RN First Assist

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A Brief Overview
The purpose of the Registered Nurse First Assistant (RNFA) in the peri-operative phase of patient care is to assist the surgeon in procedures recognized by the attending surgeon as appropriate for the RNFA to participate in by demonstrating competence through knowledge, experience and skills. The RN practices in the role of the first assistant when a physician (attending or resident) is unable to assist the attending surgeon in a particular procedure due to availability or location.

The RNFA is an experienced peri-operative nurse, functioning in an expanded role, with additional skills and education as described in the qualifications and job description. The RNFA carries out functions that will assist the surgeon in performing a safe surgical procedure with optimal results for the patient.

What you will do

• As stated by the Association of Operating Room Nurses (AORN), "The scope of practice of the nurse performing as first assistant is a part of peri-operative nursing. The intra-operative practice of the RNFA is interdependent with the operating surgeon. While independent nursing skills and judgment are essential to this practice, the intra-operative activities of the RNFA must be supervised by the surgeon." Peri-operative nursing is a specialized area of nursing practice. The activities included in first assisting are further refinements of the peri-operative nursing practice and are executed within the context of nursing practice.
• As stated by AORN, "The first assistant does not concurrently function as a scrub nurse. The decision by an RN to practice as a first assistant must be made voluntarily and deliberately, with an understanding of the professional accountability the role entails."
• The pre-operative nursing behaviors of the RNFA may include, but are not limited to:
• Completion of pre-op assessment, patient education and teaching including pre-op phone calls, chart review, review of patient studies (i.e. - X-rays, CT, MRI, Laboratory values, etc.)
• Meeting with patients and family members to answer their questions about the surgery, anesthesia and recovery.
• Helps coordinate if any discrepancy among parties, patient history and physical, consents, or scheduled procedure occurs.
• Research including of new technology
• Coordination of implants/specialty items/loaner sets
• Participates in huddle, providing specifics for each surgeon, or additional needed information
• Helps to prepare room for equipment, instrumentation, medications and positioning aids along with the nursing staff.
• Expert on had to select needed instruments & describe steps in surgery to scrub personnel to streamline surgery
• Positioning/prepping of patient
• Draping and disposable set-up
• The Intra-operative nursing behaviors of the RNFA may include, but are not limited to:
• Hands-on role in surgical procedures by providing hemostasis (coagulation, ligation, and cauterization)
• Providing visualization, retraction
• Dissection, tissue handling as directed
• Intraoperatively assesses patient, wound, and sterile field
• Participation in the "Time Out"
• Monitoring and protection against contamination/ sponge retention of the surgical site and sterile field
• Set-up scrub for progression of case and needed instrumentation.
• Minimizes the length of the operative or invasive procedure and maximizes surgeon's efficiency of movement within the surgical wound.
• Insertion of drains
• Wound closure (deep and superficial structures)
• Application of dressings
• The post-operative nursing behaviors of the RNFA may include, but are not limited to:
• Documenting the patient's progress accurately using standardized language
• Placing orders including medications/complete op-notes to be signed by attending
• Accompanying the patient to the post-anesthesia care unit (PACU)
• Wound care/assessment (removal of sutures or drains, dressing changes)
• Applies casting materials, dressings, and immobilizing devices
• Transport of patient to PACU
• Makes post-operative rounds in conjunction with or at the direction of the surgeon
• Discharge coordination
• Suture removals
• Patient education
• Makes post-operative rounds as needed in conjunction with or at the direction of the surgeon
• Wound care/assessment (removal of sutures or drains, dressing changes)
• Post-op teaching, calls-results, home care needs, return to school/work forms
• Discharge coordination

Education Qualifications

• Bachelor's Degree Nursing Required

Experience Qualifications

• At least five (5) years of previous experience as a registered Nurse Required
• At least two (2) years of peri-operative nursing experience Required

Skills and Abilities

• Credentials approved by the Non-Physician Health Practitioner (NPHP) Committee upon completion of the following:
• Employing surgeon submits letter to the NPHP committee requesting privileges for the RNFA
• Applicant submits letter to the NPHP committee requesting privileges as RNFA, along with:
• A copy of their curriculum vitae
• Three (3) current letters of reference verifying the applicant's clinical skills and competence to perform the procedures
• Verification of educational preparation
• Verification of nursing liability insurance for the RNFA
• The Director of the Peri-operative Complex, or designee, will review the application, interview and evaluate the applicant
• The Director of the Peri-operative Complex, or designee, will orient the applicant to the operating room complex, and complete a checklist of knowledge and skills
• The NPHP committee will review the applicant's submission and recommendations by the Director of the Peri-operative complex. If all are satisfactory, the applicant will be appointed to Non-Physician Health Practitioner status for a one-year period including a 3-month probationary period. Privileges are limited to the Operating Room.
• Annual review of privileges will include recommendation by the Director of the Peri-operative complex as to whether the performance of the RNFA meets accepted standards
• The NPHP committee will verify continuation of insurance coverage, current licensure, and continuing education.
• For privileges for the RNFA to function outside the Operating Room Complex, a request must be submitted by the employing surgeon and reviewed by the NPHP committee.
• The NPHP committee will grant renewal of privileges biannually.

Licenses and Certifications

• Registered Nurse (Pennsylvania) - Pennsylvania State Licensing Board - upon hire - Required and
• Certified Perioperative Nurse - Operating Room Nurse Certification (CNOR) - Competency and Credentialing Institute (C&CI) - upon hire - Required and
• Registered Nurse First Assistant (RNFA) - National Institute of First Assisting (NIFA) - upon hire - Required or
• Registered Nurse First Assistant (RNFA) - Delaware County Community College - upon hire - Required and
• Basic Life Support (BLS) - issued through on organization that requires a hands-on instructor lead psychomotor skills verification (ex. American Heart Association or Red Cross). - upon hire - Required and
• Pediatric Advanced Life Support (PALS) - issued through on organization that requires a hands-on instructor lead psychomotor skills verification (ex. American Heart Association or Red Cross). - upon hire - Required

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must be fully vaccinated against COVID-19 and receive an annual influenza vaccine. Learn more.

Employees may request exemptions for valid religious and medical reasons. Start dates may be delayed until candidates are immunized or exemption requests are reviewed.

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