Surgucal NPs

[sosoraff]

Hello ,

My name is Jimmy and I am very interested in surgery. I am wondering if there are NPs that can specialize in surgery. I know that as a PA you can specialize in surgery but I prefer the nursing route do to the fact that you have more background to fall back on (working as a RN ). However I know very little about the nursing route , until recently I have been looking only into the PA profession. I know that nuse anesthesists work in surgical settings but do they get alot of pt contact or do they primarily just work on the anesthesia and thats it? Anyway , if anyone could help me with any or all of these questions I greatly appreciate it. Thank you .

[elcue]

Hi Jimmy

We have a couple of NPs who come to our OR to first-assist their MD-employers. Surgical NPs, when employed directly by the physician, may also see patients in the doc's office in their nurse practitioner capacity. I have been an OR nurse for over 20 years and have not seen hospital-employed surgical NPs anywhere I've worked.

Nurse-anesthetists (CRNAs) DO have patient contact. They assess their patients pre-op, plan their care, and provide anesthesia care. They are usually experienced critical-care nurses prior to beginning their anesthesia training. They may be hospital-employed, self-employed and working on contract, or agency-employed. I have found them to be meticulous, patient-centered providers. I worked in one center where they did everything from carpal tunnels to open hearts and complex neuro procedures; everything from local-sedation cases, to GETA, to epidurals and other regional blocks.

The CRNAs only work in surgical settings, such as ORs, surgicenters and office-based ORs.

You probably can't go wrong pursuing either of these options; you need to decide which bettter suits your own interests. Do you want to work for a physician? Or a hospital or an agency? Or would you like to be self-employed?

Good luck as you explore this!

[sosoraff]

thank you elcue for all your help...

as of right now I am trying to get accepted into a basic RN program ...

after graduating I would like to work in the OR part time as I continue into graduate nursing....

can new grad rn's work in the OR and do CRNA programs aaccept the OR as an acute setting???

[elcue]

I have never worked in an OR that accepted new grad RNs. They all require at least a year's experience as an RN. I believe this is a good policy. Working for at least a year on the floors develops your assessment, time management, and delegating skills. Not to mention your self-confidence.

I have worked with some RNs in the OR who started out in other ORs never having worked on the floor. I have found that you can pick these nurses out of the group without being told their backgrounds. They seem to lack a broader view of nursing care and their assessment skills tend not to be as sharp. Which is not to say that these nurses don't succeed in the OR; they just have a narrower perspective. I don't intend to insult anyone, but I have really noticed this over the years.

[elcue]

Jimmy,

Some CRNA programs used to accept RN's without critical care experience. I don't know whether this is still true. I think a year in the ICU is now the norm.

I think the professional organization for CRNAs is AARN (or google nurse anesthetist). The organization for OR nurses is AORN. Check out their websites.

Look into part-time/summer work in an OR as a care assistant or transporter - anything to get you behind those big double doors to see whether you really are comfortable in that setting. The OR really is its own little world and it won't take long for you to know whether this is the place for you.

My son, a college student, has a part time summer job in an OR (his first OR job) and is so comfortable there that he is considering changing his major from PoliSci to something that will land him in the OR setting.

I've also seen RNs spend just a couple of weeks in OR internships and find it's not for them after all. So do what you can to get a foot in the door and test the waters.

[MissJoRN, RN]

Hi Jimmy! I'm going to go right ahead and agree with elcue on a lot of points.

Many ORs in this area do accept new grads, some have better internships than others. If you really know that you'll be on OR nurse forever that's great, skip floor nursing, but I think floor nursing is a good place to start for most nurses. If you think you want to go on to be an NP, I think it would be in your best interest to have general nursing experience. Maybe try out he post op floors, coming through nursing school you'll get to know what you like... maybe ortho, maybe cardiac, etc and you might tie your med surg experience in with your OR experience.

Anyway sounds like you want to assist docs in the OR and see patients as outpatients? I'm not too sure about the NP role... I did once work with a nurse who identified herself as a surgical NP, this was news to me and I never really looked into it. I do know that the PAs assist in the OR, see patients on the floor, see patients in the office, and write orders. There is also such an animal as an RNFA. OR nurses with a few years experience, extra training, and certifications that enable them to work as an assistant to the surgeon. Some are hired by hospitals and assigned to surgeons for the day, other surgeons hire their own. I know some RNFAs who do see patients in the office but they aren't given the same scope of practice as a PA. For instance the RNFA might write post-op orders "informally" but they must be signed by the surgeon, as if she was simply transcribing them for him.

As far as CRNAs, there is a thread on the CRNA board right now about being an OR nurse first. Doesn't hurt, but not necesssary. CRNA is the epitome of critcal care nursing so what is needed is a few (minimum 1, but in many cases that doesn't really seem adequate) years of ICU nursing- ICU, CCU, etc. Enough to become comfortable with high tech equipment, sensitive monitoring, and potentially dangerous medications. Many CRNAs do interview and medically examine their patients ahead of time so they can determine if they are healthy enough for elective surgery or how sick their emrgency patient really is and decide what drugs they want to give, how much fluids and blood are needed, etc. I some hospitals though they do cases only and all pre-op assessments and most planning is done by the anesthesiologists.

(not sure where I was when I started writing this yesterday and was interrupted! So that's it)

[elcue]

Hi again Jimmy

I just came across the post i've pasted below in another forum. I think her (his?) comments may inerest you. Take care. elcue

well i just graduated 2 years ago from nursing school myself and went straight to the OR from school.

so i will tell you this. i am now looking to get some experience else where. i enjoyed my OR time.. but (and i don't want to offend anyone) just coming from nursing school i feel like i am loosing some of my nusring knowledge that you may get from working on a floor or icu . anyways to my point if you have a chance to get the experience in an OR do it. because it is something you can have. most of the time OR's are looking for someone with experience. but if you do not want to be stuck there make sure you try other nursing after about two years. i have talked to alot of nurses i work with and they have said after 20years in the OR they don't feel like they would be comfortable going to work any where else but that OR.

so i dont' know if that helps

[sosoraff]

thank you both for all of your help......

lots of good info....