MissouriAssociationof RN First Assistants

RNFA Specialty Assembly Mission Statement

The RNFA Specialty Assembly is a coalition of perioperative nurses dedicated to the advancement of the role of the RN First Assistant.  Operating within the jurisdiction of and in collaboration with the Association of Operating Room Nurses (AORN), we provided a forum for the development of standards, the exchange of information, and the opportunity for education relative to the practice of the RN First Assistant.  In so doing, we enrich the quality of patient care and promote the enhancement of the role of the RN First Assistant among our health care colleagues and the community at large.

Revised AORN Official Statement on RN First Assistants

PREAMBLE

Perioperative nursing practice has historically included the role of the RN as assistant at surgery. As early as 1980, documents issued by the American College of Surgeons supported the appropriateness for qualified RNs to first assist.

AORN officially recognized this role as a component of perioperative nursing in 1983 and adopted the first Official Statement on RN First Assistants (RNFA) in 1984. All state boards of nursing recognize the RNFA role as being within the scope of nursing practice.

AORN’s official statement delineates the definition, scope of practice, qualifications, educational requirements, and clinical privileges that must be met by the perioperative nurse who practices as an RNFA. AORN further recognizes the need for appropriate compensation/reimbursement to RNs who fulfill this role in providing perioperative patient care.

DEFINITION OF RN FIRST ASSISTANT

The RN first assistant at surgery collaborates with the surgeon and the health care team in performing a safe operation with optimal outcomes for the patient. The RN first assistant practices perioperative nursing and must have acquired the necessary knowledge, skills, and judgment specific to clinical practice. The RN first assistant practices in collaboration with and at the direction of the surgeon during the intraoperative phase of the perioperative experience. The RN first assistant does not concurrently function as a scrub nurse.

SCOPE OF PRACTICE

The scope of practice of the nurse performing as first assistant is a part of perioperative nursing practice. Perioperative nursing is a specialized area of practice. The activities included in first assisting are further refinements of perioperative nursing practice which are executed within the context of the nursing process. The observable nursing behaviors are based on an extensive body of scientific knowledge. These intraoperative nursing behaviors may include:

• handling tissue,
• providing exposure,
• using instruments,
• suturing, and
• providing hemostasis.

These behaviors may vary depending on patient populations, practice environments, services provided, accessibility of human and fiscal resources, institutional policy, and state nurse practice acts.

The decision by an RN to practice as a first assistant must be made voluntarily and deliberately, with an understanding of the professional accountability that the role entails.

QUALIFICATIONS OF THE RN FIRST ASSISTANT

Qualifications for RN first assistants should include, but not be limited to:

• certification in perioperative nursing (CNOR);
• documentation of proficiency in perioperative nursing practice as both a scrub and circulating nurse;
• ability to apply principles of asepsis and infection control;
• knowledge of surgical anatomy, physiology, pathophysiology, and operative technique related to the operative procedures in which the RN assists;
• ability to perform cardiopulmonary resuscitation;
• ability to perform effectively in stressful and emergency situations;
• ability to recognize safety hazards and initiate appropriate preventive and corrective action;
• ability to perform effectively and harmoniously as a member of the operative team;
• ability to demonstrate skill in behaviors unique to the RN first assistant (as defined);
• meets requirements of statutes, regulations, and institutional policies relevant to RN first assistants; and
• successful completion of an RNFA program that meets the AORN Recommended Education Standards for RN First Assistant Programs.

PREPARATION FOR THE RN FIRST ASSISTANT

The complexity of knowledge and skill required to effectively care for recipients of operating room nursing services compels nurses to be well educated and to continue their education beyond generic nursing programs.¹

Perioperative nurses who wish to practice as RN first assistants must develop a set of cognitive, psychomotor, and affective behaviors that demonstrate accountability and responsibility for identifying and meeting the needs of the recipients of their nursing services.

Development of this set of behaviors begins with and builds upon the education program leading to licensure as an RN, which provides basic knowledge, skills, and attitudes essential to the practice of perioperative nursing. Further preparation for the RN first assistant includes perioperative nursing practice with diversified experience in scrubbing and circulating. This should culminate in the nurse achieving certification as a CNOR. Additional preparation is then acquired through completion of an RNFA program which meets the AORN Recommended Education Standards for RN First Assistant Programs.

These programs should consist of curriculum that address all of the content areas of the modules in the Core Curriculum for the RN First Assistant, take place in, or in collaboration with, institutions approved by the appropriate regional accrediting body for higher education,² and award college/university credits and a certificate upon satisfactory completion of all requirements.

ESTABLISHMENT OF CLINICAL PRIVILEGES FOR THE RN FIRST ASSISTANT

To determine if an RN qualifies for clinical privileges as a first assistant, an approval process must be established by the institution in which the individual will practice.

The process of granting clinical privileges should include mechanisms for:

• assessing individual qualifications for practice,
• assessing continuing proficiency,
• evaluating annual performance,
• assessing compliance with relevant institutional and departmental policies,
• defining lines of accountability,
• retrieving documentation of participation as first assistant, and
• establishing systems for peer review.

Each RN first assistant demonstrates behaviors that progress on a continuum from basic competency to excellence. Once having met the educational and experiential requirements, the RNFA is encouraged to achieve and maintain certification (CRNFA) for this specific role.

AORNs web site can be found at http://www.aorn.org/

RNFA Specialty Assembly web site at http://www.aorn.org/abtaorn/abtaorn/mbrship/rnfa/index.htm