NPs trained for surgery but are not F.A.s

[nursetim, NP]

Are there any NPs here that were not first assistants but were taken on by a surgeon as one and trained by said surgeon. Are there any legal implications I am not seeing? Any personal experiences?

[danceluver]

would like to know as well!

[core0]

Are there any NPs here that were not first assistants but were taken on by a surgeon as one and trained by said surgeon. Are there any legal implications I am not seeing? Any personal experiences?

Its going to depend on your hospital and what the bylaws are. First from a billing standpoint most insurance companies could care less what your surgical training is. Medicare cares are you an NP or CNS in states where they are APNs. Private insurance is pretty much the same.

Where it gets tricky is with credentialing and a very few state boards. The problem is that the nursing profession (ie the AORN) has decided that the APN (within their loose definition) for the operating room is the RNFA. Never mind that specialty does not meet the standard widely used for APN (masters, course content etc). There have been several attempt to get RNFAs medicare billing rights and licensed in a few states as APNs. They have been universally shot down. On the hospital level however, NP credentialing is usually done at least partially through nursing with input from the various departments. In this scenario NPs are usually required to be RNFAs. When credentialing is done through the medical staff office its a mixed bag again depending on whether nursing has input, but its pretty common to require an RNFA for any nurse to assist (including NPs). My N is a survey of about 100 hospitals in 5 metropolitan areas a few years ago.

There is at least one state that I am aware of that states the surgery is in the scope of practice of the RNFA.

The good news is its relatively easy for an NP to get their RNFA. Bad news its fairly expensive. There are a number of companies that will provide "training" for a fee.

David Carpenter, PA-C

[Boatswain2PA]

David - this is probably a stupid question, but who awards the RNFA title? The state BON?

[jer_sd]

From a risk managment stanpoint. If you are first assisting in a surgery and there is a complicaiton. Would you be able to show that your training, abilities and care meet the standard of care if you do OJT under one physician? Especially when AORN has a position statement on first assisting.

If you complete a RNFA program then nurses use RNFA after there names. There is a certification that requires graduation and experience then you can be certified by CCI (same people who do CNOR exams) and use CRNFA

[Boatswain2PA]

Jer - Thanks. The numerous RN/NP certification boards can get confusing to someone outside the profession (and, likely, to those inside as well!)