Nurse practitioners (NPs) are advanced practice registered nurses (APRNs) who possess graduate-level education, which allows them to function with an expanded scope of practice in healthcare settings. These clinicians receive specialized training that includes a strong focus on diagnostics, pharmacology, and comprehensive patient management across the lifespan. While NPs do not act as the primary surgeon who makes the main incision and is ultimately responsible for the operation, they are integral members of the surgical team and play an active, hands-on role in the operating room.
Defining the Nurse Practitioner’s Role in Surgery
The primary role of a Nurse Practitioner in the surgical environment is that of a surgical first assistant, a function distinct from the primary surgeon who directs the procedure. This specialized support is provided directly at the operating table to enhance efficiency and patient outcomes. This function requires specialized training, often pursued by NPs in acute care or a surgical subspecialty.
This collaborative model ensures the NP practices within their defined scope while contributing their advanced clinical knowledge and skills. Some NPs pursue credentialing as a Registered Nurse First Assistant (RNFA), which documents the acquisition of specific surgical assisting skills and knowledge. This specialized training allows the NP to provide seamless care across the entire perioperative trajectory, from initial consultation through recovery.
Specific Intraoperative Duties
During surgery, the Nurse Practitioner’s contribution is technical and hands-on, focusing on tasks that facilitate the primary surgeon’s work. A primary duty is providing surgical site exposure, which involves manipulating and retracting tissues to give the surgeon a clear view of the operative field. They are also responsible for achieving hemostasis, meaning controlling bleeding.
The NP may handle and manipulate tissues and organs, suction fluids, and use various surgical instruments and medical devices to assist the procedure. Crucially, the NP often performs the meticulous closing of the surgical site at the conclusion of the main procedure. This closure can involve suturing multiple layers, including fascia, subcutaneous tissue, and the skin, which is a significant technical skill performed under the surgeon’s direction.
Regulatory Models and State Variation
The extent of an NP’s autonomy, including their ability to function as a surgical assistant, is determined by state-level practice regulations. These regulations fall into three categories defining the required relationship between the NP and a physician.
Full Practice Authority (FPA)
FPA states permit NPs to evaluate, diagnose, treat, and prescribe medications independently, without physician oversight.
Reduced Practice Authority
Reduced Practice Authority states require the NP to maintain a career-long regulated collaborative agreement with a physician to perform certain practice elements, such as prescribing medications.
Restricted Practice Authority
Restricted Practice Authority states impose the greatest limitations, requiring career-long supervision or team management by a physician for the NP to provide patient care. These state nurse practice acts directly dictate the necessary level of physician collaboration or supervision required for the NP to be granted hospital privileges to act as a surgical first assistant.
Pre- and Post-Surgical Patient Management
Beyond the operating room, the Nurse Practitioner manages the patient’s surgical journey across the perioperative period.
Pre-operative Phase
In the pre-operative phase, NPs conduct detailed physical examinations and risk assessments to ensure the patient is optimized for surgery and anesthesia. They order and interpret diagnostic tests, coordinate with specialists, and address existing health conditions that could complicate the procedure or recovery.
Post-operative Phase
After surgery, the NP manages the patient’s immediate post-operative care, monitoring for complications and implementing appropriate pain management plans. They perform daily hospital rounds, evaluate wound healing, and adjust medications as necessary. NPs are also involved in discharge planning, writing discharge summaries, providing patient education, and coordinating follow-up appointments, ensuring a smooth transition to recovery.