The last several years have seen increased rates of burnout amongst APPs and physicians alike. Since provider engagement is a proven antidote to burnout, several of us have chosen to engage by becoming involved in ongoing research efforts. Using us as a local resource not only helps to increase engagement but also results in the feeling of being a true stakeholders in our department’s successes on regional and national levels. I have personally experienced the satisfaction of a poster presentation, and have been a first-author on a publication in a major spine journal. With a new original study pending publication and multiple publications as first and second author submitted this year alone, I have been provided with an opportunity for continued education, career development and a feeling of accomplishment. I have also become an example for other APPs who are looking to provide meaningful contributions to published medical knowledge. Being deeply involved in our research and academics program has helped to increase my level of engagement in the clinic and in the operating room as I can see the direct impact of my work on improving the care of our spine patients.

Many in the medical field remain unaware of the potential of utilizing an advanced registered nurse practitioner (ARNP) in surgical settings. The use of ARNPs in outpatient settings or hospital-based services is relatively routine, yet there is a lack of clarity regarding the steps necessary to become first assistants in the operating room. Some states explicitly permit NPs to function as first assistants while others require additional steps or have specific limitations. I chose to pursue certification through the National Institute of First Assist, as this certification is widely accepted within the healthcare industry and satisfies most state requirements. Each hospital may have its own rules as well. At Virginia Mason, my certification did not automatically result in credentialing committee approval for first assist privileges Through effective leadership and advocacy, I was able to obtain approval for my certification and formalize the process for future ARNPs who meet the institutional requirements. I have a gratifying level of autonomy as an ARNP and first assist in the operating room. As a new graduate it is crucial to educate potential employers about one’s skill set, scope of practice, and their relative advantages. This proactive approach can pave the way for NPs to contribute significantly in the dynamic environment of surgical practices.

Having worked at Virginia Mason Franciscan Health for over 10 years I have witnessed both my surgical skill and clinical abilities increase substantially. Our position as a large hospital without a neurosurgical or orthopedics residency has allowed our APP group to step into a role more analogous to an experienced resident rather than being regulated to a typical first assist role. From the APP perspective, education starts with senior members, both APP and MD, mentoring newer colleagues to ensure their career is advancing in technical skill, understanding, and knowledge base. Outside of the hospital system, inclusion in activities such as journal clubs, conferences and CME further enhances the education of the entire team. These opportunities have resulted in increased surgical skill, increased responsibilities in the operating room, improved job satisfaction and less turnover among staff. All practitioners a benefit from this training as it allows for better skill-task alignment, freeing up a surgeon’s valuable time. Greater autonomy allows more items to be delegated to the APP team both in and outside of the operating room, including APP-independent exposure and closure and skilled assistance during instrumentation and positioning. Consultations and rounding are handled by the APP team and reviewed with the on-call attending. While our complex spine fellows initially often have worries about the effect that APPs may have on their training, they typically find that an experienced APP team is extremely efficient, especially in their early months, with the team acting as a valuable resource and knowledge base to ensure continuity of care.