Nurse Practitioner for a Surgeon

Specializes in General Surgery.

I'm a registered nurse with 1.5 years experience in general surgery (I always give a quick background). I will be cross training soon a cardiothoracic surgical floor.

My question is, What is it like being an NP for a surgeon? I work with surgeons, all day everyday.

What is the role of a Nurse Practitioner working with a surgeon?

Do you assist in surgery & do you also do postoperative follow-ups (inpatient and outpatient)?

If I were to want to assist during surgery, is there a certain certification I'd need? Would OR experience be recommended vs necessary?

Are there surgical NP's that adhere strictly to managing postoperative care?

If you're a surgical/postoperative NP, what services do you work? Which do you enjoy the most/have worked with? Which do you dislike the most and why?

As a floor RN I work with general surgery, vascular surgery, urology, plastics, OMFS, ENT, orthopedics (rarely ortho), neurosurgery, hepatobiliary surgery, GI, and trauma.

I feel that urology may be less stress in terms of on-call and acuity, but may get boring after a while?

I am not interested in orthopedics in the least.

I believe postoperative management of whipples/hepatobiliary patients may be more complex and interesting.

I haven't worked with cardiothoracic surgery YET (I will very soon) but this is the one I'd be truly interested in.

Thank you in advance.

13 Answers

Specializes in OR, Nursing Professional Development.

A lot of what an NP will do will depend on the facility and/or surgeon group. In my OR, we have only 1 or 2 NPs who assist in surgery. The vast majority of those who assist in surgery are PAs. However, there are NPs who round on patients on the floor or who take care of discharge orders for same day surgery patients. They may also see patients in the office.

Specializes in ICU.
If you're interested specifically in assisting in surgery there is an advanced practice role called RNFA (Registered nurse first assist).

Vanderbilt has that program, I think.

Just to clarify:

RNFA is not an advanced practice role. It's a certification that an OR RN and an NP can obtain (takes a few months). You don't have to be an NP to become an RNFA. They basically just first assist for the surgeons (do more than a scrub tech). But they don't manage the patients pre- or post-op unless they're also an NP.

Specializes in Outpatient Psychiatry.

Most likely you'll round and discharge. You may or may not do anything procedural. You'll also probably be the surgeon's gatekeeper seeing all new patients first. You'll likely do everything but cut at a third of the reimbursement at best. Then again, you may find someone to let you get elbow deep in the gut.

Specializes in ICU.
Do you feel there is benefit to obtaining RNFA + NP? Especially if one wants to say in the surgical world as opposed to the medical world. What about OR experience? I would be open and thrilled to obtain OR experience however would be greatly displeased to be pigeonholed in OR - as I want to try different aspects of nursing (general surgery, Surg-ICU, cardiothoracic surgery, PACU and intraop).

I've heard that as of January 2016, a NP will need to also have RNFA if they want to bill for their surgery time.... But I'm not 100% sure on the accuracy of that. I think the main benefit to having both is that you're better trained for the role. NP programs traditionally don't offer a lot (if any) surgical training. So obtaining the RNFA will give you the extras you don't get during NP school.

I think OR experience could be helpful. I, unfortunately, don't have it and am worried it might hold me back a little. (I'm halfway done with my NP program and plan to be a surgical NP- first assisting and managing those patients pre- and post-op.) I don't think it's an absolute must though- because what you'd do as an OR RN won't be the same as an NP. If anything- it'll help you network more with the surgeons! But I think the experience you'd get in an ICU and PACU would be helpful too!

Find a school that fits your needs/desires for your future goals. Going to one that will help you get some OR experience as an NP student will be beneficial!

Specializes in Surgery.

Hey there. I round on inpatients in the morning, write progress notes, discharge orders and scripts and discuss plan (usually by text message) with surgeon.

Then I go to the OR and first assist. I mainly work in one specialty.

I either write day surgery orders for PACU with follow-up instructions or inpatient orders. I follow the patient while they're in the PACU and the RNs call me if there are any issues.

In my state I needed a RNFA to practice in the OR.

Check your state board for what certifications you would need but I think RNFA is nice either way, because you are forced to spend 175 hours (the number varies by program) with your primary surgeon which you won't get in NP school..

Yes, I per diem at another hospital as a surgical NP too. Same job, almost double the hourly rate.

Feel free to PM..

to the OP

Work at a level one and am with the Burn service; my attendings are Burn/Trauma surgeons.

I manage the floor patients for acute issues as well as just regular day to day stuff. Many of my patients are on service for a couple of weeks with wound care and such so lots of management of their baseline medical issues DM, HTN CAD.... as well as the acute stuff. I also have a out pt clinic twice a week (4hrclinics) where I see new and followup pts that have been discharged. For us increasingly burn patients are being managed on a out pt basis. I go to the OR on rare occasions just to see whats going on and say hello to my team. We have a robust residency program and we keep the interns and residents in the OR. They watch the floor pts on night/weekends and holidays, hence I have a nice schedule! I myself have no interest in the OR, my partner on service is a PA and she does of course. We are supposed to be getting trained up to do laser therapies the next year, either in the OR or in clinic.

I am as independent as I need want to be/it is a large team so we are always running lists and giving each other signoffs on what is going on. Very few PA's in the OR. not any NP's, not really our training or at least mine.

a

Specializes in Surgery.

Forgot to mention I see patients in the ER; perform exams, review lab work and imaging (usually just read CT report I'm not that good yet, lol). Then I discuss with surgeon/ER attending and write up consult/ History & Physical and surgical consent and admit orders if need be..

But that's only if they come in during a regular week day as I don't take call or work weekends.

I went to the wesite and it says they are advanced practice RN's

"Registered Nurse First Assistant (RNFA)

The Registered Nurse First Assistant (RNFA) is an advanced practice nurse specializing in the Operating Room environment. First Assisting is within the scope of nursing practice in all fifty state boards of nursing.

As a provider of surgical assisting, the RNFA is often reimbursed by insurance companies for services rendered at a significantly lower cost to the consumer while providing safe quality patient care.

To be accepted into an RNFA program, the RN must have at least two years of professional nursing experience in the operating room environment and achieved the credential of CNOR (Certified Perioperative Nurse), or possess an advanced practice degree.

Certification is not required to function under the Florida State Nurse Practice Act as an RNFA. The program is usually a 2 semester program involving both classroom and clinical components. The nurse may then apply for and complete a national exam to receive the credential (CRNFA) through the Competency & Credentialing Institute.

What do RNFAs do? The RNFA has preoperative, intraoperative, and postoperative duties including patient history and assessment, collaborating with surgeon and other professionals for an optimal surgical outcome, assisting with patient positioning, skin preparation, draping, providing wound exposure, handling tissue, controlling blood loss, suturing tissue, and performing follow-up care.

NIFA RN First Assisting Program - RNFA

Plus it doesn't look to be that expensive. There's a $2995 early bird special.

Specializes in CTICU.

I work with CT surgeons. In the past it's been strictly inpatient, now it's evolved to cover pre and postop outpatient clinic as well. We see consults, round in the morning, manage the postop patients in the ICU and on the floor, write notes, do admission H&P/progress notes/discharge summaries. Surgeons are very irritating to work for (hah!) - our fellows and residents are often in the OR and unavailable to round or help with our patient workload, so our patient census varies a lot.

Specializes in OR, Nursing Professional Development.
WKShadowRN said:
If you're interested specifically in assisting in surgery there is an advanced practice role called RNFA (Registered nurse first assist).

Vanderbilt has that program, I think.

Excellent resources on RNFA from AORN.

The big difference between NP/PA and RNFA is that not all states allow an RNFA to bill independently.

Specializes in General Surgery.
Just to clarify:

RNFA is not an advanced practice role. It's a certification that an OR RN and an NP can obtain (takes a few months). You don't have to be an NP to become an RNFA. They basically just first assist for the surgeons (do more than a scrub tech). But they don't manage the patients pre- or post-op unless they're also an NP.

Do you feel there is benefit to obtaining RNFA + NP? Especially if one wants to say in the surgical world as opposed to the medical world. What about OR experience? I would be open and thrilled to obtain OR experience however would be greatly displeased to be pigeonholed in OR - as I want to try different aspects of nursing (general surgery, Surg-ICU, cardiothoracic surgery, PACU and intraop).

Specializes in General Surgery.
Most likely you'll round and discharge. You may or may not do anything procedural. You'll also probably be the surgeon's gatekeeper seeing all new patients first. You'll likely do everything but cut at a third of the reimbursement at best. Then again, you may find someone to let you get elbow deep in the gut.

Out of curiosity:

Do you know how often surgical NPs do locum tenens as opposed to a NP that does ER etc?

I know I'm asking a lot of questions.

Big thanks to everyone.

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