HomeFeaturesDay in the Life of a Surgical Nurse Practitioner (NP)

Day in the Life of a Surgical Nurse Practitioner (NP)

“It’s really exciting to see more NPs learning about the exciting career that they can have within the surgical realm. We’re passionate about this work, and the future, to me, is really about helping more people match to what their passion is.”

Dr. Jennifer Rodgers, Vice President of Advanced Practice for the University of Colorado Hospital and University of Colorado School of Medicine

Surgical NPs specialize in one or more aspects of surgical care. Often beginning their career with training as acute care nurse practitioners (ACNPs), their work environment typically exists within a hospital, but they can work anywhere there’s an operating room or clinic.

Surgical NPs may specialize in a particular patient population, such as adult or pediatric care, or they can focus on a particular aspect of surgical care. In addition to their clinical duties, surgical NPs will also counsel patients and their families during what can be a difficult time.

Surgical care is an intense, rewarding, and fast-paced specialty practice area for NPs; some new NPs may find the initial transition into surgical care challenging. As a result, many NPs are turning to fellowship programs that facilitate the transition to specialty practice alongside other advanced practice providers (APPs) such as physician assistants or associates (PAs). These programs are forming new and robust pathways for NPs looking to practice in areas like surgical care, and they’re also setting standards of interprofessional and multidisciplinary collaboration that are a working prototype for the future of healthcare delivery.

Read on to learn more about the role of the surgical NP, the rise of specialty fellowship programs, and the importance of collaboration between APPs in areas like surgical care.

Meet the Experts

Jennifer Rodgers, DNP, ACNP-BC, FAANP

Dr. Jennifer Rodgers is Vice President of Advanced Practice at the University of Colorado Hospital and School of Medicine, and Founder of the UCHealth APP Surgical Fellowship Program.

Dr. Rodgers is a voting member of the Medical Board at the University of Colorado. She leads over 700 APPs and nearly 50 APP leads. She oversees and supports APP workforce, recruitment, hiring, development of new APP models of care, strategic and operational oversight, promotion, mentoring, professional advancement, and student placement.

Dr. Rodgers received her DNP from the University of Alabama. She is board-certified as an acute care nurse practitioner (ACNP-BC), with 21 years of experience as a pulmonary nurse practitioner, caring for adult patients from critical care to hospice.

She also serves on the National Advanced Practice Advisory Council and is a fellow of the American Association of Nurse Practitioners (FAANP). Dr. Rodgers was awarded the AANP State Award for Clinical Excellence and the University of Colorado Hospital Medical Staff Leadership Award.

Dr. Rodgers was interviewed for this feature in August 2022.

Kara Mestnik, DNP, APRN, FNP-C

Dr. Kara Mestnik is a family nurse practitioner specializing in thoracic and foregut surgery at the University of Rochester Medical Center (URMC). She is also a surgical advanced practice provider (APP) manager at URMC.

Dr. Mestnik completed her bachelor of science in nursing and master of science degree at St. John Fisher College in Rochester, New York. She went on to complete her DNP from the University of Rochester School of Nursing.

Dr. Mestnik holds a national certification with the American Academy of Nurse Practitioners (AANP). Her career passion incorporates the professional advancement of the Advanced Practice Provider while helping to shape clinical care outcomes among the surgical population.

Dr. Mestnik was interviewed for this feature in March 2024.

The Role of the Surgical NP

A surgical NP is, broadly speaking, an NP who works in surgical care. But that’s a wide area of practice, with the continuum of care consisting of several stages: preoperative care, which includes diagnosis and setting of a surgical plan; intraoperative care, which involves the actual surgical procedure; and postoperative care, which includes the recovery from surgery, and can take place in any setting from critical care to acute care, depending on the depth and complexity of the procedure.

“A surgical NP specializes in some aspect of surgical care,” Dr. Rodgers says. “They might follow a particular population across that entire surgical continuum, or they might specialize in one part of surgical care and then rely on their NP or PA colleague to do another part of care.”

Surgical care can be an intense, high-stakes area of practice. Surgical RNs play an important role, too: they’re experts at assessing and implementing patient care. But while a surgical RN’s work is largely driven by orders, a surgical NP is generally the one making decisions.

“It can be a very quick and emergent situation,” Dr. Rodgers says. “Sometimes you’re at the bedside, making decisions. It builds on the foundation you have as an RN: that understanding of patients, of relationships, of connectivity, is still there. But the surgical NP role adds the diagnosis, the treatment, the idea of being the person managing that surgical care. It’s a big adjustment.”

The nursing foundation is a crucial aspect of surgical care for NPs. Whether preoperative or postoperative, whether complex or relatively simple, surgery is often an anxious time for patients. So, in addition to being expert clinicians, surgical NPs must maintain their ability to see and treat the whole person.

“A good surgical NP connects on a deeply personal level,” Dr. Rodgers says. “This is a vulnerable and pivotal time for patients. It’s complex and scary. A really good surgical NP will be there for a patient and their family throughout their journey, advocating for them, answering questions, being available and supportive.”

The Rise of Fellowships for Surgical NPs

Surgical NPs are typically trained as acute care NPs (ACNPs), rather than family NPs (FNPs). But there is no degree program related specifically to surgical care for NPs. As a result, one of the big challenges for NPs and other APPs moving into surgical care is the rapid immersion one experiences when moving from training to practice.

“I remember my first day in surgical care,” says Christan Bartsch, PA-C, past director of the APP Surgical Fellowship at UCHealth. “It was a little like drinking water from a fire hose.”

Surgical fellowship programs like the one at UCHealth aim to smooth that transition from training to practice, and create clear paths for NPs, PAs, and other APPs who want to specialize in a high-intensity area like surgical care.

The 12-month fellowship includes weekly didactic education and a skills lab, where the APP learns knot-tying, laparoscopic techniques, and other lab skills needed in surgical care. It also includes several rotational experiences, so the fellow can gain experience in areas like acute care surgery, trauma surgery, critical care, surgical oncology, breast surgery, colorectal surgery, and cardiothoracic surgery.

“I’ve watched our fellowship grow from four APP fellows per year to eight, and we’re hoping to see it grow even further next year,” Bartsch says. “It gives our APPs a lot of perioperative experience, and the confidence to be autonomous APPs in surgical care following their graduation from the fellowship.”

Fellowships are also an important way of fostering collaboration between surgical NPs and other care team members, from resident physicians to RNs, to PAs, to support staff, to everyone in between. Especially in a specialty like surgery, an orchestra of different specialties is required, and to have those specialties work together in a fluid and efficient manner is an essential component of providing quality care.

“We each have our specialty, our area of interest, the place we thrive,” Bartsch says. “When we all work together, everyone’s receptive to hearing other people’s opinions to optimize patient outcomes. It’s not a hierarchy; it’s a multidisciplinary approach.”

“In a teaching hospital like ours, we work really hard to bring our learners together,” Dr. Rodgers says. “We have our physician residents on the team, and we have our post-graduate NP and PA fellows, and we bring them together as a collaborative group to learn about each other. If you don’t have that intentional focus, you could indirectly create an environment where people are competing against one another, or not working towards the same goal. And if you’re new and you haven’t had the opportunity to learn how to collaborate well, it could be really hard to find your way as a surgical NP.”

The Future for Surgical NPs

The next frontier for surgical care is the reimagining of the healthcare environment. Innovations in how providers connect with patients mean that care is moving outside of the hospital and taking on creative forms. Surgical NPs, with their patient-focused and holistic approach, will be a valuable resource in adapting care to the future healthcare environment in a compassionate, human way.

Surgical NPs will also continue to advocate for patient access, whether that is through new forms of care delivery or for the wider acceptance of their fellow APPs as critical components of a collaborative medical workforce.

“A main point of advocacy for surgical NPs, PAs, and APPs continues to be improving access to care for patients,” Dr. Rodgers says. “If we always come from a place of wanting to serve patients and then matching our skills and expertise to that, that’s the best approach. There’s plenty of work for all of us in healthcare.”

Both Bartsch and Dr. Rodgers see a bright and growing future for NPs who choose to work in surgical care. The rise of fellowship programs, like the one at UCHealth, is already an important step toward the field’s growth and maturation. Standardizing the credentialing recommendations and accreditation criteria related to postgraduate fellowship programs will help them take the next step.

As those standards become established and fellowship programs continue to grow in popularity and rigor, NPs and APPs will contribute to increasing academic research, establishing themselves further as important pieces of the multidisciplinary structure in the field of surgical care.

“It’s really exciting to see more NPs learning about the exciting career that they can have within the surgical realm,” Dr. Rodgers says. “We’re passionate about this work, and the future, to me, is really about helping more people match to what their passion is.”

Update 2024: Increased Capacity and Collaboration

Over the last few years, more surgical departments have turned their eyes towards their NP and PA staff. New fellowships have cropped up to educate and train APPs to assist in specialized surgical care. As a result, the APP workforce is growing more sophisticated and capable.

“I’ve certainly seen the role of the advanced provider change and morph, even within my own subspecialty of thoracic surgery,” Dr. Mestnik says. “In my role as Surgical Manager at URMC, one of my passion areas has been finding ways to increase bandwidth and capacity in terms of APP practice.”

Surgical care is unique as a practice area in that, unlike primary care or neurology, patients are rarely seen individually. Surgical care is a team sport with defined roles for physicians, nurses, NPs, and PAs. Interprofessional collaboration is more important than ever.

“No one person within the Department of Surgery can do everything for our patients individually,” Dr. Mestnik says. “We each have something we bring to the table, a unique skill set.”

In response to the Covid-19 pandemic, many surgical NPs had to adapt. As elective surgeries got put on hold, surgical NPs stepped up in other areas—for example, in facilitating surgical emergency rooms—and many found themselves better prepared than they might’ve expected.

“A lot of us were asked to reinvent ourselves,” Dr. Mestnik says. “And we realized that we really have the ability as a group to collaborate with and work in other subspecialties. Our training allows us to do that.”

In 2024, surgical NPs and other specialized APPs are finally being used to the full extent of their scope of practice. That’s a major win: even ten years ago, Dr. Mestnik says, APPs were still drastically underutilized. Much progress has been made, and many hope the trend will continue.

“If I were to make a prediction, it’d be that APPs will continue to be used to the top of our scope of practice,” Dr. Mestnik says. “I think everyone is starting to recognize the role and the value of the contribution that we make on a day-to-day basis for our patients.”

As more specialized fellowship programs, like the one at URMC, come into existence, more and more NPs will have the chance to gain firsthand experience and expert training simultaneously. These programs offer fellows a chance to experience what Dr. Mestnik calls “the controlled chaos of surgical care” and learn more about the accountability that goes with the field’s high stakes. Those high-pressure environments might cause reticence to the layman, but surgical NPs tend to be drawn toward them.

“As we were putting the fellowship program together, we kept saying that we wished we could’ve gone through it ourselves,” Dr. Mestnik says. “A lot of us are lifelong learners, and in medicine, you have to be.”

The future remains bright for surgical NPs. Currently, URMC is developing a perioperative program devoted to intraoperative care for patients, which will expand the capabilities of the surgical NP even further. And, in the not-so-distant future, Dr. Mestnik sees opportunities for surgical NPs to work with robotics (for surgical assists) and AI (for documentation).

“It’s a very exciting time,” Dr. Mestnik says. “If people have the slightest bit of interest in pursuing a surgical fellowship, they absolutely should.”

Resources for Surgical NPs

To learn more about the work and advocacy of surgical NPs, and to connect with those in the field, check out some of the resources below.

Academy of Medical-Surgical Nurses (AMSN): The only professional association for medical-surgical nurses, AMSN supports nurses throughout their professional careers, from nursing school through certification.
MEDSURG Nursing: A scholarly journal dedicated to advancing evidence-based medical-surgical nursing practice, clinical research, and professional development.
UC Health Advanced Practice Provider (APP) Surgical Fellowship Program: Designed for both physician assistants (PAs) and adult acute care NPs (AG-ACNPs), this fellowship program is ideal for APPs looking to make a smooth transition into a surgery specialization.
URMC Advanced Practice Provider (APP) Fellowship Program in Surgery: Through evidence-based education, mentorship, and hands-on clinical training, this fellowship seeks to cultivate clinical expertise, critical thinking, and leadership capabilities in NP and PA fellows.

Matt Zbrog

Writer

Matt Zbrog is a writer and researcher from Southern California, and he believes nurse practitioners (NP) are an indispensable component of America’s current and future healthcare workforce. Since 2018, he’s written extensively about the work and advocacy of NPs, with a particular focus on the rapid growth of specialization programs, residencies, fellowships, and professional organizations. As part of an ongoing series on state practice authority, he’s worked with NP leaders, educators, and advocates from across the country to elevate policy discussions that empower NPs. His articles have featured interviews with the leadership of the American Association of Nurse Practitioners (AANP), the National Association of Pediatric Nurse Practitioners (NAPNAP), and many other professional nursing associations.