From the April 2, 2009 Issue

Donna Howerton, RN, BSN, CNOR, CRNFA
Galesburg, IL

I had been an OR staff nurse for 12 years when I decided to take NIFA’s First Assistant program in 1998. I thoroughly enjoyed the ease of the program and especially the didactic workshop in Denver. It was well worth the money I spent to further my education.

After I returned to work, I dropped one day in the OR to work as First Assistant to an orthopedic surgeon who was willing to be my sponsor. This went on for a couple of weeks, when suddenly my OR Director (who used to be the Private Scrub for this same surgeon) took me aside and told me, “I’m afraid that you working as a First Assistant and as an OR staff nurse is a conflict of interest.” I told him that I was a First Assistant only on my day off. He said, “The patients who see you may not know the difference and it could cause us problems.” I told him that I introduced myself to the patients as a First Assistant on my First Assistant days and as the staff nurse on the other days. Besides, it’s not like the same patient was there everyday to even notice me with different “hats” on. He said, “Well, you are going to have to make a decision to either be a staff nurse or a First Assistant.”

I went home fuming and talked it over with my husband. I also called the orthopedic surgeon I was working with and told him the story. He said he would love to work with me full-time but they didn’t have any openings in his office. I proposed that I would work for him as an independent practitioner; he would have First Assistant services from me on every one of his cases, whether they were billable or not, and it wouldn’t cost him a dime. He jumped at that idea. He said he would have his office nurse call me with his schedule the next day. We planned on starting as soon as I was released from my job at the hospital in two weeks.

After that conversation, my husband and I decided to pull four months of living expenses out of his 401K and I wrote up my resignation. When I delivered it to my Director, he said, “This is not the answer I expected from you.” I told him that I refused to let anyone stand in the way of advancing my career. I got business cards printed and a brochure about me and what a First Assistant was, so that the doctors offices could hand them out to patients. Two weeks later, I was working full-time with this orthopedic surgeon, plus I added on another orthopedic surgeon and two general surgeons. I kept a date calendar and worked on a first-come, first-served basis. Sometimes, I was juggling two surgeons at two different hospitals.

I signed on with NIFA Medical Billing. I contact the doctor’s office for my billing information and forward it to their office in California. It takes two to three months from the time I do a case before I receive either a check or a denial from the insurance companies. NIFA Medical Billing appeals every case that is denied and often they win the appeal. I cannot say enough nice things about that billing group and how hard they work for their clients.

Even though half of the cases I do are Medicare or Public Aid (which non-NP RNFAs don’t get paid on but PAs do – grrrrrr!), and some of my cases are denied because a First Assistant is considered “not medically necessary,” I still receive more money than I did as a full-time OR staff nurse, and that’s including call pay! A single case will sometimes pay what I would have received for a full day (or even four days) as an OR nurse. And the best part is I usually am done by noon or 1:00 p.m. I’m not involved in the “politics” of the OR; I do my job and I leave. The doctors are happy and I am happy. I am finally doing the job I love and am so happy that I “stepped out of the boat” on faith and prayer to make this change. I schedule myself with a surgeon for the day regardless of whether I get paid or not, because it helps improve my skill level and builds camaraderie.

It was tough the first few weeks working in a new capacity with the OR staff I had worked with for so many years. To get around any resistance, I made sure to help them in the room in any way I could. I stayed and helped clean up the room and prepared for our next case. I would let them know exactly what the doctor needed if I didn’t see the instrument on the field and I would thank them all when I left. I wanted them to know that I was still a team player even though I was no longer officially one of them. It took a while, but we all have a great relationship now. They comment how they appreciate my help and are glad to see me come with the doctor. My goal was never to be better than any of them. My goal has been to make the day easier and enjoyable for everyone.

Oh, and by the way, I have been an independent CRNFA for 10 years now!!!!