Being A Registered Nurse First Assistant 

By Rebecca Czapski

                The Registered Nurse First Assistant (RNFA) is a very versatile role; a role that I desired to play because of its extensive involvement with the patient’s whole surgical experience. The RNFA not only assist during surgery by performing skills like retracting, tying sutures, clamping bleeding vessels, and closing incisions; but is also involved both pre and post-operatively with tasks such as patient history, physical exams, teaching, ordering routine laboratory test, changing dressings, removing sutures and evaluating the patient’s overall condition and emotional status. This total involvement has proved to be beneficial for the doctor, patient, and nurse while being both a personal challenge and a reward.  I can think of no other exciting opportunity available to the OR nurse that can expand a career with the breath and wealth of experience as a RNFA.

                There are extensive qualifications for a RNFA that include a current RN license, national certification in perioperative nursing (CNOR), and the completion of a nurse first assistant educational program approved by AORN.  Acceptance into the RNFA course requires the following:

                - RN license in the state of practice

                - CNOR with 2 years perioperative experience

                - Proficiency in scrub and circulating role

                - Basic knowledge of anatomy and physiology

                - BCLS/ACLS

                - Letters of reference from specified colleagues and surgeons

                - Professional liability insurance

Some of these requirements stem from state legislation  demanding strict educational and practical experience before performing in the RNFA role.

                My personal experience began over twenty years ago where I started nursing fresh out of the University of Arizona.  I was lucky to begin my career at a specialty hospital with a six month preceptor ship in cardiovascular.  After completing my preceptor ship I was trained as a heart scrub and also learned how to first assist going on cardiopulmonary bypass, and closing the incision from harvesting of the vein. This experience was an influential process in the development of my desire to maintain a hands-on role in the OR.  But as fate would have it, the man of my dreams stole my heart and my permanent residency. Traveling about the country every few years resulted in numerous surgical positions at different hospitals. Increasingly, I found myself performing less and less in a position of scrubbing and first assisting and more and more circulating. I began to miss the surgical experience I started out in.  I’ve wanted to return to school for over ten years to become a RNFA, but the timing was never good with all my family responsibilities. Moving to Texas provided the catalyst to return to the first assisting job.  The Texas Board of Nursing began a process of passing amendment 217.18 to the Nurse Practice Act regarding RNFA’s.  This amendment would limit the RN’s ability to first assist unless they met certain criteria.  This prompted me to enroll in a RNFA AORN approved course so that when the amendment goes into effect, I will be able to assist in surgery.

                The didactic portion of the course was in Taos, New Mexico in October and the weather was beautiful with the turning of the leaves. This made for a relaxing environment to study the detailed material of the course.   We had a very diverse group with 25 RN’s from 14 different states and areas of expertise like plastics, orthopedics, cardiovascular, pediatrics and neurosurgery.  We were in class from 8am to 5pm for six days.  Tests were conducted over the material presented during the week and we spent an extensive amount of time going over and performing procedures for tying and suturing.  The instructor Louise Pasaka was excellent and provided a detailed and thought provoking environment in the class that gave all the students the in-depth knowledge needed to succeed.   It was a great experience especially getting together with the other RN’s in the class for lunch and dinner. The personal interaction not only cemented a friendship, but provided additional insight into surgical procedure and experiences that would benefit my career. While doing class work for this RNFA course and studying for the CNOR exam, I really discovered there were numerous things I didn’t know. This course helped to improve my knowledge base and sharpen my OR skills.

                 I believe that in becoming a RNFA, my role as an RN will expand and provide me with the qualifications and marketability of a seasoned perioperative nurse.  I’ll meet the requirements to first assist enforced by the amendment 217.18 so that my current role will not be limited.  Additionally, it will open up an avenue to start my own business as an RNFA and possibly work hours that better fit my schedule.  I would like to take this opportunity to encourage any RN who is currently first assisting or is interested in first assisting to enroll in a RNFA course.  Opportunity has knocked and the doors have flown wide open. The doctors I have contacted to fill the 120 case hours have been enthusiastic and cooperative.  This networking will be vital to any future OR endeavors and is enriching on a personal and professional level.  For anyone who’s interested, AORN has the information on their website for RNFA courses that they have approved.