Regulations Related to Providing Certain Health Care Services

     Re: First Assisting at Surgery

Q:  What is the current information regarding NPs first assisting in the OR?  If you have specifics on who can bill and the current law, that would be helpful.  Do you anticipate any additional legislation addressing this issue?

A: HB 1718 became law and was effective on September 1, 2005. As of that date, NPs and other advanced practice nurses (APNs) are exempt from the requirement for other RNs to be a certified nurse in perioperative nursing (CNOR). As a consequence, APNs first assisting under this provision are not required to have two years of OR experience. APNs must complete a first assisting course acceptable to the Board of Nurse Examiners (BNE), just as they have since the BNE wrote it position statement on that topic in the early 1990s. APNs first assisting under this provision may bill for first assisting services.

Other RNs and APNs who have not met these requirements may first assist under the “direct supervision” provisions added to the Nurse Practice Act (NPA) by HB 1718. That provision in the NPA does not permit any provider to bill for the RN or APN’s services.

The BNE recognizes Registered Nurse First Assistant (RNFA) courses approved by the Certification Board for Perioperative Nursing (CBPN). Therefore, if they have not already done so, NPs who wish to first assist and bill for the service should complete a CBPN approved course in first assisting as soon as possible. These courses generally take about 6 months to complete, and involve approximately 6 days of onsite content. The rest of the course involves online assignments and clinical experience in your home town. To find a list of CBPN approved courses, go to http://www.cc-institute.org/cert_crnf_prep_rnfa.aspx. Unfortunately, there is only one RNFA course offered in the state of Texas, and that course at UT Arlington does not currently admit APNs who have not had at least two years of OR experience.