RN First Assist

About the Role

Responsible to the patient and the surgical team to assist, educate, and otherwise facilitate an optimal outcome for the patient.

Responsibilities

• Participate in preoperative assessment and planning for surgical patients specific to RNFA activities (e.g., anatomical exposure, wound closure) in collaboration with perioperative team members.
• Develop and implement an individualized perioperative patient plan of care.
• Assist with or independently perform positioning, prepping, and draping of the patient as directed by the surgeon.
• Protect the patient from injury caused by extraneous objects and chemical, electrical, laser, mechanical, and thermal sources.
• Participate in accounting procedures to prevent unintended retained surgical items.
• Perform interventions to ensure correct site, side, and level of the procedure; delay surgery if discrepancies arise.
• Assist with management of the patient’s specimens as necessary.
• Communicate the patient’s current status to relevant parties throughout the continuum of care.
• Administer medications safely and correctly.
• Perform interventions to maintain or improve the patient’s wound and tissue perfusion, genitourinary, gastrointestinal, musculoskeletal, endocrine, respiratory, cardiovascular, and neurological systems, as well as fluid, electrolyte, and acid-base balances.
• Perform interventions to return the patient to normothermia by the conclusion of the immediate postoperative period.
• Perform interventions to protect the patient from surgical site infection.
• Assess the knowledge level of the patient or designated support person and provide education on expected responses, pain management, wound management, and medication management.
• Operate specialized equipment intra-operatively (e.g., stapling instrumentation, laparoscopic tools, orthopedic drills, lasers).
• Act as a resource person for the operating room staff.
• Involve the patient or designated support person actively in decisions affecting their perioperative care and rehabilitation process.
• Protect patients’ rights, dignity, and privacy; provide age-specific, culturally competent, and ethical care.
• Function as an RN first assistant during operative and other invasive procedures by:
  • Providing exposure through correct use of instruments, retractors, suction, and sponging techniques.
  • Placing and holding surgical retractors, demonstrating stamina for sustained retraction.
  • Retaining manually controlled retractors in position set by the surgeon.
  • Anticipating retraction needs based on surgeon preferences and anatomic structures.
  • Packing sponges or laparotomy pads into body cavities to hold tissues and organs out of the operative field.
  • Managing instruments in the operative field to prevent obstruction of the surgeon’s view.
  • Considering anatomical and physiological implications when selecting, placing, and moving retractors.
  • Suctioning the surgical site to improve visualization and decrease biohazard exposure.
• Provide hemostasis by:
  • Applying electrocautery tip to clamps or vessels as directed by the surgeon.
  • Sponging and utilizing pressure as necessary.
  • Applying clamps on superficial vessels and tying off or electrocoagulating them as directed.
  • Placing suture ligatures in muscle, subcutaneous, and skin layers.
  • Placing hemoclips on bleeders as directed by the surgeon.
• Perform knot tying and wound closure by:
  • Choosing suturing material and techniques based on physician preference, tissue density, and cosmetic effect.
  • Tying knots firmly to avoid slipping and approximating tissue without causing necrosis.
  • Demonstrating proficiency in skin stapling techniques.
• Handle and dissect tissues in collaboration with the surgeon, including:
  • Clamping and severing tissue.
  • Grasping and fixating tissues with screws, staples, and other devices.
  • Performing specialized tissue handling, dissection, or cutting techniques under the surgeon’s direction.
  • Clamping blood vessels, coagulating bleeding points, and ligating vessels.
  • Suturing muscle, fascia, subcutaneous, and skin layers.
• Place drains as directed by the surgeon.
• Assist with applying casts, plaster splints, or other devices as indicated.
• Serve as an educator, mentor, consultant, and resource to peers and colleagues regarding RNFA activities.
• Transfer care as applicable and delegate tasks according to the TN Nurse Practice Act.
• Document nursing care accurately, completely, and legibly.
• Collaborate effectively with other disciplines.
• Demonstrate self-direction in coordination and decision-making responsibilities.
• Listen attentively, comprehend information, and keep others informed accurately.
• Establish and maintain effective working relationships with employees, administrative staff, and the public.
• Communicate changes in the patient’s situation to the healthcare team to determine new or adjusted treatments.
• Address customer concerns and complaints, implementing innovative approaches to meet patient and family needs.
• Assess, plan, implement, and coordinate patient care throughout the perioperative continuum.
• Correlate clinical data with patient’s medical and nursing care.
• Handle difficult situations involving patients, physicians, or others professionally.
• Support perioperative patients’ healthcare rights by involving them in their own care.
• Report illegal, incompetent, or impaired practices.
• Assume a leadership role in providing quality nursing care.
• Understand and apply clinical competency standards for safe patient care.
• Assist with safety survey scores and actions to improve them.
• Remain informed of innovative clinical trends through benchmarking and evidence-based practice.
• Actively participate in preparation for regulatory agency reviews.
• Assist in ensuring operational, equipment, and supply costs stay within the unit’s budget.
• Collaborate with the surgeon and healthcare team to promote efficient use of time, supplies, equipment, and personnel.
• Seek opportunities to increase skills and maintain competency as an RNFA.
• Assist with orientation, training, and development of department employees.
• Identify, initiate, and collaborate on educational programs.
• Ensure compliance with educational requirements.
• Maintain current evidence-based practice and licensure.
• Complete annual performance evaluations and implement correction plans as needed.
• Maintain required competencies and pursue professional growth.
• Influence multidisciplinary relationships by enhancing collaborative processes and professionalism.
• Practice first assisting in accordance with professional standards, laws, and regulations.
• Maintain patient confidentiality at all times.
• Report to work on time and as scheduled, wearing identification while on duty.
• Maintain regulatory requirements, including state, federal, and local regulations.
• Represent the organization positively and professionally.
• Comply with organizational policies and ethical business practices.
• Participate in performance improvement and continuous quality improvement activities.
• Attend regular staff meetings and in-services.

Requirements

• Current and valid Registered Nurse licensure in Tennessee.
• RN First Assistant licensure in Tennessee (CRNFA preferred but not required).
• Certified Nurse of the Operating Room (CNOR).
• BLS certification required by hire date.
• ACLS and CPI certifications required within 90 days of hire.
• Two years of perioperative RN or RNFA experience.

Skills

• Ability to operate specialized surgical equipment (e.g., stapling instrumentation, laparoscopic tools, orthopedic drills, lasers).
• Proficiency in knot tying, wound closure, and tissue handling techniques.
• Strong communication and collaboration skills with multidisciplinary teams.
• Ability to assess, plan, implement, and coordinate patient care.
• Leadership and mentorship abilities.
• Self-directed with strong problem-solving and decision-making skills.
• Commitment to maintaining patient confidentiality and professional standards.