nurse practioners and surgery

Specialties NP

Published

HI,

I have a few questions here. Do nurse practitioners do clinical rotations/training in surgery (like MDs,DOs and PAs)?

If they dont, then do Dr.Nps do rotations in surgery?

Thanks

Nev

so how do RNFAs differ from PAs?

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Good question! Besides the obvious training differences (one is a nurse, one is not, one needs a Graduate degree, one does not) I have no idea. Maybe there is an OR forum that could help?

so how do RNFAs differ from PAs?
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Specializes in ICU, ER, HH, NICU, now FNP.

NP's practice advanced nursing, NOT medicine. If you want to practice medicine you need a whole different degree, a whole different license and a whole different title to do that.

state law and the nurse practice acts say so!

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what I'm asking is .....what is the difference between PAs assisting doctors in any specialization of surgery and RNFAs?

Thanks

Nev

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Specializes in ICU, ER, HH, NICU, now FNP.

Depends somewhat on your state - some states no difference at all

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NP's practice advanced nursing, NOT medicine. If you want to practice medicine you need a whole different degree, a whole different license and a whole different title to do that.

state law and the nurse practice acts say so!

Guage,

In NY state, the line between primary care medicine and the type of nursing that DrNPs will be practicing is blurry at best. For one thing, The Board of Regents gave full autonomy to DrNPs so they're not restricted to working with or under MD supervision. My understanding of the DrNP degree is that the BOR approved it to help make up for the declining number of MDs in primary care. I also heard that they plan to make the DrNP the standard for NPs in NY, and I agree with other posters that this will probably take many years to happen.

I wouldn't pay too much attention to the rants at the studentdoctor forum although I can see why the physicians might be concerned about DrNPs "invading their territory" in NY. Congress is threatening to slash medicare reimbursement rates to physicians by 26% (beginning 2006). The physicians are worried about being forced to compete for fewer healthcare dollars with nurses who will now be called "doctors". The AMA is fighting back with all its might, threatening to limit access to their services to people who are covered by medicare if physician reimbursement rates are cut. (It will be interesting to see if the AMA has the clout to get HR2356 and S1081 passed.) If Congress cuts the reimbursement rates the private insurance companies will surely all follow suit---and it blows my mind to think about what this would do to the glamour of the medical profession.

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Okay, had a looooong lecture today about the DrNP program, so here goes, from my notes:

The name of the degree is Doctor of Nursing Practice. Columbia started it out of the belief that the current standard of MSN is not sufficient for truly advanced independent practice. (side note, please don't yell at me for any of this, absolutely none of it is my personal opinion, kay?) They felt that there was an educational void, given that there are research-related doctorates for nurses and not practice-based doctorates. MDs have doctorates, PTs have doctorates, lawyers have doctorates, but not nurses. Courses are given in pathophys, advanced assessment, advanced pharm, and a few others I didn't write down, plus mad clinical hours and case studies and a dissertation. The first class of doctorally-prepared NPs has just graduated, and the Dean's practice, CAPNA, has been the first to receive reimbursement at 100% of what physicians make, as opposed to 85%, which had been the max. The scope of practice will not change, only the level of education and hopefully reimbursement. It was not made clear whether an attempt would be made to standardize the scope of practice across states - apparently the AMA has a lot of influence over state legislatures, and the more powerful the state chapter of the AMA, the narrower the NP scope of practice.

Okay, here's the part I reeeeeally don't want to get yelled at for: They have been in contact with the AACN to make the DrNP the standard for NPs by 2015. I believe they are still sussing out the method of "grandmothering" (yes, that's what she called it) in current NPs. This is an aspect of the drive to reduce the number of ADN nurses. Oh god, I hope I don't get kicked out of school for posting this. It's basically the trickle-down theory as applied to nursing education. She said change will come from the top, not the bottom. She cited a study by Aiken showing that morbidity and mortality rates had a direct correlation to the education level of the primary nursing provider. There's some sort of push to have ADNs relicensed as "technical nurses" with BSNs as "professional nurses", however, change in professional title is upsetting to those being renamed. Plus she said some things about ADN programs just teaching to the NCLEX.

This is what we, as BSN students, are being taught about other nurses.

Kay. Please no flaming. Just the messenger. Also, mods, if what I just did is totally inappropriate, please feel free to move or delete this post.

http://www.aacn.nche.edu/DNP/DNPPositionStatement.htm

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Specializes in I got hurt and went to the ER once.
NP's practice advanced nursing, NOT medicine. If you want to practice medicine you need a whole different degree, a whole different license and a whole different title to do that.

state law and the nurse practice acts say so!

Okay, I know I'm replying to an old thread but maybe someone can help me out anyway.

What's the functional difference (i.e. more than just the resume) between practicing medicine and practicing nursing at the NP level, particularly in the areas where the NP and MD scope of practice overlaps. Is it really just somantics?

I'm sure this has been asked elsewhere so if someone could direct me to the thread I'd appreciate it.

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NPs training and practice focus on providing primary health care to pts while making health promotion and illness prevention of utmost importance- thats what makes us a unique discipline. (Or so we think....)

Both of which would be difficult to do in an OR! As several previous posters said, RNFAs or PAs are better suited/trained for scrub roles like those.

RNFAs and PAs are not even equitable. RNFAs are not mid-levels. They may be able to bill in some places for assisting, but they do not have prescriptive authority or the same primary care training that PAs/NPs get.

As for thinking that NPs are too noble to get involved in surgery, as this would be such a waste of "health promotion" and "illness prevention" duties...if that type of idealism and holier-than-though thing is what does it for you, great. But there is nothing wrong with wanting to be involved in the surgical aspects of care, make more money, whatever.

As an intelligent OR nurse, I'd be the first to admit that you don't use a lot of your nursing skills working in the OR. But you do learn an entirely new set of skills. When you then go to NP school, and begin to learn/strengthen the skills needed to function/thrive as a mid-level, you've now got two huge skill sets. The only way that the PA-centrism (present in the minds of many physicians, and in surgery settings as a whole) will be lessened is by a bunch of intelligent NPs proving that we can function as capably in surgical settings as PAs (with the added bonus of our autonomy).

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I am a pediatric nurse practitioner who invesigated the DrNP at Columbia in NY. Kentucky also has a program. The cost for NY was $900 per credit. I was planning on starting in Sept of 05 but opted to wait until they fine tuned the program. I know someone who attented the pilot semester and was somewhat disappointed in the residency area.

I have been indepednently seeing patients for almost ten years and am quite sucessful. I was a peds and OB nurse for 5 yars before I went back for my masters. I am glad I didi it but I originally took my MCAT's for Med school and decided to stay in nursing. I live in NJ so I have many options.

The DrNP programs will flourish soon, are they worth it? we'll see

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Just wanted to add that I am a FNP student and we are learning how to do sutures and nerve blocks.

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Just wanted to add that I am a FNP student and we are learning how to do sutures and nerve blocks.

Fortunately or unfortunately there is more to surgery than suturing;). I've done one nerve block in 7 years. This does point out a difference that is often missed about surgery. The difference between a clinician and a technician. Suturing is a technical skill. Vein harvesting is a technical skill. First assisting is a technical skill. What NPPs bring to the table in the OR is our skills as a clinician. At least where I am we are not hired specifically for our OR skills but our ability to medically manage patients in the pre-op and post op setting. The ability to assess and counsel someone about surgery. The ability to manage post op complications is where we earn our money. Unfortunately the way the system is designed we only get reimbursed for the technical portion of the surgery (for the most part). So going to the OR is kind of the cherry on top of the patient sundae:D.

David Carpenter, PA-C

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