I'm pretty sure there are three types of surgical assistants.
CFAs are "Certified First Assistants". They were at one point CSTs, which are Certified Surgical Technologists. CSTs basically fill the role of the scrub nurse, by keeping instruments sterile and passing them to the surgeon. CFAs have to work as First Assistants on 350 cases and then they take the CFA exam.
Getting your CST means going to school and getting a certificate or an Associate's. About two years.
RNFAs are "Registered Nurse First Assistants." They are RNs that get some of additional training at a surgical course. They have to have been CNORs first. CNOR is the certification for OR nurses. They don't need BSNs, so you can go with a Diploma in Nursing or an Associate's.
And then of course there are PAs. I don't know too much about their training. I'm pretty sure they just graduate with their PA and their surgeon trains them.
Duty wise, I'm not really sure. I think its basically suturing and suctioning.
http://www.aorn.org/practice/rnfa.htm
http://www.surgicalassistant.org/html/Certification.html
http://www.aaspa.com/
Maybe those links will help you out.
It's a little bit more than suctioning and suturing.
I'm a neurosurgical PA and I'll give you a little taste of what my job involves.
Monday is a clinic day and we usually start by rounding on patients. I'll go ahead of my doc and see the patients in the ICU/CCU/floor and do quick exams, talk with their nurses, review labs and events overnight and change dressings and pull drains, if needed.
When my doc gets there we will see the patients he is concerned about again and then we will split up the work of writing progress notes, writing discharge orders and discharge summaries.
After this we will head to the office and start clinic. We will see forty to fifty patients and we just go with the flow and grab the next chart that's up. If it a post-op I'll usually just see them, do what needs to be done and talk with him about the patient later. If I have questions or want him to look at something I'll grab him. If its a new patient I'll do a history and physical and then present the patient to him and we'll go see them together after that. At the end of the day we finish our dictation, do pre-op labs/orders, refill scrips and anything else that needs to get done.
Tue, Wed and Thu are OR days and I'll get to the office a few minutes early and grab any MRI's or CT's that we need for our cases and then I'll head over to the OR. When I get there I or my doc, if he is there yet, will go see the patient that we're about to operate on mark their surgical site and answer any questions they might have. I also review the consents and pre-op orders to make sure their are no problems.
After this I'll hit the OR and pull up the CT/MRI, if its on the computer and I'll check with the scrub tech to make sure they have what we're going to need for the surgery. By this time the patients in the room and I'll help do whatever is needed to get the case going, whether it is helping anesthesia or positioning the patient or shaving the head and applying the Mayfield/Sugita clamp, if my doc is on the phone or out of the room.
Once they are all positioned I'll go scrub and drape the patient out. This is usually when my doc scrubs in and we'll start the surgey. I help with retracting, suctioning, suturing, drilling burrholes, whatever is needed. This sometimes includes doing parts of the instrumentation (drilling while he holds the drill guide and then screwing in the screws) or preparing the bone flap by putting on plates and screws, etc, etc. Near the end I'll help with the job of suturing the wound closed, placing drains and I usually apply the dressings. After the case I'll remove the clamps and wrap the head if needed. After that, we'll go see more patients on the floor while they are getting the room ready for the next case.
Friday is another clinic day like Monday.
This is what it's like when we are not on call. There are only two neurosurgeons for a large surrounding area and because of that we take call every other week. While on call, I may do consults or if we have an emergency case, I'll usually get there before my doc (I live closer) and get a quick H and P, review the CT scans and possibly call the OR if I'm pretty sure that we're going to be coming up. I also usually do the H and P right before surgey and get the consent forms going.
Every other weekend I make rounds at the two different hospitals that we work at and I'll write notes and take care of any problems. I usually consult with my doc after I make rounds just to make sure that he is up-to-date.
Just keep in mind, I graduated a little over three months ago and have not been with him very long and he trusts me to do more and more every day. (Disclaimer: I have a background in the OR, lab and as an EMT), so this may be a little faster than some graduates are given responsibility.
I also take call for patient problems and if I can't answer the question, I'll call my boss.
I have a very good relationship with my doc and everything is pretty free-flowing. If I have any questions at all or don't feel comfortable with something I'll either just wait until he gets there or I'll give him a call.
Lately, my boss has stated that he wants me to see patients entirely on my own, do a history and physica, review the X-rays/CT/MRI and then present to him with what I want to do for the patient or what I think needs to be done. I'm still making some mistakes, but that is to be expected, but more often that not, I'm pretty close. In addition, he wants me to take a larger role in surgery and has said that eventually he will have me do ventrics, nerve/muscle biopsies, carpal tunnel releases and turn skull flaps, always with him right by my side of course.
There is no real reason for him to do this other than he loves to teach and he knows I'm intrested and motivated. I will never be doing them alone and I really would not want to. Some of the operations are simple enough, but complications can rear their ugly head and that is where you really need experience.
For someone who spent many years in the OR as a scrub tech, its a great job as I've really missed the OR. I get to do what I love, help people and am still evolving in my role and responsibilities. I may tire of it someday, but as a PA I can move on to a different surgical speciality or another special entirely if I so choose.
So, there is a little more to it than suturing and suctioning.
-Mike
