February 2017 • Volume 10, No. 2
From the Editor

Operating the nation’s largest online training program for RN First Assistants gives NIFA an excellent observation deck for noticing trends in the industry. One trend we see is that more and more APRN (Advanced Practice Registered Nurse) students are enrolling in our formal, online program and also attending our SutureStar™ Workshops. Why are so many APRNs going into the specialized field of the OR?

In this issue we look at this phenomenon and what it may mean.

Our Graduate in the Spotlight is Charlene Campbell, APRN-BC, of New Haven, CT. Scroll on down for links to jobs, an APRN terminology crossword puzzle, and NIFA’s favorite links.



Julie Lancaster, Editor

News: APRNs in the RN First Assistant Role

Last month our SutureStar™ Workshop in Denver was packed with 42 RNFA students eager to master the first assisting skills of the nation’s top practitioners. Noticeably, we saw what seems to be a growing trend–Advanced Practice Registered Nurses (APRNs) registering for RNFA training. Indeed, in the Denver class, 66% of the class were APRN/RNFA students!

Ten years ago, fewer than 10% of our workshop attendees were APRNs. What’s changed?

Here’s What’s Changed

1.  Increased numbers and capabilities of APRNs in the workplace. “Advanced Practice Registered Nurses (APRNs) have expanded in numbers and capabilities over the past several decades,” begins the 2008 document, Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education (informally known as the L.A.C.E. Report; notably, this report suggests that the term “APRN” should now be adopted by agencies versus the older term “APN”). The report, a collaborative work by dozens of nursing organizations and colleges, and referenced by all 50 states, presents a model for APRN regulation and is the go-to resource for APRN terminology and certification

2.  More potential nurses are being drawn to becoming APRNs than in the past. Even though becoming an APRN requires earning a master’s degree, being licensed in one’s state and passing a national certification exam, people are attracted to the increased opportunities that the APRN role presents in terms of both the work itself and salaries. Increased opportunities exist due to healthcare legislation (the Affordable Care Act allows expanded roles for APRNs) and a variety of other changes. One example is the 2016 rule proposed by the Department of Veterans
Affairs (VA)
that would provide full practice authority for APRNs working in the Veterans Health Administration.

As background, the four primary APRN position titles are Clinical Nurse Specialist (CNS), Certified Nurse Midwife (CNM), Certified Registered Nurse Anesthetist (CRNA), and Certified Nurse Practitioner (CNP). Within these roles are a myriad of specialties. For example, CNPs may have such titles as Acute Care Nurse Practitioner, Adult Gerontology Nurse Practitioner, Emergency Nurse Practitioner, Family Nurse Practitioner, Pediatric Nurse Practitioner and Psychiatric Nurse Practitioner.

3.  APRNs are seen as an important piece of solving the primary care provider shortage. See this article published by the Robert Wood Johnson Foundation and this Nursing Shortage Fact Sheet from the American Association of Colleges of Nursing.

4.  AORN’s position statement. One key piece to understanding why APRNs who want to work in the OR are studying the RNFA curriculum is AORN’s Position Statement on Advanced Practice Registered Nurses in the Perioperative Environment (2014). That document included a requirement that, as of January 1, 2016, the APRN practicing in the perioperative environment as a first assistant at surgery must complete a formal program that covers the content of the AORN Standards for RN First Assistant Education Programs.

5.  The desire of perioperative nurses to increase their value to the patient and the surgeon. “What I see is that not only do APRNs want to continue their education but also that having the background of NIFA’s training makes them more marketable,” says Kimberly Jones BSN, RN, CNOR, RNFA, Peri-Operative RNFA Program Director. “They can see a patient throughout the entire surgical process, from office visit to surgery, post-op hospital stay and then follow-up in office. Nurses of all levels of education like seeing that what they do makes a difference to a patient.

“Surgeon groups like the continuity of a specific APRN/RNFA in the OR, and having the bonus of one who can also do rounding is a plus,” added Jones. “It also helps with patient education and explaining to the patients what is going to happen or what did happen when they can get the information from someone who works in the OR with the surgeon. Lastly, with 76 million baby boomers entering Medicare ranks, the APRN represents a solid revenue stream for surgeons’ groups since they can legally bill for Medicare services.”

New Curriculum
Whatever the causes, NIFA is experiencing so many APRNs matriculating into its RNFA programs that it has created a curriculum specific to the APRNs needs. See brochure.

Answer to Last Month’s Teaser
Finally, last month we asked you to guess which was the most common title of APRNs attending the January Denver workshop. You may be surprised to see how the 28 APRN students lined up within the four categories of APRN:
CNS              0
FNP              15
ACNP            11
ANP              2

Perioperative Puzzle: APRN Terms

Check out  this month’s all-new crossword puzzle on APRN terms.

When you’re ready to check your answers, follow this link to see how well you did. Good luck!

Student Spotlight: Charlene Campbell

Name: Charlene Campbell

Credentials: APRN-BC

Student Status: SutureStar workshop, April 2016

Current Position:   APRN in Surgical Services (Endocrine Surgery), New Haven, CT

Where did you get your RN degree?
Columbia University (NYC)

Why did you choose perioperative nursing?
I currently work inpatient for a surgical service. I requested OR time in order to see what occurred in the operating room so that I could give anticipatory guidance to patients during their initial consultation visit. This also helped me be aware of possible complications post operatively on the surgical floor and potential patient concerns.

What is one of the most funny or scary moments you’ve seen at the table?
My surgeons perform certain surgeries under MAC (monitored anesthesia care) sedation. Patients are basically awake while we operate in their neck. Sometimes during our conversations, the patient pipes in their thoughts as well! The patients are totally rational and offer opinions as well as ask questions.

What is one technique or RNFA trick you’ve learned from NIFA that you will use for life?
Gosh, hard to answer! I’ve learned so many techniques. I love the slip knot and suturing technique used when skin is under tension.

How do you feel having your RNFA will impact your life/career?
I think as an RNFA, so many more doors are opened for you career-wise.  You are able to perform procedures that previously only surgical residents or PAs were able to do. The world becomes your oyster!


Click here for the RNFA job postings we’ve collected for you this month.

NIFA – Office Hours

Monday-Friday 8:00am – 4:00pm

Practice Resources

Here are several of the most-in-demand sites for our students, prospective students and grads:

ACS Surgery News: Specialty News and Commentaries, Videos and More
AORN’s “What’s Happening in My State”
RNFA Scope of Practice by State
ACS List of Cases that Require an Assistant at Surgery, 2016 (PDF)
AORN Perioperative Bookstore
Perioperative Nurse Links (state nursing boards & professional associations)
APRN Nurse Links

Disclaimer: The views expressed in this newsletter are strictly those of their respective authors and do not necessarily represent the views of NIFA. NIFA does not give any express or implied warranty as to the accuracy of statements made by our contributors and does not accept any liability for error or omission. It is the responsibility of all perioperative personnel to work within and adhere to their facility bylaws and individual scope of practice.

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