July 2019 • Volume 12, No. 7

From the Editor

This month The Lancet published a report on a study about nerve transfer surgery for spinal cord injury patients, in which nerve transfer surgery enabled 13 individuals with paralysis to regain some arm and hand functions—see the story later in this issue.

That is impressive news, and we’re using that as our reason to feature a variety of nerve-related topics in this issue.

Read on for an announcement about our new team member, Dr. John Russell, DNP, APRN, FNP-BC, RN, CCRN, RNFA, who has just been named NIFA’s APRN RNFA Program Director.

We bring you a new crossword puzzle, this time on the topic of bullying.  Scroll down for jobs we’ve collected for you, along with NIFA’s favorite links.


Julie Lancaster, Editor


New APRN Program Director Announced

Dr. John Russell, DNP, APRN, FNP-BC, RN, CCRN, RNFA, has just been named NIFA’s APRN RNFA Program Director/Instructor.

Back in 2016, when John was pursuing a Doctorate of Nursing Practice, he was a student in NIFA’s RNFA program.  Click here to see the Student Spotlight profile we ran about him then.

Still working as a Cardiothoracic Surgery Nurse Practitioner, John is a First Assistant at Swedish American Hospital in Rockford, IL. For the past few years he has worked for NIFA as an instructor and as a grader of online logs and case studies.

In addition, two years ago John founded a company, Skills On Point, which delivers transitional education for nurses who are becoming NPs and PAs. They offer online training and destination workshops where experts teach needed NP skills at a basic level—what John calls, referring to the best-known Girl Scout Cookies, “the Thin Mints® and Samoas® of skills: the most popular skills that everyone should have”—with a focus on skills needed for credentialing/privileging. They also offer continuing education and custom-built, concierge programs for NPs.

John’s company puts him into contact with schools around the country that are offering NP programs. The majority of students Skills On Point supports are within a year of graduation of NP school, either pre- or post-graduation. So he is in an excellent position to identify people on an NP track who are candidates for becoming RNFAs and talk to them about NIFA. Which he is glad to do, because he himself is a graduate and a fan.

“I love what NIFA does for people,” he says. “The National Institute of First Assisting, Inc., takes nurse practitioners like me with zero experience in the operating room and invests a considerable amount of time and 1:1 training to guarantee you will be successful in your role in surgery. Although I cannot speak to other first assisting training programs, I can speak as a NIFA graduate that I was well trained and am able to use those skills daily in my role.

“I also can say that without the skills taught at NIFA, my company Skills On Point LLC would not have a skill set for me to teach others from,” he adds. “I certainly give credit where it was due and want to give that back to help others.”

Surgical News

13 Adults with Complete Paralysis Benefit from Nerve Transfer Surgery

“A new study showcases the benefits of nerve transfer surgery—sometimes in combination with traditional tendon transfer surgery—for restoring upper limb function in people with complete paralysis,” writes Ana Sandoiu in Medical News Today.

Traditionally, surgical interventions to restore the function of the hands and arms have involved tendon transfer surgery. To perform this procedure, surgeons take healthy, functional muscles that have a less important role and relocate them, replacing the muscles that sustained damage as a result of the injury.

“Nerve transfer is an alternative to tendon transfer. Unlike the latter, nerve transfer involves reanimating, or re-innervating, the damaged muscle. . . . Now, a prospective study has examined the effects of nerve transfer surgery in 16 young adults, following up on their progress up to 2 years after surgery.”

Read about the study in Medical News Today.

Read the abstract/link to the full study in The Lancet.

Perioperative Peripheral Nerve Injury (PNI)

Perioperative Peripheral Nerve Injury (PNI) is an important cause of disability and malpractice claims. Although much of the focus in prevention has do do with anesthesia, PNI can also result from positioning errors and direct mechanical injury, among other causes. Here are two resources:

  • Summary from TND: Experts in Neurology and Neurosurgery. This overview discusses the anatomy of peripheral nerves, terminology (e.g., nerve insult, neurapraxia, nerve injury, neuropathy and nerve dysfunction), specific types of PNI, and the causes. Read more . . .
  • Perioperative Peripheral Nerve Injuries: A Retrospective Study of 380,680 Cases during a 10-year Period at a Single Institution. “Perioperative peripheral nerve injury represents a notable source of anesthetic complications and can be very debilitating,” reads the abstract for this 2009 report. “In the most recent American Society of Anesthesiologists (ASA) closed claims analysis, nerve injuries comprise 15–16% of the claims. The fact that this percentage was relatively unchanged between studies performed almost a decade apart underscores the need for a more comprehensive understanding of risk factors for this persistent problem.”   Read more . . .


Peroneal Nerve Decompression. Peroneal neuropathy symptoms include pain, numbness, and foot drop. When secondary to compression of the nerve at the fibular head, peroneal (fibular) nerve release is a low-risk procedure than can provide pain relief and return of function. University of Wisconsin School of Medicine and Public Health, Madison, WI. Watch video . . .

Animation: Peroneal Nerve Decompression. For further learning, here’s an animation of the same kind of process as above.
Watch video . . .

Decompression Transposition Surgery on Elbow. This video shows a Decompression Transposition Surgery on the ulnar nerve (aka “funny bone”) in the elbow of the patient. The surgery will reduce pain in the elbow and numbness in the fingers that has caused severe problems with the hand. Christian Hospital in St. Louis, MO.  Watch video . . .

A Minimally Invasive Lumbar Discectomy. The patient had lumbar disc herniation resulting in severe back and buttocks pain. In this video, the surgeon pulls out a piece of disc that had been pressing on the nerve. Johns Hopkins University, Baltimore, MD. Watch video . . .

Crossword Puzzle: Bullying

This month’s all-new crossword puzzle addresses a topic that has received more and more attention in recent years: bullying in the health-care setting. Click here for the blank puzzle.

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

Jobs Front

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

NIFA – Office Hours

Monday-Thursday, 8:00am – 4:00pm
Friday, 8:00am – 3:00pm

Practice Resources

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

MD Edge Surgery News: Specialty News and Commentaries, Videos and More
RNFA Scope of Practice by State (PDF)
ACS List of Cases that Require an Assistant at Surgery, 2018 (PDF)
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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