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3 Keys to Success for PAs and NPs in the OR

Posted on September 30, 2020   |   by   |   Advanced Practice Structure, Employers, Healthcare Teams, New Grads, Professional Development


Editor Elizabeth Moran, MSN, RN, CPNP-PC

For many Physician Assistants and Nurse Practitioners, working in surgery is a very exciting and rewarding part of their career. Perhaps it is the excitement of hands-on procedures and performing complex skills in conjunction with the surgeon, or perhaps it is the ability to see the immediate result of your efforts, but one thing is for sure:  it is never boring in the OR. In this article, we will talk about a few of the unique steps it takes for Physician Assistants and Nurse Practitioners to successfully enter into a first assistant role and some ways you can make yourself stand out as the applicant for these roles.

When do you Learn your Hands-on Skills as a PA or NP?

Physician Assistants undergo a comprehensive program for training with a portion including a rotation in the operating room. Most PA programs include a five week surgical rotation, but in many larger institutions with multiple “levels” of training occurring, many PA’s will agree there is a bottleneck to spending meaningful time “at the table” when in competition with interns, fellows, and the like. Nevertheless, as a generalization, the Physician Assistant curriculum actively prepares graduates better than Nurse Practitioners to enter the operating room, since zero operating room rotation is included in the Nurse Practitioner training underwent by most NPs.  Nurse Practitioners who seek to gain first assisting privileges and Physician Assistants who desire to improve their skills and work in the operating room may undergo a formalized first assistant training. 

Key to Success #1: keep track of your training for all privileges and skills. Anything that you may have to prove you have done to maintain your privileging is your responsibility to keep tabs on. A spreadsheet is an easy way to keep your dates of training, repetitions, and de-identified data on hand for easy retrieval by potential employers.

Why Become a First Assistant?

Although not required by most institutions for Physician Assistants, obtaining a formalized initial education from a reputable first assist training program is necessary for an increasing number of Nurse Practitioners who seek to obtain privileges to assist in the operating room, and this trend is changing the dynamic of the OR. Over the past 10 years, a considerable shift has occurred with Nurse Practitioners entering the OR where previously Physician Assistants dominated the landscape. The benefit to the surgeon is multifaceted, with your advanced practice clinician observing and participating in surgery, being able to educate the patient with the surgery from first-hand experience, but also the ability to bill for appropriate first assisting services for an expanded population compared to surgical tech and registered nurse first assistants, specifically for Medicare and Medicaid populations. Whether a Physician Assistant or a Nurse Practitioner, if you can make your resume stand out to potential employers as an easy choice to improve revenue generation, hiring a new-grad becomes a less risky decision since one of the biggest hurdles to hiring a new grad has been diminished. The bottom line value added to the practice is increased, and as a NP or PA, your salary will reflect this if you negotiate well. Take a look at our latest salary survey and see for yourself!

Key to success #2: whether a PA or a NP, consider undergoing a formalized first assisting program from a reputable training organization. You put yourself in a different category to employers when your skills are refined prior to hiring and this drastically simplifies the privileging and credentialing process.

What does a First Assisting Program Include?

With only a handful of accredited Nurse Practitioner and Physician Assistant first assisting programs available in the United States, consider your location and general goals in your training when picking your first assisting programs. The National Institute of First Assisting, Inc (NIFA) located in Centennial, Colorado, prepares the lion share of registered nurse and nurse practitioner first assistants in the US, and is available for Physician Assistants as well. Participants will start their didactic training with an online portion of the training. Then, participants undertake the 3 or 5-day SutureStar Summit workshop, which offers some of the most comprehensive training available for operative simulation and hands-on training. This will include simulation of common surgeries, suturing and knot tying, safe instrument passing, anticipating the surgeons’ needs, and maintaining the sterile environment. Their courses are offered throughout the year in many desirable locations throughout the US, and will include expert instructors, high-quality instruments, and a superior experience to any similar program, as they truly focus on getting the hands-on time needed to be prepared for the real world of surgery. 

NIFA stands behind their product with a guarantee that you will learn to master the skills of the nation’s top assistants or they will retrain you free-of-charge. Once the hands-on portion is completed, the student will work with a surgeon to complete the 140 clinical hours required to satisfy their clinical training portion. Once graduated from the program advanced practice clinicians will be uniformly prepared to enter the OR with confidence and the skills to match, regardless of their previous experience.

Key to success #3: spend the money for a reputable first assisting program that gives you ample hands-on time. NIFA is known by many as the best organization for first assist training because of their focus on preparing you this way. Lesser quality programs will skimp on the hands-on time and although this seems attractive with a lower price point, you actually suffer quality and preparation, which are the whole point of gaining the training to make you stand out.

For information on hiring or evaluating PAs or NPs for a first assist in the operating room job opportunity, please contact Jill Gilliland, President, Melnic.  See our RNFA NP or PA First Assist job opportunities. 

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