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Rebecca Davis
(253) 535-3490

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Ellen Bencken, RN,BSN,CNOR

(208) 908-1527

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» RN Circulator Laws and Language


WAC 246-320-236 Hospital - Surgical Services If providing surgical services, hospitals must (6) Assure that a registered nurse qualified by training and experience functions as the circulating nurse in every operating room during surgical procedures. [Statutory Authority: Chapter 70.41 RCW and RCW 43.70.040. 09-07-050, ยง 246-320-236, filed 3/11/09, effective 4/11/09.]


WAC 246-330-210 Ambulatory Surgical Facilities - Surgical Services An ambulatory surgical facility must: (6) Assure a registered nurse qualified by training and experience functions as the circulating nurse in every operating room whenever deep sedation or general anesthesia are used during surgical procedures. [Statutory Authority: Chapter 70.230 RCW. 09-09-032, ยง 246-330-210, filed 4/7/09, effective 5/8/09]

» Registered Nurse First Assistants (RNFAs)

Reimbursement: Revised Code of Washington, Title 48, Chapter 48.41, 48.41.110 (3) The health insurance policy issued by the pool shall pay only reasonable amounts for medically necessary eligible health care services rendered or furnished for the diagnosis or treatment of illnesses, injuries, and conditions which are not otherwise limited or excluded. Eligible expenses are the reasonable amounts for the health care services and items for which benefits are extended under the pool policy. Such benefits shall at minimum include, but not be limited to, the following services or related items: (b) Professional services including surgery for the treatment of injuries, illnesses, or conditions, other than dental, which are rendered by a health care provider, or at the direction of a health care provider, by a staff of registered or licensed practical nurses, or other health care providers;

Definition: None

Scope: Washington State Department of Health, Health Professions Quality Assurance, Nursing Care Quality Assurance Commission, Position Statement, Adopted March 19, 2001 - RNFA: Registered Nurse First Assistant at Surgery. The Registered Nurse (RN) can function in the position of First Surgical Assistant, as long as the nurse stays within the scope of practice of the Registered Nurse license and practices in collaboration with and under the on-site supervision and direction of a surgeon. The RN First Assistant does not concurrently function as a scrub nurse. The activities included in first assisting are further refinements of perioperative nursing practice, which are executed within the context of the nursing process. The observable nursing behaviors are based on an extensive body of scientific knowledge. The intraoperative nursing behaviors may include, but are not limited to: 1. handling tissue 2. providing exposure 3. using instruments 4. suturing, and 5. providing hemostasis. It is not within the scope of licensed practical nursing to be placed in the role of a first assistant to a surgeon. The first assist nursing role represents a specialized, expanded, scope of practice of the registered nurse, which builds upon the education obtained in the generic nursing program.

Guidelines for Perioperative Practice


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