New NP/RNFA advice?

[Alicia777, MSN, NP]

Hello. I just finished my RNFA certification but unfortunately most of my hours (175 to become certified) were spent holding retractors or a camera. I feel like I never was able to get a grasp of the basics. For instance, I recently just taught myself how to tie a surgeons knot. This aspect is something of a rarity for NPs so I'm having trouble commiserating with anyone, ha!

I just started a new position and I was honest about needing to 'continue my training' and that is one of the reasons I left my previous position. Yesterday I was in an orthopedic case though where I needed to dislocate the hip and sew layers and I felt inadequate. The surgeon was patient and kind but I couldn't help but think that everyone in the room was thinking 'who is this jacka$$ we hired?'

I'm looking to hear experiences of RNFAs in my situation. How did you become comfortable with another service (like Ortho) that you rarely have to scrub? How did you beef up your familiarity with cases and anatomy?

[BostonFNP, APRN]

Outside of my personal area of expertise.

I can say, via several colleagues that work as NPs in surgical roles, they there is an expected learning curve. No one inherently knows how to do these things; the orthopedic surgeons you are working with spent thousands of hours learning specialized techniques and procedures. They understand that you will need to learn how to do them. The colleagues that I spoke with both stated that their colleague surgeons have been great teachers.

Best of luck!

[Jules A, MSN]

I'm not sure about your field but in psych many of the wonderful psychiatrists who I work with were not aware of the limitations of our education and seemed surprised by our minimal course work. They expect us to come out of school and hit the ground running, which I agree is a reasonable expectation although it seems few actually are prepared to this extent. Because I had an extensive psych background I made the transition fairly seamlessly but there were definitely things I had to learn from my physician peers that I would have expected and appreciated to have been taught in school.

While I'm sure others might disagree that we aren't the most wonderful competent practitioners in the universe after a mere two years education who should never have to defer to the more experienced physician there were times early on when I felt it necessary to say something along the lines of "Thank you for assisting me with this. Although in a perfect world I would have come out of school knowing XYZ NP education is sorely lacking compared to medical school." To me being humble regarding the physician's background and insight as well as being interested in learning from them has been invaluable for me.

[Alicia777, MSN, NP]

Thank you both, true points.

[BostonFNP, APRN]

While I'm sure others might disagree that we aren't the most wonderful competent practitioners in the universe after a mere two years education who should never have to defer to the more experienced physician there were times early on when I felt it necessary to say something along the lines of "Thank you for assisting me with this. Although in a perfect world I would have come out of school knowing XYZ NP education is sorely lacking compared to medical school." To me being humble regarding the physician's background and insight as well as being interested in learning from them has been invaluable for me.

This is a bit off-point but I think in light of the OP it's important to add.

No provider graduates from school as "the most wonderful competent provider" regardless of their educational path; it takes experience. Any provider that tells you they did has either forgotten what it's like to be a novice, is overconfident, or doesn't practice to their full ability. Every provider requires assistance along the way from an experienced provider. I don't think that provider needs to be a physician; by the nature of their training (not necessarily their education) physicians have more experience entering practice because they have essentially had a collaborative practice as a resident for 3+ years.

Respecting and benefiting from a physician's education and training is invaluable, just as that same physician should benefit from the experience and training of a nurse.

You can always ask your colleague physician is they feel like they were fully competent on day 1 of their internship.

[Jules A, MSN]

You can always ask your colleague physician is they feel like they were fully competent on day 1 of their internship.

But when we are starting as a practicing NP we are not in an internship situation.

A physician's additional experience before entering practice better prepares them to actually practice. I don't think it is an unreasonable expectation and wish nursing school did a better job at preparing us for practice.

[BostonFNP, APRN]

But when we are starting as a practicing NP we are not in an internship situation.

Medical residents have finished their didactic education and have entered into paid practice in a supervised/collaborative arrangement with an attending physician. That is not all that dissimilar from NPs practicing within a collaborative arrangement with a physician. Surgical interns aren't expected to be able to perform surgery competently, nor should the OP be. There is no where in the world (to my knowledge) where an NP and independently perform major surgery, as a novice or an experienced NP.

And I don't disagree, the better nursing school is the better we all are, so asking/hoping for more is a good thing.