RN can be a RNFA.. but I have seen PA's and NP's doing procedures alone (kidney stone removal/stent placement, TURP's, etc.), with no surgeon present. I don't think an RN can do something to that capacity, as far as I know.

So I'm curious if the FNP would be able to work in this capacity..

What you're describing is not the role of an RNFA and it's probably smart to quantify that in the opening post before you drop something that's geared to draw the ire of multiple groups.

That being said, how an np works should be routed in how their school/certification prepares them first followed by how their clinic work/real world training prepares them second. An fnp can work in an outpatient setting and in some specialities minor "surgeries"are performed regularly. Now Im not comparing the small derm procedures such as wart removal or Id's I perform in primary care to the more complex urologic procedures you mention, but there are a broad range of procedures across numerous disciplines where physicians place extra training and faith in their collaborated mid levels.

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