AORN Position Statement on
RN First Assistants
PREAMBLE
Perioperative nursing practice historically has included the role of the registered professional nurse (RN) as assistant at surgery. As early as 1977, documents issued by the American College of Surgeons supported the appropriateness for qualified RNs to first assist.1
AORN officially recognized this role as a component of perioperative nursing in 1983 and adopted the first "Official statement on RN first assistants (RNFA)" in 1984.2 AORN's official statement delineates the definition, scope of practice, educational requirements, and qualifications that must be met and suggests clinical privileges for the perioperative RN who practices as an RNFA. AORN supports appropriate compensation/reimbursement for RNs who fulfill this role.
DEFINITION OF RN FIRST ASSISTANT
The RNFA is 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.
SCOPE OF PRACTICE
All state boards of nursing recognize the role of the RNFA as being within the scope of nursing practice. Perioperative nursing is a specialized area of practice. Registered nurses practicing as first assistants in surgery are functioning in an expanded perioperative nursing role. Activities included in first assisting are further refinements of perioperative nursing practice and are executed within the context of the nursing process. First assisting behaviors are based on an extensive body of scientific knowledge. Certain of these behaviors include delegated medical functions that are unique to the perioperative RN qualified to practice as an RNFA. Registered nurse first assistant behaviors may vary depending on patient populations, practice environments, services provided, accessibility of human and fiscal resources, institutional policy, and state nurse practice acts.
Examples of RNFA behaviors in the perioperative arena include
PREPARATION OF THE RNFA
The complexity of knowledge and skill required to effectively care for recipients of perioperative nursing services compels nurses to be specialized and to continue their education beyond generic nursing programs. Perioperative nurses who wish to practice as RNFAs should develop a set of cognitive, psychomotor, and affective behaviors that demonstrate accountability and responsibility for identifying and meeting the needs of their perioperative patients.
Development of this set of behaviors begins with and builds upon the education program leading to licensure as an RN, which teaches basic knowledge, skills, and attitudes essential to the practice of perioperative nursing. Further preparation for the RNFA includes perioperative nursing practice with diversified experience culminating in the nurse achieving CNOR certification through the Competency and Credentialing Institute (CCI).
Additional preparation is then acquired through completion of an RNFA program that meets the "AORN standards for RN first assistant education programs" and is accepted by CCI. These programs should be equivalent to one academic year of formal, post-basic nursing study; consist of curricula that address all of the modules in the Core Curriculum for the RN First Assistant1; and award college credits and degrees or certificates of RNFA status upon satisfactory completion of all requirements. The RNFA programs should be associated with schools of nursing at universities or colleges that are accredited for higher education by an accrediting agency that is nationally recognized by the Secretary of the US Department of Education. The registered nursing program should be approved by a state licensing jurisdiction for nursing programs at the university, college, or community college level or by another national or regional agency that is nationally recognized by the Secretary of the US Department of Education as a specialized accrediting agency for nursing programs.
Each RNFA demonstrates behaviors that progress on a continuum from basic competency to excellence. When educational and experiential requirements have been met, the RNFA is encouraged to achieve and maintain certification status (CRNFA) through CCI, an independent entity.
QUALIFICATIONS FOR ENTRY INTO RNFA PRACTICE
AORN believes the minimum qualifications to practice as a RN first assistant are as follows:
To determine if the RN qualifies for clinical privileges as a first assistant, an approval process should be established by the facility(ies) in which the individual will practice.
The process of granting clinical privileges should include mechanisms for
The decision by an RN to practice as a first assistant must be made voluntarily and deliberately, with an understanding of the professional accountability that the role entails.
For additional sources of information, refer to the following AORN publications:
For additional information regarding CRNFA certification, contact the Competency and Credentialing Institute (CCI), (888) 257-2667, or online at http://www.http://www.cc-institute.org.
References
1. "American Colleges of Surgeons: Statement and qualifications for surgical privileges in approved hospitals," Bulletin of the American College of Surgeons 62 (April 1977) 12-13.
2. "Task force defines first assisting," AORN Journal (February 1984) 403-405.
Original approved by the House of Delegates, Atlanta, March 1984
Revision approved by the House of Delegates, March 1993
Revision approved by the House of Delegates, April 1998
Revision approved by the House of Delegates, March 2004
Revision approved by the House of Delegates, December 2005
Sunset review: December 2010
Perioperative nursing practice historically has included the role of the registered professional nurse (RN) as assistant at surgery. As early as 1977, documents issued by the American College of Surgeons supported the appropriateness for qualified RNs to first assist.1
AORN officially recognized this role as a component of perioperative nursing in 1983 and adopted the first "Official statement on RN first assistants (RNFA)" in 1984.2 AORN's official statement delineates the definition, scope of practice, educational requirements, and qualifications that must be met and suggests clinical privileges for the perioperative RN who practices as an RNFA. AORN supports appropriate compensation/reimbursement for RNs who fulfill this role.
DEFINITION OF RN FIRST ASSISTANT
The RNFA is 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.
SCOPE OF PRACTICE
All state boards of nursing recognize the role of the RNFA as being within the scope of nursing practice. Perioperative nursing is a specialized area of practice. Registered nurses practicing as first assistants in surgery are functioning in an expanded perioperative nursing role. Activities included in first assisting are further refinements of perioperative nursing practice and are executed within the context of the nursing process. First assisting behaviors are based on an extensive body of scientific knowledge. Certain of these behaviors include delegated medical functions that are unique to the perioperative RN qualified to practice as an RNFA. Registered nurse first assistant behaviors may vary depending on patient populations, practice environments, services provided, accessibility of human and fiscal resources, institutional policy, and state nurse practice acts.
Examples of RNFA behaviors in the perioperative arena include
- preoperative patient management in collaboration with other health care providers, including but not limited to,
- performing preoperative evaluation/ focused nursing assessment,
- communicating/collaborating with other health care providers regarding the patient plan of care, and
- writing preoperative orders according to established protocols;
- intraoperative surgical first-assisting, including but not limited to,
- using instruments/medical devices,
- providing exposure,
- handling and/or cutting tissue,
- providing hemostasis, and
- suturing; and
- postoperative patient management in collaboration with other health care providers in the immediate postoperative period and beyond, including but not limited to,
- writing postoperative orders/operative notes according to established protocols,
- participating in postoperative rounds, and
- assisting with discharge planning and identifying appropriate community resources as needed.
PREPARATION OF THE RNFA
The complexity of knowledge and skill required to effectively care for recipients of perioperative nursing services compels nurses to be specialized and to continue their education beyond generic nursing programs. Perioperative nurses who wish to practice as RNFAs should develop a set of cognitive, psychomotor, and affective behaviors that demonstrate accountability and responsibility for identifying and meeting the needs of their perioperative patients.
Development of this set of behaviors begins with and builds upon the education program leading to licensure as an RN, which teaches basic knowledge, skills, and attitudes essential to the practice of perioperative nursing. Further preparation for the RNFA includes perioperative nursing practice with diversified experience culminating in the nurse achieving CNOR certification through the Competency and Credentialing Institute (CCI).
Additional preparation is then acquired through completion of an RNFA program that meets the "AORN standards for RN first assistant education programs" and is accepted by CCI. These programs should be equivalent to one academic year of formal, post-basic nursing study; consist of curricula that address all of the modules in the Core Curriculum for the RN First Assistant1; and award college credits and degrees or certificates of RNFA status upon satisfactory completion of all requirements. The RNFA programs should be associated with schools of nursing at universities or colleges that are accredited for higher education by an accrediting agency that is nationally recognized by the Secretary of the US Department of Education. The registered nursing program should be approved by a state licensing jurisdiction for nursing programs at the university, college, or community college level or by another national or regional agency that is nationally recognized by the Secretary of the US Department of Education as a specialized accrediting agency for nursing programs.
Each RNFA demonstrates behaviors that progress on a continuum from basic competency to excellence. When educational and experiential requirements have been met, the RNFA is encouraged to achieve and maintain certification status (CRNFA) through CCI, an independent entity.
QUALIFICATIONS FOR ENTRY INTO RNFA PRACTICE
AORN believes the minimum qualifications to practice as a RN first assistant are as follows:
- certification in perioperative nursing (CNOR);
- successful completion of an RNFA program that meets the "AORN standards for RN first assistant education programs" and is accepted by CCI; and
- compliance with statutes, regulations, and institutional policies relevant to RNFAs.
To determine if the RN qualifies for clinical privileges as a first assistant, an approval process should be established by the facility(ies) in which the individual will practice.
The process of granting clinical privileges should include mechanisms for
- assessing individual qualifications for practice,
- assessing continuing proficiency,
- evaluating annual performance,
- assessing compliance with relevant institutional and departmental policies,
- defining lines of accountability,
- retrieving documentation of participation as first assistant, and
- establishing systems for peer review that include a process for incorporating continuing education/contact hours relevant to RNFA practice.
The decision by an RN to practice as a first assistant must be made voluntarily and deliberately, with an understanding of the professional accountability that the role entails.
For additional sources of information, refer to the following AORN publications:
- Standards, Recommended Practices, and Guidelines
- RN First Assistant Guide to Practice
- Core Curriculum for the RN First Assistant
For additional information regarding CRNFA certification, contact the Competency and Credentialing Institute (CCI), (888) 257-2667, or online at http://www.http://www.cc-institute.org.
References
1. "American Colleges of Surgeons: Statement and qualifications for surgical privileges in approved hospitals," Bulletin of the American College of Surgeons 62 (April 1977) 12-13.
2. "Task force defines first assisting," AORN Journal (February 1984) 403-405.
Original approved by the House of Delegates, Atlanta, March 1984
Revision approved by the House of Delegates, March 1993
Revision approved by the House of Delegates, April 1998
Revision approved by the House of Delegates, March 2004
Revision approved by the House of Delegates, December 2005
Sunset review: December 2010