How long before NPs will be able to do surgery solo?

Specialties NP

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Fellow NPs, I think this is coming soon. I know many NPs who are first assists right now. They do 95% of the surgery while the MD does the other 5%

However, the NPs I know are well trained to where they could easily do the other 5% of the surgery that the MD does currently

I think its time for our PAC and lobbying organizations to get behind this effort. Doing surgery has been part of nursing practice for a long time now, its time for the world to recognize that we NPs are surgeons too and we can do it just as well as the MDs, if not better.

We need to move on this issue.

I used to be a RN.. I decided nursing wasn't right for me so I went to medical school, and now I am doing a surgical residency. I have scrubbed on hundreds and hundreds of cases. I work between 80-100 hrs/week. This is for 5-7 years of general surgery residency, not including a fellowship. My pager beeps and I answer... always. I know tons of EXCELLENT nurse practitioners. Seriously though, regarding this issue you really have to consider referrals.. most people are terrified about going under the knife, even for "minor" surgery. I find it VERY hard to believe a patient would go to a nurse rather than a surgeon for an actual surgery.

As is the case with midlevels in almost all fields- they can handle the job in about 95% of cases. The problem is that in surgery 5% = a hell of a lot of patients, (especially elective, routine surgery) and the OR is NO place for error/mistakes. This is why I am in the hospital for 80-100 hrs/week for 5-7 years after medical school. Elective/routine surgery is the WORST type of surgery to have a complication. SURGERY is to be performed by a SURGEON. Period. End of discussion.

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Specializes in Psych.
I used to be a RN.. I decided nursing wasn't right for me so I went to medical school, and now I am doing a surgical residency. I have scrubbed on hundreds and hundreds of cases. I work between 80-100 hrs/week. This is for 5-7 years of general surgery residency, not including a fellowship. My pager beeps and I answer... always. I know tons of EXCELLENT nurse practitioners. Seriously though, regarding this issue you really have to consider referrals.. most people are terrified about going under the knife, even for "minor" surgery. I find it VERY hard to believe a patient would go to a nurse rather than a surgeon for an actual surgery.

As is the case with midlevels in almost all fields- they can handle the job in about 95% of cases. The problem is that in surgery 5% = a hell of a lot of patients, (especially elective, routine surgery) and the OR is NO place for error/mistakes. This is why I am in the hospital for 80-100 hrs/week for 5-7 years after medical school. Elective/routine surgery is the WORST type of surgery to have a complication. SURGERY is to be performed by a SURGEON. Period. End of discussion.

Thank You! RNS performing surgery, WOW! I have NEVER heard of such a thing. From the looks of this thread, I'm ignorant. As an RN, BSN, I have no desire to perform surgery, or to enter a "training program" that would equip me to do so. If I wanted to be a surgeon, I would have gone to medical school. If I wanted to prescribe medication independently, I would have gone to medical school. If education teaches us anything, it should be that NO ONE knows everything. There are reasons why there are so many specialities in BOTH medicine and nursing. There is just TOO MUCH to know. I work primarily in inpt psych, and I don't even think it is safe for non-psychiatrist MD's to prescribe psych meds. I have seen this sort of thing lead to some pretty hairy situations. Where I live, it is NOT common practice for NP's to prescribe medication. It is not unheard of, mind you. I myself would not accept a prescription from an NP. Sorry, I realize they have advanced degrees, but they still have not gone to medical school. Just MHO. BTW, what is an RNFA?. And, could anyone tell me what the minimum req't is to become a PA? I am almost sure I saw a brochure advertising a 3yr technical program to become a PA. Am I mistaken? Am I wrong to be worried about this? I realize the cost of healthcare has become a hungry monster in this country, but I tend to believe that has more to do w/costs of equipment and WAAAYYY too much bureaucracy. Opinions? Flames?

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I used to be a RN.. I decided nursing wasn't right for me so I went to medical school, and now I am doing a surgical residency. I have scrubbed on hundreds and hundreds of cases. I work between 80-100 hrs/week. This is for 5-7 years of general surgery residency, not including a fellowship. My pager beeps and I answer... always. I know tons of EXCELLENT nurse practitioners. Seriously though, regarding this issue you really have to consider referrals.. most people are terrified about going under the knife, even for "minor" surgery. I find it VERY hard to believe a patient would go to a nurse rather than a surgeon for an actual surgery.

As is the case with midlevels in almost all fields- they can handle the job in about 95% of cases. The problem is that in surgery 5% = a hell of a lot of patients, (especially elective, routine surgery) and the OR is NO place for error/mistakes. This is why I am in the hospital for 80-100 hrs/week for 5-7 years after medical school. Elective/routine surgery is the WORST type of surgery to have a complication. SURGERY is to be performed by a SURGEON. Period. End of discussion.

Amen to that! G-d bless you guys. It takes incredible personal sacrifice, physical and mental endurance just to make it through this hell, called surgical residency. But as far as this thread is concerned I don't think the OP could be serious, unless not in his/her right mind. Hope we could leave it at that. General public will never support something like that. The analogy with Rx privelledge does not hold the water, and depending on the State regs has it's limitations. Anyway, I hope this day will never come when surgical non-physician is allowed to do solo surgeries :nono: :uhoh3:

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Ok children, now if you want us old folks to keep reading these wonderful posts you are going to have to provide us with a list of abrevations.:smackingf

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To answer your question about PA school... Most schools are at the Masters level now, so the mininum degree requirement is a Bachelor's Degree for those schools. Yes, a lot of PA schools are now going to 3 years. Most are still 2 years, full time. There is a big difference in the cost of the state schools and private ones. In my program, we take 23 credits a semester (no time for work), and the same type of classes you would find in medical school. I would recommend you go to www.physicianassistant.net It's the best website to learn about PAs!

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My concern is, when something goes wrong and NPs operating, are they trained to handle that? Probably not, but you know that surgeon is. We're not pushing the line with this one, we're jumping over and looking to get our heads busted up as a profession if something like this were to come to pass. Just my oppinion.

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Great post pds10. All I know is if I ever need surgery I'll be sure not to be in Mayberry where the OP lives.

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Specializes in med/surg, psych,LTC(Boo).
I think surgery should be taught as a high school elective....let everybody have access!:lol2:

shhhhh, don't give dude any ideas. from the time i read his first post, i knew he was full of XX. did you read his inquiries about where is the best place to work as an NP, meaning working totally independently as a NP? well those of you who didn't, need to. it sounds to me like his experience in the medical field amounts to getting his Rx filled.

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Specializes in med/surg, psych,LTC(Boo).
nurse god

you keep bringing up the same stuff that I already addressed. I'm talking simple bread and butter surgeries here, not double transplants. Stuff like appys, lap choles, hernia repairs, lymph node dissections

All of those things are READILY DONE IN RURAL HOSPITALS AND NOT ONLY AT LARGE ACADEMIC CENTERS. We see those cases every single day and the RNFAs can handle them just as well as the MDs

Complications can arise from ANYTHING YOU DO MEDICALLY, whether its scripting tPA for acute stroke or doing a lap chole. Nurses have been proven to be able to handle complications arising from medication, with extra training for RNFAs the same is true for the bread/butter surgeries that I mentioned above.

As for your comment that if you want to do surgery, then you should go to med school, thats the same kind of red herring BS argument that doctors used against nurses for decades: "if you want to script medicine, then go to med school. if you want independent practice go to med school. if you want to deliver gas, go to med school" Nurses have shown time and time again that you DO NOT NEED MED SCHOOL FOR THAT, and the same is true for simple surgery.

Everybody thinks I'm trying to argue that RNFAs are good enough to REPLACE ALL surgeons, and thats NOT what I said. Please read my posts. I simply said that its quite reasonable for RNFAs to get an extra couple of years of training and be able to handle many routine bread/butter surgeries solo.

XXXXXXXXXXXX. i wouldn't believe you were in the medical field if you were appointed surgeon general! put away your medical dictionary for laymen, and go play somewhere else!!!!

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Specializes in med/surg, psych,LTC(Boo).
I used to be a RN.. I decided nursing wasn't right for me so I went to medical school, and now I am doing a surgical residency. I have scrubbed on hundreds and hundreds of cases. I work between 80-100 hrs/week. This is for 5-7 years of general surgery residency, not including a fellowship. My pager beeps and I answer... always. I know tons of EXCELLENT nurse practitioners. Seriously though, regarding this issue you really have to consider referrals.. most people are terrified about going under the knife, even for "minor" surgery. I find it VERY hard to believe a patient would go to a nurse rather than a surgeon for an actual surgery.

As is the case with midlevels in almost all fields- they can handle the job in about 95% of cases. The problem is that in surgery 5% = a hell of a lot of patients, (especially elective, routine surgery) and the OR is NO place for error/mistakes. This is why I am in the hospital for 80-100 hrs/week for 5-7 years after medical school. Elective/routine surgery is the WORST type of surgery to have a complication. SURGERY is to be performed by a SURGEON. Period. End of discussion.

right on!!

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Specializes in Day Surgery/Infusion/ED.
I am an RNFA (certified). I have harvested vein. Harvested radial arteries. Assisted in plastics removing parts of breast for reductions. Sure there are lots of procedures I could perform solo BUT for what I am paid I would not accept the liability. I did a procedure by myself once but it was because the MD told me to start the case and then he had an emergency and could not get back. It was a minor case. I would not willingly do this unless I got a lot of compensation. I think the malpractice insurance premium is probably more than 3 times what I am paid as a first assistant. BTW the majority of the first assistants here are not even RN's they are scrub techs that just took a written test and paid their $300 dollars.

The doc never showed during the surgery? You did it solo, start to finish?

Wow...would I love to get hold of the OR flowsheet for that procedure! What on earth did the circulator document? Either you were exaggerating or you were very lucky (and foolish).

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Specializes in Surgery, ICU, Emergency Care, NP.
well nps are doing more "minor procedures" such as lines, paracentesis, thoracentesis, nail removals, i+d, ect....

as for performing surgery in the uk they are starting a two year program to do hernias ect....

i think that over time nps could advance further in the us for procedures but there would have to be support from the nursing community, state law changes, and reimbursement for procedures.

this may be a good idea for starting residency or a fellowship.

but probably many years in the future unfortunately.

jeremy np, rnfa

i have read this thread with interest, i am a surgical nurse practitioner in the uk, i think the program you are talking about is the surgical care practitioner training, however these pracs will always work under the supervision and direction of a surgeon. the patient will have a consultant surgeon who is responsible for thier care and presently i dont think there are many scps who are practicing independantly. the system works very differently in the uk, nurse practitioners are very experienced qualified nurses who will have worked within thier area of expertise for many years. they apply for a nps job, sometimes they maynot have a np qualification although our governing body is proberly going to change this, it is vey much on the job training. i manage a team of 7 nurse practioners and 1 surgical care practitioner, she does not practice independently, when she operates there is always a surgeon in theatre with her.

i have to agree with the sentiments of many of the other posters, if nurses want to perform surgery unsupervised they should go to med school and learn to be a doctor.

although i practice advanced skills and i am still very much a nurse, all my training and 16 years experience working within the wards and hdu i have developed nursing skills that help me to work more effectively as a nurse practitioner. i know that there are huge differences between the uk and the us - we are supervised directly by our medical colleagues, but as a nurse practitioner manager i would not be looking to develop my service into allowing my team to perform surgery. i dont think it is appropriate delegation.

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