NP practicing as a First Assistant in a Surgical Specialty By Kemp Smith, MSN,CNOR,RNFA,ARNP,FNP-C

Transcription

1 NP practicing as a First Assistant in a Surgical Specialty By Kemp Smith, MSN,CNOR,RNFA,ARNP,FNP-C Objectives The attendee will have a better understanding of the of the NP in surgery. The attendee will have the resources to obtain First Assist status. The attendee will have an understanding of what is needed to obtain rnfa status. The attendee will have the information to better market themselves in a surgical specialty environment. Objectives The attendee will have an idea of the reimbursement for the NPRNFA

2 Understanding the NP in the RNFA RNFA is a RN, or APRN who has achieved further education in first assisting gaining professional recognition, and once completed is eligible to sit for national certification exam. Understanding the NP in the RNFA The NPRNFA provides Preoperative, Intraoperative, and Postoperative care of the patient. Understanding the NP in the RNFA Preoperatively the ARNP RNFA Provides Pre-op teaching by having a detailed understanding of the specific procedures depending on specialty. Ordering preop lab tests and specific diagnostic studies.

3 Understanding the NP in the RNFA Intraoperatively the NPRNFA has competent knowledge of sterile technique. Advanced knowledge of surgical anatomy. Incision landmarks. Incision making. Dissection techniques Understanding the NP in the RNFA Intraoperatively Providing exposure. Suturing and tying techniques. Wound closure techniques. Understanding the NP in the RNFA Postoperatively Postoperative orders Provide care of specific specialty postop patients. Hospital rounds. Postoperative teaching.

4 Why become a RNFA MARKETABILITY As an APRN with first assisting experience it broadens your job opportunities. You are able to care for both surgical (depending on specialty) and non-surgical patients. Why become a RNFA MARKETABILITY It places we as APRN s on a more even keel with Physician assistants, from the surgical standpoint. Places you in a situation to be as marketable if not more marketable than a PA. Why become a RNFA Employment wise, it can be used as an incentive to your potential employer for more income brought into the practice, which relates to either possible bonuses or even a higher salary for you. Self-Employment is always an option. As an RNFA you can contract yourself out to specific surgeons and bill for your first assistant work.

5 Office Visits: Level III Initial O/V Charge $ Reimbursed $61.09 Level IV Initial O/V Charge $ Reimbursed $86.85 Office Visit: Level III F/U visit Charge $70.00 Reimbursed $33.23 Level IV F/U visit Charge $ Reimbursed $52.30 Level V F/U visit Charge $ Reimbursed $76.67 Hospital Rounds Consult Billed $ Consult Reimb. $64.45 Initial Visit Billed $ Initial Visit Reimb. $ Daily Visit Billed $68.00 Daily Visit Reimb. $36.42

6 O.R. Charges Open L4-5 Hemilam/Diskectomy First Assist Fee $ First Assist Reimb. $ Level ACDF First Assist Fee $3, First Assist Reimb. $1, DLL L3,exploration of hardware L4-L5, removal of old inst. PSF L3-L5. First Assist Billed $3, First Assist Reimb. $ DLL L5-S1 with PSF L5-S1. First Assist Billed $3, First Assist Reimb. $1,237.78

7 Rt. Frontal Stealth Guided Craniotomy for excision & biopsy of intracranial lesion. First Assist Billed $ First Assist Reimb. $ Implantation of Intrathecal Opiod pump and catheter. First Assist Billed $1, First Assist Reimb. $ Certainly dependent on insurance carrier. Medicare/Medicaid Private insurance Work Comp. ***Some do not even cover a first assist fee***

8 Requirements Must be an RN or APRN, with proof of licensure. CNOR or CNOR eligible (exception to APRNs who have passed their assessment of clinical skills and knowledge. Requirements CPR, BCLS, or ACLS. Letters of recommendation Training Home study or site training programs. Spend at least 1 week at an on site training facility. Clinical internship of hours of documented first assisting with supervising surgeon.

9 Training Must log all cases first assisting in. May have to write up a specific case study encompassing complete care from preoperative state through completion of postoperative care. Training AORN will wave the CNOR status for ARNP s wishing to obtain RNFA, but the ARNP must provide documentation of Credentials. Certification in specific field. Must test out of Aseptic Technique. Training REMEMBER: Your training speaks for itself. What do you bring to the table. How will you increase the pt. load, while decreasing the work load of your surgeon.

10 Contacts Debbie Moore at AORN ext.452 John Kekos at NIFA suture and surgical training workshops. xpress.htm Contacts Offers for attendees AORN video library series at This is free for RNFA students, otherwise $50. Introduction to the Surgical Suite for NPs at Original cost $1425, now $1025. My as ARNP RNFA PREOPERATIVELY Seeing pts. In clinic Clinical decision making i.e. surgical vs. nonsurgical. Non-surgical treatment options Therapy, pain mgmt., or meds.

11 My as ARNP RNFA Surgical pts. Type of procedure. Discuss specific surgical procedure with its indications, limitations and complications. Present and review with attending. Set up surgery. My as ARNP RNFA INTRAOPERATIVELY Positioning. Prep/Drape Depending on type of procedure. Make initial exposure, surgeon performs rest of procedure, or Surgeon and I work at the same time, or Strictly first assisting. Always retraction, exposure, hemostasis, and closure. My as ARNP RNFA POSTOPERATIVELY Post-op orders. Rounds daily orders, etc Discharge summaries. Post-op f/u in clinic.