New guide provides updates, resources
For novice, expert RN First Assistants

Get your copy of the updated 
RN First Assistant Guide to Practice

This fall, members will be able to purchase the RN First Assistant Guide to Practice from the AORN online perioperative bookstore. The new guide will include chapters on:

• AORN education standards and official RNFA statement
• RNFA competency statements
• Career planning and development
• Networking basics for the RNFA
• CRNA certification
• Credentialing
• RNFA reimbursement
• Ethical and legal considerations
• Evidence-based practice for RNFAs
• Legislation and public policy.
  

 Considering the ever-growing number of regulatory, practice and billing changes RNFAs must deal with, an up-to-date guide to practice is an invaluable tool. The good news is that an updated edition of AORN's RN First Assistant Guide to Practice is slated for release this fall.

The revised guide offers novice, expert and aspiring RNFAs a comprehensive resource, detailing current information on a broad range of practice issues, from reimbursement and career planning to evidence-based practice and advocacy.

"So many times people post questions to the RNFA SA's (Specialty Assembly's) Online Community of Practice, asking 'How do I do my own billing?' 'How do I get a copy of a job description or evaluation tool?' This guide is a one-stop resource providing a knowledge base for practicing RNFAs, as well as those who work in other perioperative nursing roles and may be interested in pursuing professions as an RN First Assistant," said Nancy Rove, RN, CNOR, CRNFA, an RNFA at Providence St. Joseph Medical Center, Burbank, Calif., and education chair of the RNFA SA.

From its inception in 1992, a major goal of the RNFA SA has been to pass on the SA's collective expertise to keep all members, both veterans and novices, abreast of rapidly changing practice guidelines and standards, Rove added. "This guide is the culmination of our continued efforts in that process."

Expanded competencies
The new guide's resources will reflect significant changes in RNFA business practice that have evolved since the second edition of RN First Assistant Guide to Practice was published in 2005, noted Barbara Firlit, RN, BS, CNOR, CRNFA, a physician-employed RNFA who collaborated with RNFA colleague Nikki Collier, RN, CNOR, CRNFA, and AORN Perioperative Nursing Specialist Byron Burlingame, RN, MS, CNOR, in developing the new guide's updated chapter on RNFA competency statements.

Firlit chaired AORN's original RNFA SA Competency Task Force, which was established in 1996 to develop a document articulating six competency statements, and she also chaired the 2006-2007 task force charged with revising the competencies. "These competencies encompass everything that RNFAs do, all of the actions they perform and services they provide, almost like a descriptive summation of our role in the healthcare field," Firlit explained.

One of the most significant changes in the upcoming guide is that all RNFA competency statements conform to Perioperative Nursing Data Set (PNDS) format. The goal is "to incorporate perioperative nursing language into everyday thinking about RNFA scope of practice," Firlit said. Other revisions aim to reduce redundancies and make the competency statements more concise.

"My major concern when we took over this endeavor was to keep the meat of what was in the original statements," Firlit emphasized. "We wanted to make sure the competencies remained true to what RNFAs do."

Burlingame noted that several new competencies are added, including new language under the competency statement addressing perioperative safety stating that an RNFA "participates in Time Out (pause for universal identification protocol) with surgeon, and other members of surgical team."

Along with the new PNDS format, the revisions include a Recommendation for Validation of Competencies section, Burlingame said. "What this does is offer tools that can be used to assess competency, which not only helps RNFAs assess their practice, but also provides a measurement tool for administrators managing RNFAs."

The updated competency statements also illustrate ways that RNFAs can expand their practice, Firlit observed. "Because RNFAs practice in different environments, it is important for each of us to understand our roles and be aware of the changes each of us faces for our type of practice, whether hospital-employed, physician-employed or self-employed independent."

Standardized reimbursement
For independent-practice RNFAs, seeking reimbursement for services can be a complicated issue because Medicare guidelines don't recognize RNFAs as providers. That hurdle makes it difficult for RNFAs to acquire reimbursement from secondary insurance payers when RNFAs assist with patients whose primary insurance is Medicare. In such cases, the only avenue left for an RNFA is to attempt to obtain a Medicare "denial letter," a process that varies with geographic location, said Angela Barnard, RN, BSN, CNOR, CRNFA, a self-employed RNFA who authored the guide's updated chapter on reimbursement.

"The new guide outlines the work AORN is doing to establish more standardized steps in the reimbursement process for RNFAs to obtain Medicare denial letters," Barnard noted.

Barnard's updated chapter also includes information on obtaining a National Provider Identifier (NPI) through the federal Department of Health and Human Services. As of May 23, 2007, an RNFA must include their NPI when submitting a claim for reimbursement for services they provide.

"For an independent RNFA, this reimbursement information is invaluable," said Barnard. "In school they don't teach the Ins and Outs of business practice, so it is important for me and other experienced RNFAs to share the knowledge we've attained over the years."

Comprehensive Career Planning
In addition to outlining specific business resources for practicing RNFAs, the new guide includes a chapter on career planning for those beginning to endeavor a career as an RNFA.

In a significant expansion from the second edition, Sheila Allen, RN, BSN, CNOR, CRNFA, drafted new information on education requirements for a new career planning chapter. These education requirements conform to new AORN Standards for RN First Assistant Education Programs, which the association developed to help RNFA programs establish consistent and comprehensive curricula.

"We want prospective RNFA students to be aware of the criteria the standard developers thought were the important components of an RNFA education," Allen explained. "When selecting a program you want the one that gives you the most complete educational background, skills, expertise and knowledge, and the RNFA education standards outlined in the guide serve to aid this process."

In addition to educational information, Allen's chapter also focuses on the keys to succeeding as an RNFA. It includes information on licensure, job descriptions and business planning for various RNFA roles, including facility-employed, physician-employed and self-employed RNFAs.

"Regardless of where you are in your practice, this is an important time to be aware of the many changes in RNFA practice coming from regulatory agencies and other stakeholders in health care. Whether a novice, an expert or an aspiring RNFA, this new guide will be an excellent resource," Allen noted.

Beyond business
In addition to the more practical business concerns of working as an RNFA, the guide includes a complete update of the research chapter. Written by Brenda Hoss, RN, MSN, a career perioperative nurse and Clinical Nurse Specialist, the revised research chapter focuses on evidence-based practice, which Hoss describes as the dominant philosophy of clinical nursing practice today.

"I changed the focus of the chapter to evidence-based practice because most practicing nurses were educated before computers were common in hospitals and in nursing programs," Hoss explained. "We all need to look for other supporting evidence and rely less on opinion. Expert RNFAs may be ready to learn more about conducting integrative reviews for guideline development or to partner with a researcher to design and conduct a study."

Recognizing the RNFA role
When the RNFA SA was formed, the role was relatively new, so SA members wrote the RNFA competencies and the RN First Assistant Guide to Practice as part of its mission as an AORN SA to educate the rest of the health care field about RNFA practice, said current RNFA SA Chair Terri Aldama, RN, CNOR, CRNFA. Aldama authored the guide's updated chapter on public policy.

"Advocacy is the basis for being a Registered Nurse because we speak up for our patients when they cannot. But we need to also take this advocacy to the legislative arena," Aldama stressed. "As RNFAs, we need to foster relationships with our legislators to communicate the important impact the RNFA makes in a patient's surgical experience and recovery."

Aldama urges members of the RNFA SA to take advantage of the information and resources offered in the new RN First Assistant Guide to Practice  "As our practice evolves, it is important to make sure our resources evolve, too. And the RNFA SA provides an invaluable resource for all RNFAs, whether they are starting a new practice or working with medical staff to write the criteria for staff privileges."

She also advises members to visit the RNFA SA Online Community of Practice and to participate in networking sessions and update meetings during AORN educational events. To access the RNFA SA Online Community of Practice, visit http://communities.aorn.org/COP/RNFA/.