How to Become A Surgical First Assistant Douglas J. Hughes, MEd, CSFA, CSA, CST, CRCST October 19, 2013
Agenda 1 Introduction 2 3 History of Surgical Assisting This Scope is of an Practice example & text. Job Go Description ahead and replace it 4 Educational & Experience Pathways 5 Credentialing 6 Future of the Profession 7 Frequently Asked Questions
Introduction About Me Education Master of Arts in Education, Curriculum & Instruction California State University, Fresno Bachelor of Applied Science, Surgical Technology Boise State University Surgical First Assistant Meridian Institute of Surgical Assisting Experience Director of Surgical Technology, Concorde Career College Tissue Recovery Specialist, Community Tissue Services Vice President, Association of Surgical Assistants Associate Member, American College of Surgeons Surgical First Assistant, Orthopedic Associates & St. Alphonsus Medical Center - ID
Introduction What is a surgical assistant anyway? American College of Surgeons (ACS) The first assistant during a surgical operation should be a trained individual who is able to participate in and actively assist the surgeon in completing the operation safely and expeditiously by helping to provide exposure, maintain hemostasis, and serve other technical functions. The qualifications of the person in this role may vary with the nature of the operation, the surgical specialty, and the type of hospital or ambulatory surgical facility It may be necessary to utilize nonphysicians as first assistants. Surgeon's Assistants (SAs) or physician's assistants (PAs) with additional surgical training should meet national standards and be credentialed by the appropriate local authority. -Statements on Principles, Section 1G (ACS, 2008)
Introduction How does this role vary from the surgical technologist? Surgical First Assistant Assists the surgeon in the performance of the operation Primarily responsible for exposure and visualization of the operative site May manipulate tissue and utilize manual, thermal, or chemical methods to achieve hemostasis Closes tissue planes Requires specialized education and credentialing Second Assistant Holds but does not place retractors Suctions the field Blots with sponges Handles instrumentation such as hemostats placed by the surgeon Cuts suture These tasks are routinely performed by the surgical technologist
History Evolution of the Profession Surgical Allied Health began in WWI & WWII as female nurses were not allowed to assist surgeons on the battlefield or aboard Navy vessels. Military use of allied health practitioners was more defined during the Korean and Vietnamese conflicts. President Harry Truman called for more allied health practitioners in 1952. American Medical Association formally recognized SFAs in the early 1970 s. WWII Combat Hospital
History Evolution of the Profession A Very New Field 1979: Virginia Association of Surgical Assistants (VASA) formed by surgical allied health practitioners 1980: ACS passed a resolution to formally recognize SFAs as practitioners in the OR 1983: National interest in the profession led VASA to become the National Surgical Assistant Association (NSAA) Shortly after, the first SFA program was established at Eastern Virginia Medical School (EVMS) 1990: The first formal job description for the SFA was developed by the Association of Surgical Technologists (AST) 1993: Core Curriculum for educational programs published by AST 1993: First accredited surgical assistant credential awarded by the National Board of Surgical Technology and Surgical Assisting (NBSTSA, formerly LCC-ST) 2003: First SFA programs accredited by CAAHEP and included EVMS, among others
Job Description How is the SFA professional defined? Job Description As defined by the American College of Surgeons (ACS), surgical assistants provide aid in exposure, hemostasis, closure, and other intraoperative technical functions that help the surgeon carry out a safe operation with optimal results for the patient. In addition to intraoperative duties, the surgical assistant also performs preoperative and postoperative duties to better facilitate proper patient care. The surgical assistant performs these functions under the direction and supervision of the surgeon and in accordance with hospital policy and appropriate laws and regulations. -American Medical Association, 2010
Scope of Practice What technical functions can the SFA perform? Scope of Practice Specifics defined by local legislation and hospital policies SFAs should be granted facility priviliges through the medical staff or credentialing office Some intraoperative tasks include: Clamping and/or cauterizing vessels or tissue Tying and/or ligating clamped vessels or tissue Applying hemostatic clips Placing local hemostatic agents Applying tourniquets Applying vessel loops, noncrushing clamps, and direct digital pressure Specific RSOPs are available through ASA & AST -Association of Surgical Assistants, 2013
Pathways to Practice How can I get the training necessary to become an SFA? Experience Pathway Prior to 2003, most SFAs were trained on the job without formal education or accredited pathways to practice Commonly referred to on-the-job training (OJT) Includes military experience Educational Pathway Industry-recommended pathway currently preferred by most employers Formal education and training in an accredited program ensures that practitioners have met minimal standards
Experience Pathway On-the-job Training Current CST Minimum 6 months remaining in NBSTSA certification cycle 135 cases performed in the SFA role across specific specialties Surgeon approved Notarized case logs Not recognized by all credentialing boards or in all states This route to the profession is being phased out in favor of formal education
Experience Pathway Military Training Graduate of a military training program in surgical technology with 350 clinical cases and 24 total months as a surgical first assistant within four years Not recognized by all credentialing boards or in all states Military pathways close from time to time
Educational Pathway Important Points to Remember 1. Experience Some programs require prior experience in surgical services, such as a surgical technologist, surgical nurse, or physician assistant. Other programs accept applicants with no prior experience in the field. 2. Accreditation 1. Not all schools or programs are accredited. 2. Ensure that the program is CAAHEP accredited. 3. For degrees, ensure that the institution offering the program is either regionally or nationally accredited and recognized by the US Department of Education. 3. Degrees 1. Educational programs for the SFA may offer either a certificate/diploma or an associate or master s degree. 2. Programs range from 1 to 2 years in length.
Educational Pathway What types of courses will I take? Course content is guided by the Core Curriculum for Surgical Assisting, published by the Association of Surgical Assistants (ASA) Sample Course Outline Surgical Anatomy & Physiology Microbiology Pharmacology Anesthesia Agents & Principles Fundamentals or Intro to SFA Practice Professionalism or Role Definition Medical Ethics & Law Perioperative Patient Care & Monitoring Surgical Wound Management Operative Procedures & Complication Management Business Principles & Practices Laboratory Skills Clinical Rotations
Educational Pathway Accredited Schools for the SFA Campus-based Programs Gulf Coast State College, Panama City, FL Diploma or Associate Degree College of Southern Idaho, Twin Falls, ID Associate Degree CST required for all students, including nurses Madisonville Community College, Madisonville, KY Certificate Program CST, CNOR, or documented SFA experience required Wayne County Community College, Belleville, MI Certificate Program CST, CNOR, or PA-C required University of Cincinnati, Clermont College, Batavia, OH Certificate Program BS or AS in Surgical Technology with 3 years experience Eastern Virginia Medical School, Norfolk, VA Master s Degree BS degree required in any field
Educational Pathway Accredited Schools for the SFA Distance-based Programs Didactic courses typically taken online Labs & finals are proctored on campus (travel required) Clinical rotations completed locally Meridian Institute of Surgical Assisting, Nashville, TN Certificate Program CST recommended, OPA-Cs and RNs with scrub experience may also apply Program courses articulate with the Master of Orthopedic Assistant (MOA) Program offered through St. Augustine University for Health Sciences Other online programs exist but are not currently accredited.
Educational Pathway Benefits of Formal Education Not all states recognize SFAs lacking a college degree and/or formal education in surgical assisting for licensure applications at this time. Not all professional credentials for SFAs recognize OJT routes. The ASA is in support of closure of the experience/ojt route. Employers prefer formal education.
Credentialing Which national agencies certify surgical first assistants? ABSA American Board of Surgical Assistants SA-C: Surgical Assistant Certified Requires graduation from a formal program approved by ABSA Requires an associate degree or higher in a related field specific courses required Accepts a large number of foreign-trained physicians Not accepted in KY www.absa.net NCCSA National Commission for the Certification of Surgical Assistants CSA: Certified Surgical Assistant Arm of NSAA Requires graduation from a formal program Military & foreign physician applicants allowed under specific criteria Nationally recognized www.nsaa.net NBSTSA National Board of Surgical Technology & Surgical Assisting CSFA: Certified Surgical First Assistant Formerly CFA The only NCCAaccredited credential Nationally recognized Accepts Experience Route & Graduates of CAAHEPaccredite programs www.nbstsa.org ASA currently recognizes all 3 professional credentials
Credentialing So which credential is right for me? CSFA Accepted throughout the US and viewed by many as the principle credential Not as popular among some major East Coast hospital systems NCCA accredited Currently accepts the Experience Route Required in Indiana State for vein harvesting and other functions Promoted and recognized by AST CSA More popular in the Eastern US Preferred by employers such as Mayo Clinic and Johns Hopkins Oldest credential for SFAs Nationally recognized but few practitioners in the West, limited scope in IN Promoted by NSAA SA-C Requires an associate degree for application Less recognized nationally but accepted by most employers Not recognized under legislation in some areas of the country: KY, IN Friendly to foreign medical graduates
Future of Surgical Assisting Is the field still expanding? Legislation Increased Patient Populations Physician & Nurse Shortages
Future of Surgical Assisting Legislation States with legislative Regulation TX, KY, IL, CO, DC, IN Reimbursement Bills States with active legislative efforts FL, VA CSFAs added to Cigna in FL The Association of Surgical Assistants (ASA) is actively backing legislative efforts around the nation to bring the profession into the forefront.
Future of Surgical Assisting Increased Patient Populations With the passing of ObamaCare, the American Association of Colleges of Nursing (AACN, 2012) estimates that 32 million additional Americans will soon gain access to healthcare services. The expected need for healthcare workers across fields is expected to increase dramatically as Baby Boomers continue to reach and surpass retirement age (GAO, 2001). Increased public demand for specialty services will drive market need for more allied health practitioners such as surgical first assistants.
Future of Surgical Assisting Physician and Nurse Shortages Krupa (2010) projects a shortage of nearly 100,000 medical doctors by 2020 The Association of American Medical Colleges anticipates figures as high as 150,000 by 2025 in the wake of ObamaCare (Sataline & Wang, 2010) Weekly working hours for surgical residents has decreased from 90-100 with 36-hour call rotations to a max of 80 with 24-hour rotations and 1 mandatory day off per week SFAs are filling in the gaps (AHRQ, 2010) Federal funding caps have prevented medical programs from accepting more residents (Sataline & Wang, 2010)
Future of Surgical Assisting Physician and Nurse Shortages BLS projects 1.2 million new job openings for nurses through 2020, with only 712,000 RNs to fill those jobs Nearly half a million positions will go unfilled The ratio of caregivers to patients is projected to decrease by 40% through 2030 There simply are not enough nurses to fill specialty nursing roles within surgical services, such as RNFA positions - (AACN, 2012)
Future of Surgical Assisting Association of Surgical Assistants Mission Statement The Association of Surgical Assistants represents a broad coalition of surgical assistant practitioners, who shares several common goals including optimizing surgical patient care, promoting the recognition of all surgical assistants, advancing legislative strategies and providing relevant continuing education experiences. Visit www.surgicalassistant.org for more information
Frequently Asked Questions How much experience is generally required before applying for an SFA program? Most employers and colleges are looking for 2-5 years experience as a CST or CNOR prior to applying; however this is usually a recommendation and not a requirement. How much money do SFAs typically make? Salaries for SFAs vary greatly depending on employment type, either hospital employed, group practice employed, or independent. CAAHEP (2013) reports average salary ranges as follows: Starting: $55,000/yr. Hospital Employed: $75,000/yr. Independent: $120,000/yr. Can I work as a surgical assistant without formal training or certification? AST and ASA Recommended Standards of Practice (RSOPs) state that first assistant skills like wound closure and tissue manipulation are outside the scope of practice of the surgical technologist. However, local legislation in Oregon leaves choosing the SFA on the case to the delegation of the surgeon. ACS states that the first assistant must meet national education and credentialing standards.
Frequently Asked Questions Discussion What additional questions do you have?
For Additional Information ASA: CAAHEP: NSAA: www.surgicalassistant.org www.caahep.org www.nsaa.net Surgical Assistant Resource: www.surgicalassistantresource.org NBSTSA: ABSA: www.nbstsa.org www.absa.net
THANK YOU! For more information contact me at dhughes@concorde.edu