Need input from Surgical APRNs

[idontsave]

This is my first post here, though I have been lurking the forums for quite some time. Decided it was about time to make an account, reach out, and break the silence.

To give you guys a bit of background on myself, I am currently a student in an accelerated BSN program quickly approaching my final year and have been doing a considerable amount of research regarding different tracks I could potentially follow as a new-grad. I have known since early on as a nursing student that I want to end up assisting in surgery and also that I want to pursue an NP degree to be able to implement my medical inclination alongside my newly acquired nursing knowledge at its full potential. Luckily, I have a few connections that are almost purely in outpatient surgery and managed to acquire a position shadowing/volunteering/working-under the head circulating RN at a small, physician-owned ambulatory surgery center. I have logged roughly 65 hours as of right now. The surgeon who owns the practice has also expressed that he intends to hire me as soon as I am licensed, although I'm still not sure if he'll end up offering me a circulating or PACU position.

What I want to ask you guys is what would be the best track to follow after graduating to eventually obtain a position as a Surgical NP that also functions as a first assist?

I know that UAB currently offers a dual-track AGACNP/RNFA program, but it seems to be the only one of its kind. Would this be the best route to go after gaining some experience at the surgery center as an RN? Would it make a difference if I spent the interim time working in PACU or circulating?

Also, considering that the surgery center is outpatient and the majority of the procedures do not require a first assist, how would you guys recommend going about finding a preceptor willing to let me obtain the hours necessary for the RNFA certification? Ideally, I would want to end up working in cardiothoracic surgery but I am willing to go into any surgical specialty necessary to acquire the proper credentials.

I've also recently noticed several paid 12-month surgical fellowships/residencies offered at academic institutions for both NPs and PAs but I'm not sure if solely completing one of these residencies will allow me to work as a first assist without the RNFA credential. I live in California and am willing to move but intend to end up back here at some point if that makes a difference.

Any input you guys have is appreciated. Thanks in advance and sorry for the long/detailed post! :)

[SunshineNRainbows, BSN, RN]

So, I'm just a student myself, but I just finished an elective in perioperative nursing and I loved it! From what I understand, you need to be a CNOR or eligible to take the test during your RNFA program (different programs have different requirements) but I think you only qualify for CNOR if you work in the OR.

[idontsave]

So, I'm just a student myself, but I just finished an elective in perioperative nursing and I loved it! From what I understand, you need to be a CNOR or eligible to take the test during your RNFA program (different programs have different requirements) but I think you only qualify for CNOR if you work in the OR.

As far as I'm aware it seems that APRNs are actually allowed to bypass the CNOR eligibility requirement that is required of RNs by RNFA programs. I too have been in love with surgery for quite some time now and I really had no idea the RNFA program existed until after I started nursing school. Following the APRN/RNFA route to act as a first assist in the OR does seem to be the road less traveled for those interested in surgery, as PA programs include formal surgical training in their curriculum, but considering that I am already this deep into nursing and that California is much more NP-friendly than PA, this career path seems like the one I should follow.

Hopefully some of you that are well-informed or experienced in this field can chime in? I just want to formulate a solid plan so that I know which steps to take as a new-grad to get there.

*Thinking about reposting this in the NP or Advanced Practice Nursing forum to get more replies...

[MissBell]

I recently completed an adult-gerontology acute care NP program, and have taken a job with a general surgery group. They are training me to first-assist on the job, as an ARNP I am not required to complete a formal RNFA program. But the job isn't just assisting in the OR, I also round on patients and write progress/H&Ps/consult notes and see patients one day a week in the clinic. As an RN, I worked on an inpatient surgical floor caring for patients post-op, we took care of patients after general, urological, vascular, thoracic, trauma, and GYN procedures, and this experience has been invaluable learning the rounding and clinic portion of my job (my hospital didn't have a med/surg floor, we had a separate medical and surgical floors). Another ARNP I work with was a circulating nurse in the OR, thus she was very comfortable starting off in the OR and learning the first-assist portion, but didn't have the post-operative experience. So we took two different paths but ended up in the same position. If you want to end up as an ARNP with a surgical group, then I suggest you either go the OR or inpatient surgical floor route as an RN. Both would provide a clear a path to your final career goal. Good luck!

[KHasenstein]

Hello! I am currently an RN surgical educator for surgery who is going back for my NP. In my experience, the NPs that we have coming into surgery do not have additional training within the perioperative environment, but it definitely is something that would be beneficial if that is where you are looking to end up. Being a surgical NP is what I am looking to do as well, and I'm hoping that by being familiar with the environment it will give me a leg up. It's definitely a much different environment than that of a floor nurse, and because of that the orientation takes at least 6 months. By having that background knowledge, I would assume that it would make you more marketable as an NP - especially as most of the time a surgical rotation for clinicals could be difficult to come by. Where I am employed, if a new NP is hired to assist and has no experience in the OR, they will train you to suture and assist on the job. However, I can tell you that as a previous circulator, the awareness of the surgical environment and sterile technique is very different for those outside of the OR. Body awareness is something that definitely needs to be learned. Saying this, I would try to get into the specialty as an RN and then go for your NP from there. Best of luck!