FIVE MINUTES WITH VICKI FOX author of Core Curriculum for RN First Assistants   by Megan Flaherty As one of the first registered nurse first assistants in Texas, clinical nurse specialist Vicki Fox, MSN, RN, considers herself a pioneer. Fox started assisting surgeons in 1983 and has opened the operating room door for many RNFAs since then. She co-wrote the textbook used all over the country to teach nurses how to assist operating surgeons, Core Curriculum for RN First Assistants. She also helped revise the Association of Operating Room Nurses’ official statement on RNFAs in 1993. She is currently enrolled in a post master’s acute care nurse practitioner program. What kind of training does it take to become an RNFA? First, one should already be proficient as a perioperative nurse. Then you get further preparation in a formal program given by either a college or a university. The program includes both a didactic [classroom] portion and a supervised clinical portion. There is a voluntary RNFA certification exam. But one doesn’t have to be certified as an RNFA to practice. Why do nurses become RNFAs? You’d be surprised how many nurses move into it or add it to their resumes so they are qualified to do one more thing. Most nurses like to have as broad a base of skills as possible. In the changing healthcare environment, the broader your base of skills, the more likely you’ll have a job. If a nurse is qualified to first assist, then she or he can be a circulating nurse, first assistant, or scrub nurse. It depends on the practice setting how much she first assists. What are an RNFA’s responsibilities? That person is responsible for collaborating with the operating surgeon to achieve the best surgical outcome for the patient. There are some specific behaviors that are listed in the official statement, like tissue handling and using instruments. The statement is very broad on purpose because RNs in different geographic locations practice differently. For example, in some states RNFAs use instruments to harvest veins in legs. In other places they may not be given the responsibility to harvest veins but may use instruments for retracting and clamping. How has the role of RNFAs gained acceptance in the healthcare community? There is an interesting history. Back in 1983, the original official statement on RN first assistants came out. Most state boards of nursing didn’t know what it was. When I started back then, they [physicians and anesthesiologists] looked at me in a way that said, "What are you doing?" By the time we revised it in 1993, there had been quite a turnaround. During those 10 years the practice evolved because perioperative nurses saw it as an opportunity for them to advance their clinical skills. We went from hardly any state boards knowing what it was to boards that said, "Yes, nurses can function in this role as long as they are educated to do so." Now in most areas it’s an accepted role. No one even thinks twice about it. What are the advantages to the healthcare community of using RNFAs in the operating room? One of the main things is that physicians have well-qualified, well-educated assistants available when another physician or surgeon may not be available. Plus, using RN first assistants is cost-effective.