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Surgical first assist as NP?

NP   (53,807 Views 13 Comments)
by BChapp3182 BChapp3182 (Member)

6,077 Visitors; 197 Posts

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Can someone tell me what the difference is between a regular non-NP first assist and an NP first assist? What is the NP doing that the non-NP is not able to?

I see jobs for NP first assist and wonder why they would not just hire an RN or the trade school first assist people?

How do you become a NP first assist?

Is first assisting as an NP a certificate or degree we can add on or is it just having experience and training in that area? Like is there a school/program for NPs who want to do this?

Very curious about this area. It never ceases to amaze me all the areas we can get into as NPs!

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traumaRUs has 25 years experience as a MSN, APRN and works as a Asst Community Manager @ allnurses.

472 Likes; 14 Followers; 127 Articles; 184,857 Visitors; 20,492 Posts

I have a friend who is an NP first assist. Her nursing background is OR and she works for a neurosurgeon too. She does many of the follow-ups and hospital visits for these patients AFTER surgery. When she has talked about what she does in the OR, she is usually talking about her role as an RN first assist. At least in her job, there is no difference in the OR between her and an RN first assist. It is what she offers OUTSIDE the OR.

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46 Likes; 2 Followers; 102,769 Visitors; 14,620 Posts

I have a friend who is an NP first assist. Her nursing background is OR and she works for a neurosurgeon too. She does many of the follow-ups and hospital visits for these patients AFTER surgery. When she has talked about what she does in the OR, she is usually talking about her role as an RN first assist. At least in her job, there is no difference in the OR between her and an RN first assist. It is what she offers OUTSIDE the OR.

:yeahthat:

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jer_sd works as a NP.

7,574 Visitors; 369 Posts

The one big difference is that a CNS or NP can bill for first assisting and most payors will not reinburse for a RNFA first assisting.

Some APNs learn first assisting OTJ but it is better to go through a formal program. It makes it easier to obtain facility credentialing and you have training that is hopefully appropriate not just how one physician likes things.

Most RNFA programs will accept APNs without CNOR certification (required for RNs) and sometimes confrences will ahve a day or two on first assisting.

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46 Likes; 2 Followers; 102,769 Visitors; 14,620 Posts

The one big difference is that a CNS or NP can bill for first assisting and most payors will not reinburse for a RNFA first assisting.

That's an important difference, but I don't think it's "the one big" difference. Another big difference is what an FA who is also an advanced practice nurse can do outside of the OR, as trauma noted.

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core0 works as a Liver transplant.

8 Likes; 15,465 Visitors; 1,811 Posts

That's an important difference, but I don't think it's "the one big" difference. Another big difference is what an FA who is also an advanced practice nurse can do outside of the OR, as trauma noted.

I would disagree. While a surgeon will hire an NP or a PA for what they do outside the OR, the ability to bill is key. The issue is that surgical reimbursement revolves for the most part around the operation. If you do a Liver transplant (for example) with Medicare as the Payor,the surgeon will receive around $20k for the surgery and all of the follow up care for the next 90 days. If they use an RNFA they will receive no other reimbursement and the RNFA will not be able to participate in follow up care in a way that meets Medicare documentation requirements. On the other hand if a PA or NP first assists they will receive 13.6% of the surgeons fee (85% of 16%). So they will bring in around $2700 dollars to help support their salary as they do follow up care for the patient. In addition they can round in the hospital, order and interpret labs and test as well as D/C the patient. All of which frees up the surgeon to do other things.

In a Medicare environment it absolutely makes no sense to use anyone but an NP, PA or CNS (where allowed). Other insurers make reimburse other first assistants such as CFAs and RNFAs. So it might make sense to use them there. However this ignores the real value of of an NP or PA. The AAPA has a very nice study that they use in their billing course. It was done by a national consulting firm and looks at the revenue generate by PAs in orthopedics. On the average they generated $302,000 for the practice (2002 dollars). One third was first assist fees. One third was office procedures and visits. The final one third was increased physician productivity enabled by the PAs doing unbillable care (post of follow ups). This allowed the physician to see more consults and schedule more surgeries. This is something that only an NPP can do.

David Carpenter, PA-C

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6,077 Visitors; 197 Posts

So my next question is what does a starting and experienced typical salary look like for NP/PA first assist? Obviously areas like transplants and heart surgery reimburse at higher rates so I'm assuming those pay better than say ENT procedures?

I see jobs out there for it but no salary is listed, some say they will train while others prefer the RNFA certificate...

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core0 works as a Liver transplant.

8 Likes; 15,465 Visitors; 1,811 Posts

So my next question is what does a starting and experienced typical salary look like for NP/PA first assist? Obviously areas like transplants and heart surgery reimburse at higher rates so I'm assuming those pay better than say ENT procedures?

I see jobs out there for it but no salary is listed, some say they will train while others prefer the RNFA certificate...

There isn't good data for the NPs probably due to the dearth of NPs in surgery. For PAs Advance for PAs has stratified specialties by salary:

http://physician-assistant.advanceweb.com/Article/PA-Salaries-by-Specialty-2008-2009-2.aspx

There are four surgical areas in the top 10. CVS has by far the highest salary. But also procedure rich areas make up the rest of the top 10. This follows how medical billing works.

Unfortunately transplant isn't there:o. However, I'll also say that since transplant has a low volume of surgery, we are definitely appreciated for our inpatient and outpatient management skills more than first assisting. In addition transplant has a unique billing form that allows us to generate billing on inpatient surgical services.

As far as training, thats implicit in PA school. The NPs that work in the OR for the most part had significant OR experience prior to NP school. At our hospital at least they won't let you OJT. You have to have some surgical experience before they will train you in a specific area.

David Carpenter, PA-C

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KimHFNP works as a FNP, RD.

1,708 Visitors; 40 Posts

Hi, I have a tentative interview with an orthopedic surgeon this week. I am an FNP. I do not have any ortho experience or OR experience. I have a professional history with this surgeon and she likes me- which is the reason I got the interview (for those of you that are wondering :)) Anyway, I want to really sell her on the positives of hiring me. She used to work with several ortho PAs when she belonged to a big practice a few years ago. She now is on her own. I have a couple of questions.

1. Am I allowed to be trained on the job for this job? I assume that I will start out in clinic and then move to the OR later. Or is it determined by the state in which I practice (TN).

2. Are there any differences in the scope of practice that I will have vs an Ortho PA if I am appropriately trained? Or does that depend on my state also?

Thanks in advance for any answers. Kim

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1,359 Visitors; 17 Posts

good info but does the Medicare info apply to any state?

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core0 works as a Liver transplant.

8 Likes; 15,465 Visitors; 1,811 Posts

good info but does the Medicare info apply to any state?

Medicare is a Federal program. It applies to all states and most (or all) Medicaid (a joint federal state program).

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