NPs in Surgical Specialty Practices? (I have Ortho interest...)

[JLynnOR]

I would like to work as a mid-level with an Ortho Surgeon or group. Are there any NPs here who function in that role? What I'm wondering:

-How widely available were jobs for you (versus places specifically looking for a PA)?

-Did you encounter surgeons who were more accepting of PAs than NPs within the surgical mid-level role?

-Did you have an RNFA first? Would you recommend getting an RNFA also, or NP school alone? (I have 6 years OR experience, more Ortho than anything else.)

-What pay range have you seen for NPs within surgical specialties?

I've talked to PAs, I've gone to the Student Doctor Forums, I've talked to a few docs, I've looked online at the prerequisites and curriculum of various programs. PA school and the clinical training it provides appears more suited to the type of position that I want, but I don't want to write-off the NP route (for various reasons). I am a nurse, am in the process of getting my Bachelor's, and enjoy Ortho.

I know that NPs are traditionally more involved in primary care. This may be an unpopular opinion, but I have no interest in primary care for the sake of primary care. I want to be well-rounded, clinically super-competent, and knowledgeable about all systems and disease processes (as much as possible). But I'm not interested in the noble, esoteric aspects of nursing theory. I have no particular loyalty to either the "medical model" or the "nursing model", persay. And my end goal is not a practice in primary care.

Was curious whether there are any such Surgically-involved NPs in the forums, and what their thoughts are on training, pay, and job prospects for NPs in surgical specialties.

[lalaxton]

I know many NP's that work in Ortho. Don't think you really need to be a RNFA first just an orthopod willing to train you.

[Elizabeth Hanes, BSN, RN]

I'm glad you asked this question, because I'm in the same boat. I hope more NPs chime in on this.

[sirI, MSN, APRN, NP]

i considered a position in a very large sports medicine facility a couple years ago. yes, the physicians there were very open to nps. i don't think they preferred one over the other, pa vs np. but, this is in my area of the u.s.

as for surgery assisting, go here about the advanced practice nurse and rnfa. many entities require the rnfa combined with np:

www.medscape.com/viewarticle/499689

for the apn group without any or experience, significant areas of deficiencies in competence were self-identified. these areas included lack of competence in:

• establishing intraoperative nursing diagnoses and patient outcomes;
  
  
  
• developing an intraoperative plan of care (organizing nursing activities to function efficiently as the first assistant; knowing instrument, supply, and equipment needs to function effectively as the first assistant);
  
  
  
• positioning the patient for the surgical intervention;
  
  
  
• creating and maintaining a sterile field;
  
  
  
• anticipating what would be required during the surgery;
  
  
  
• performing counts of sponges, sharps, and instruments to prevent the risk for injury from a retained foreign body;
  
  
  
• participating in use of surgical medications;
  
  
  
• calculating blood loss (ie, estimating losses for the perioperative team);
  
  
  
• monitoring and controlling the surgical environment (including traffic patterns, electrical safety, environmental sanitation, and thermoregulation);
  
  
  
• exercising safe judgment and decision-making based on past experience; and
  
  
  
• evaluating desired patient outcomes for the intraoperative period.
  

[MamaTheNurse, BSN, RN]

my first job out of Family Nurse Practitioner school was with an Ortho surgeon doing exactly what you are talking about.

my biggest job was First Assisting - I wasn't an RNFA nor did I have OR experience but my surgeon was very patient and taught me all I needed to know (and we did all cases from very short carpal tunnel repairs to trauma cases plus my surgeon had done a fellowship in sports medicine so we did a lot of that kind of stuff)

my next biggest job was performing run-of-the-mill pre-surgery H&P's - the hospital we worked out of was cracking down on people going to surgery with H&P's that were too old so I did all of his plus some of his partners - patients with complex problems who needed some sort of clearance went to an internist or their family doc or cardiologist etc. but I was still pretty busy with that

I also helped with rounds - my surgeon always did his first post-op dressing change himself so I helped with that - also, he hated to write so I wrote a lot of orders and progress notes (no big deal to me)

I did minimal stuff in the office because he had great staff who did all the follow-up that was needed

in terms of NP vs PA, he didn't care, he just wanted a mid-level provider of some sort and as long as I had my own provider numbers (which I did - his biller was my biller and she did all the paperwork for me) and my services were reimbursable (which they were, for the most part - and never ever did a provider refuse to reimburse for first assisting because I wasn't an RNFA - the NP is enough), he didn't care as long as he had help in the OR and with paperwork.......

overall, however, I think surgeons in general go for PA's more because there is a surgery rotation in PA programs and I'm not trying to be chauvinistic, but you need to be really strong to assist with ortho surgery (I had the best arms from assisting!!) and I think that's why ortho surgeons go for guys - who are usually PA's instead of NP's (yeah, I know there are both sexes in both fields so don't get all freaky on me everyone but in reality, NP's are still predominantly women and vice-versa for PA's - that's just the way it is because to be an NP you need to be a nurse first and right now, nurses are mostly female - I'm not saying that's good or bad, it's just a fact)..........

well, I've rambled on enough - what you want is totally achievable as an NP - you just need to find a surgeon willing to train you - hope this post answered some of your questions - BTW, I haven't worked in that capacity for a long time - my surgeon got his dream job and moved to another state and his partners had their own people doing what I did so they eliminated my job - that's ok - onward ho.................................

good luck

Mama

[cgfnp]

Don't know about the technical stuff like the others touched on, as I've never done it. But, as far as the $$$ goes, it stands to reason that you have a better income in ortho or any other specialty as the reimbursement is better (I assume, and I've seen this reflected in surveys and just talking to midlevels from all specialties).

One thing that's not quite true yet but I think we're headed in that direction is similar physician salary trends. No, unfortunately we won't make as much $$$, but if you know what a doc makes in a certain specialty, you can bank on a similar trend with the mid level. Orthos make upwards of $600K/yr or more, so there's plenty of money to spread around, if you get the right scenario.