Ortho NP First Assist- Advice Needed

suzanne4, RN · Nov 3, 2005

AORN requires two years of experience in the OR before being permitted to even sit for the CNOR exam. In the past, training full-time would be minimum of about three months on just one service, but that is after initial OR preparation. Unfortunately, the previous experience that you have as an NP doesn't prepare you for the OR in any way. You are probably looking at minimum of six months for the facility to credential you for the OR without any previous OR training at the minimum. And that would be in the best of circumstances. More than likely, at least one year or so.

As a First Assist, it isn't just holding a retractor for the physician, but will involve closing of an incision when the doc may not even be in the room, positioning, as well as teaching.

Hope that this helps. My biggest suggestion would be to see if you could go thru the new employee orientation for the OR. There is so much to learn besides the name of each of the instruments, besides all of the implants, etc. Sterile techinique, etc.

Please let us know how things work out for you...............:)

disComBobUlated86 · Feb 26, 2008

I was just wondering if you or anyone has pursued this type of responsibility. I think it might be something I am interested in. I am in my second semester of my junior year of my BSN and I love orthopedics and I really want something to do with orthopedics and this sounds interesting. How would I go about pursuing this out of school? Does anyone have any advice?

core0 · Feb 26, 2008

I have worked with an orthopaedic surgeon (solo physician practice) for about 18 months. I currently see patients independently in the office for initial histories and physicals, pre-op visits, post-op visits, etc. The physician has asked me to expand into the OR. Initially, he said he could do "on the job training" for me and teach me what I needed to know. I currently have privileges at the hospital where he does all his inpatient surgeries. Eventually, I want to be able to function as the First Assist and be able to bill for my services. I also have a Medicare provider number. I am in the process of dialoguing with the director of periop services about additional training/credentialing that is needed.
Does anyone have a feel for minimal training I need? I do not have previous OR experience but do have a bachelors and masters degree in nursing and am certified as a family nurse practitioner. I would appreciate any suggestions on resources to consult, etc. I have visited the AORN Web site and printed off the "Official Statement on RN First Assists."

To assist in the OR you need privileges. Depending on how your hospital credentials you need to be credentialled through nursing or through the ortho department. There are a number of issue here.

1. As an NP you can first assist and bill for the assist. No additional training is needed. You bill under your NPI with the appropriate modifier. For other insurance you bill either under your NPI or through the surgeon depending on the insurance policy.

2. Nursing has decided the certification for the OR is the RNFA. To get this you need 2000 hours of first assisting and graduation from an accepted program. Here is a list of the requirements:

http://www.cc-institute.org/cert_crnf_abou.aspx

Here are a list of the programs:

http://www.cc-institute.org/cert_crnf_prep_rnfa.aspx

NIFA has distance learning options. You already have the masters for the RNFA.

One possibility is to have the surgeon send you to the NIFA course which is one week long. This will give you the basics of first assisting. Depending on the hospital completion of the course should be enough to give you privileges to assist.

3. The other issue is the the FNP. You can look in the NP section for more discussion on this. There are a lot of FNPs doing acute care in the hospital. However, the trend nationally seems to be the ACNP. This may or may not become an issue for inpatient work depending on your state and hospital.

Finally make sure that your practice understands billing for NPs in the first assist role. There are many nuances here and many procedures do not reimburse for a first assist. Some offices are suprised with the low reimbursement (generally 14.5% of the surgeons fee). It may be more productive to have you see inpatients or outpatients, especially if you are doing high value procedures such as injections.

Here is a flier from PAOS that explains some of the issues for ortho PAs (which are probably similar to what you are dealing with):

http://www.aapa.org/gandp/issuebrief/orthosurg.pdf

Realistically the reason that you are valuable to the practice is not the first assisting. This is simply a technical task. The way that NPPs are valuable is through patient management in the clinic and on the floor. Unfortunately there is a disconnect between the floor work and the OR which is primarily where the pay comes from.

David Carpenter, PA-C

november17, ASN, RN · Feb 28, 2008

Thanks for the info, Mr. Carpenter. I've been interested in this myself. I understand that there is a disconnect, but honestly it could be worth it. Thanks!! I've got a long way to go in furthering my education as an RN, but I've been in ortho 9 months and I've found it to be pretty cool work. If you can call it work...It's like getting paid to do stuff that I enjoy doing anyways.