Photo by Jim Altobell	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
Mary Weis (right), a registered nurse first assistant at CentraCare Clinic in St. Cloud, Minn., assists surgeon James Jost with an operation.

Gisele Harris, RNFA, MSN, CNOR, a registered nurse first assistant at The Toledo(Ohio) Hospital, remembers one hair-raising, on-the-job experience. She was assisting a surgeon who was preparing for a craniotomy when, suddenly, the surgeon pulled off what appeared to be the patient’s head.

“The surgeon was preparing to shave the woman’s head, and didn’t realize that the woman was wearing a wig,” Harris says. “I will never forget that experience!”

Other RNFAs say such experiences are what make working as an RFNA unforgettable and attractive. “The OR is where all the action is,” Harris says.

The RNFA waltz

Inside the OR, RNFAs assist on a variety of surgical procedures, but Harris’ favorite is open-heart surgery. “It’s so neat to see the surgeon stop the heart, cut it open, and put a valve into it, and start it back up,” she says.

Surgery is a precise practice that requires perfect teamwork. Because she works side by side with surgeons, Harris likens her role to that of a dancer. “There is a certain way to hold your arms and your hands while assisting, which is a lot like learning to position yourself during a dance,” she says.

Like Harris, many RNs are finding they are well-suited to mastering the RNFA dance.

“It’s a very attractive career path,” says Bonnie Denholm, RN, MS, CNOR, specialty assembly coordinator for the Association of periOperative Registered Nurses. “Many nurses find that this is an area in which to specialize while still staying in the clinical setting and without necessarily going into education or management.”

Jill Stanfield, RN, CRNFA, chair of consumer awareness for the AORN specialty assembly, adds that for nurses who want to stay in the OR and be at the bedside doing patient care, being an RNFA is the “only pathway.” Other alternatives are management and education, but both are “at least one step removed from the patient,” she says.

Stanfield says she was looking for a new way to stimulate her career after spending more than 30 years in the OR. She says her decision to become an RNFA “rejuvenated a flagging interest and kept me in the operating room.”

Although circulating and scrub nurses perform work that is similar to what RNFAs do, Stanfield says RNFAs who work independently have more autonomy than RNs. For example, OR nurses who are employed by a hospital must follow a set schedule, but independent contractors set their own.

“This gives us a level of autonomy that is difficult to find in nursing,” Stanfield says. However, this doesn’t mean RNFAs are qualified to do surgery. “The RNFA always works collaboratively with the surgeon,” Stanfield says. “The RNFA never does surgery independently.”

Stanfield is credentialed as an independent contractor for four hospitals in California. As such, her duties include assisting before and during surgery. Before surgery, she checks instruments, sutures, and supplies. During surgery, she assists with patient preparation and helps the OR staff with the surgeon’s requests and preferences.

“The roles of preoperative, intraoperative, and postoperative are all wonderfully intertwined,” Stanfield says. “We can make postoperative rounds, review standing orders, pull drains, help facilitate, and spend time with the patient postoperatively if the surgeon is busy.” Office-based RNFAs also can do histories and physicals.

Stanfield has been assisting Philip Bernstein, MD, an orthopedic surgeon at Mid-Peninsula Orthopedic Medical Group Inc. of San Mateo, Calif., for the past 10 years and has been involved with more than 500 cases. “Jill is very good technically and she is also readily available when I need an assistant,” he says. “She has been a wonderful help to me.”

A burgeoning field

RNs have been first-assisting in the OR for many years, but it was only in 1984 that AORN published its first official statement on the RNFA. By 1985, structured educational programs for RNFAs were established and legislative efforts began to seek third-party reimbursement. In 1990, AORN published its Core Curriculum for the RN First Assistant (revised in 1994), and the National Certification Board: Perioperative Nursing Inc. (now called Certification Board Perioperative Nursing) administered the first national certification exam in 1993.

According to the newly revised “AORN Official Statement on RN First Assistants,” the minimal requirements for an RN to practice as an RNFA include certification in perioperative nursing (CNOR); successful completion of an RNFA program that meets the “AORN recommended education standards for RN first assistant programs” and is accepted by the Certification Board Perioperative Nursing (CBPN); and compliance with statutes, regulations, and institutional policies relevant to RNFAs.