RNFA, NP, or both?

Hello,

I have been working in a CVICU for the past year as my first nursing job out of school, and have decided not to pursue CRNA, and want to focus on becoming a RNFA. I just had a few questions, and bear with me, I just finished a 12 hour night shift. Would it be beneficial to get an NP license along with my RNFA? Are you any more marketable that way? What about becoming a Surgical PA? Is there much of a pay difference between an RNFA and a Surgical PA, and how are the job duties different? Any info would be appreciated! Just looking for the best route to go with my current situation.

Jer SD has given you some great advice about the RNFA. There are RNFAs out there in private practice that make great money but this is a result of leveraging 10+ years of relationships in the OR into a business. Its a rare thing.

As far as comparison with surgical PAs like I posted above there are a few RNFA that make very good money but many make $1-2 more than RNs in the same OR. Surgical PAs on the other hand are on the upper end of the PA pay scale. CV PAs are the best paid PAs on average at around $104k. I know a few SAs and RNFAs that make close to this but like I said its rare.

As a CVICU RN you would be competitive for most PA programs assuming good GPA etc. The down side is you probably need about a year of pre-reqs to get in. There are also two surgical PA programs in addition to the other 139 programs (all of which have surgical rotations).

Finally you need to examine the market you intend to get a job in. There are some markets where NPs can be employed in surgery. However, the vast majority of surgical NPP jobs are held by PAs. Some of this is historical and some is related to scope of practice. Its not meant to be a dig at those NPs that work in surgery, its simply the statistics.

David Carpenter, PA-C

From a $$$ standpoint, it sounds like PA is the way to go here. I wonder if I could work in the O.R. as an RN and go to PA school at the same time? I applied for the OR out of school, but they didn't take new grads, so I went to the ICU instead. Now I have my year in, I would like to move.

The reason I brought this NP idea up is that I asked a nurse on my unit, who just got her NP license, if I should go to PA school, and she asked me, "why would you take a step down". She made it seem like PA's don't really make that much. Money isn't my ultimate goal, but if the difference is 30-40k, it sounds worth it.

I'll definitely have to do some more research on this.

Most PA schools are full time. By this I mean 30-40+ hours of class time per week plus assignments. There are 2-3 programs that allow the student to go part time the first year (ie take it over 2 years) then take the second year full time (clinicals). Almost every program "heavily discourages" working full time.

To be honest getting more experience in the CVICU is probably more valuable. Most ORs do not let new RNs scrub which is the skillset you really want. You can pick up assisting in school, but the ICU management skills are what really sets you apart. There are also surgical post graduate programs for those that want them.

David Carpenter, PA-C

Dear David,

Thanks for the guidance. But what is a better option between NP or PA.

Knowing that you are a PA-C, please would you give me what job profile a PA holds so I can compare to an NP. Like a day as a PA. ( Sorry for asking too much)

I am still failing to understand where should I go. As each discipline is holding on.

I have BSN -RN ,but want to pursue a higher education.

thanks

niralibp

I had admission for PA, but i chose RN, so now again at a situation

Its hard to describe a particular PA jobs since there is so much variation. Basically there are three practice patterns that you see. There are a few surgical PA jobs that only involve assisting. These are either as hospital employees or members of an assisting service.

For the rest the job involves rounding, assisting and clinic. Rounding involves seeing the patient in the hospital. It involves seeing the patient each day and addressing any problems. Handling the discharge planning as well as admission paperwork. Assisting is what it says, assisting in the OR. Clinic involves seeing patients either pre or post op as well as helping with work ups.

The most common practice pattern for PAs is what you see in Ortho (10% of PAs). Generally their day is divided between the clinic, the OR and the floor. Clinic involves initial consultations (depending on the practice) procedures such as joint injections or aspirations and working up patients that might need surgery. Assisting and the floor are pretty much as above.

The second model is used in general surgery. In this model the surgeon usually sees the patient in consult then directs the work up and schedules the patient for surgery. The PA assists with the surgery and manages the patient on the floor. They also see the patient for most of the follow up visits. This model is used in other areas such as neuro and CV.

The last model are those discliplines that have a fair amount of medicine in them. ENT, Urology, transplant are examples of this. Here the work is clinical for the most part. Seeing patient in consult or follow up and occasionally assisting in surgery. I work in transplant. Its basically high level medicine with occasional 3 AM excursions into the OR. We have PAs and NPs on our team and the job is basically the same with the exception that the NPs don't assist in the OR.

Salaries are roughly related to reimbursement of the surgeon. Since medicine reimburses the most for procedural specialties, PAs that can do lots of procedures are reimbursed better. CVS is the best example here. Most endoscopic vein harvesting is done by PAs in the US. This is reimburseable seperately from the surgery. So the PA will get 85% of the surgeons fee for the vein harvesting (or 42.5% if its considered a combined procedure) plus 14.5% of the surgeons fee to assist with any vessels. It amounts to a nice pay check. However, as in most things if you go into it only looking for the money you will be disappointed.

Finally, I don't see PA or NP as higher education from a BSN. Its a different path. Its moving from hands on direct patient care to a provider where you are responsible for making decisions about treatment and disposition. Not higher just different.

David Carpenter, PA-C