History
Registered Nurses have been assisting in surgeries for many years. As early as 1977, the American College of Surgeons showed support for RN’s as first assistants. AORN officially recognized this role in 1984 with an official statement delineating the definition, scope of practice, educational requirements, and required qualifications. The document also suggested clinical privileges for the perioperative RN who wanted to practice as an RNFA.
AORN defines the RNFA as a perioperative registered nurse who works in collaboration with the surgeon and health care team members to achieve optimal patient outcomes. The RNFA must have acquired the necessary knowledge, judgment, and skills specific to the expanded role of RNFA clinical practice. Intraoperatively, the RNFA practices at the direction of the surgeon and does not concurrently function as a scrub nurse.
The RNFA’s scope of practice is not only intraoperative, which includes retracting, tying sutures, clamping vessels and closing incisions; but can also involve pre and postoperative tasks such as taking the patient history, physical exams, patient teaching, ordering routine laboratory tests, changing dressings, removing sutures, and evaluating the patient’s overall condition and emotional status.
Preparation/Practice
To become an RNFA, one must hold a current RN License, have earned national certification in perioperative nursing (CNOR), and must complete a nurse first assistant educational program approved by AORN. In addition, course prerequisites include two years experience in the operating room, BCLS/ACLS certification, letters of reference from colleagues and surgeons, professional liability insurance, and credentialing at the hospitals where the RNFA wishes to practice.
The RNFA curriculum includes a significant amount of reading in preparation for lectures and learning activities, hands-on practice suturing and tying knots, 120 clinical hours, writing assignments and a clinical study on a procedure on which the RNFA student assisted. Upon successful completion of the course, the RNFA has a variety of practice options: independent practice as a first assistant or employment by a surgeon or group, or by an institution. After completing 2,000 hours of clinical practice (about two years), an RNFA who holds a baccalaureate or higher degree is eligible to sit for the certification exam.
The RNFA can seek reimbursement for assisting independently by filing as a first assistant with the patient’s insurance company either at an hourly rate or by case fee. Alternatively, the surgeon can file the insurance claim and pay the RNFA a salary or contract fee. At this time RNFAs are not eligible for Medicare reimbursement.
As the landscape of medicine changes, there will be a greater need for middle care providers, such as the RNFA, who can a help surgeons increase their productivity as an extension of their practice. Becoming an RNFA requires a highly motivated person who is self directed and personable. For more information please visit the following websites, www.aorn.org or www.texasrnfa.org.
My Story
At Baylor University Medical Center (BUMC) in Dallas there are seven RNFAs who have privileges to practice on the main campus. While the clinical hours are easy to achieve, establishing an independent practice at BUMC is not easy. The Credentialing Committee prohibits the RNFAs from taking the vein in cardiac bypass cases - a limitation unique to that hospital. Also, because residents first assist on most of the surgeries as a first assistant, there is often no need for additional help.
My desire to be come an RNFA started when I went back to work in 2001 in the operating room at BUMC. I was at Baylor from 1987 to 1992 when I had my first child. I had another child in 1993 and took nine years off to raise my children. Once back in the operating room part time, I really enjoyed the adult interaction and the mental and physical challenges found only in the OR. In 2003, I passed my CNOR exam. My husband is a general surgeon at Baylor, but was operating at Mary Shields and Physicians Day Surgery center. These facilities were not staffed by residents so he asked if I was interested in helping him in surgery at these hospitals. This is was what gave me the push I needed to look into a becoming an RNFA.
I enrolled in the New Mexico College program February of 2008. It required pre-classroom work, a didactic portion, and extensive learning activities with 120 clinical hours to be completed in a year from the end of the didactic section. I traveled to Taos, New Mexico in June 2009 for 6 days. Class was held at the base of the ski resort. This made for a relaxing environment but class hours were from 8am until 5 pm, with a break for lunch. We had a fun group of about 16 nurses from all over the US and one from Canada. The instructor was Louise Pasaka who kept the material interesting and had good speakers for various parts of the curriculum. We learned to sew and tie suture as well as what is involved with developing our practice once we completed the course. There was time to network with the other students in the class in the evenings and it even snowed one day!
When I got home I was ready to start acquiring my clinical hours. Getting privileges at Baylor took three months! so I had time to wok on my papers until September and network with doctors about scrubbing with them. I finished the 120 hours in three months and had established myself with several surgeons whom I hoped would use my services in the future.
I am very happy with my decision to become an RNFA. I have learned a lot about procedures and anatomy as well as what is takes to start a business. Since January, I’ve gotten privileges at two hospitals, two surgery centers, and two more hospitals are reviewing my credentials. The work is random at times, but the monetary and personal rewards are worth it!
