Transcription
RNFA Scope and Qualifications to PracticeLast update: April 2015STATEScope of PracticeQualifications to PracticeAlabamaALA. ADMIN. CODE § 610-X-7-.04:ALA. ADMIN. CODE § 610-X-7-.04:(3) When directed by the attending surgeon, theRNFA intraoperative functions include but arenot limited to:(1) The registered nurse may function as asurgical first assistant according to standardizedprocedures as defined in 610-X-6-.12. Theregistered nurse first assistant has the duty toverify that standardized procedures are in effectbefore performing the functions of a surgicalfirst assistant.(a) Positioning the patient, preparing anddraping the surgical site.(b) Providing exposure, retraction, andhemostasis.(c) Use and handling of surgical instrumentation.(d) Tissue handling, dissection, suturing, andstapling.(e) Making the skin nick or stab wound forlaparoscopic surgery or drains excludingplacement of trocar for laparoscopic access.(f) Securing drains.(g) Closing of wounds external to the fascia.(h) Harvesting extremity veins and closure of theresulting wounds.(4) Functions for the RNFA that are not listed inthese rules shall be defined in standardizedprocedures. Approval by the Board is requiredprior to implementation of RNFA standardizedprocedures for all practice settings.(6) The RNFA shall not function as a scrub nurseconcurrently with responsibility as a surgicalassistant.(2) Performing intraoperative functions as aRNFA is limited to the direct supervision of theattending surgeon physically present in thesurgical suite where the case is beingperformed.(5) Standardized procedures for the RNFA shallinclude a statement of clinical privileges foradditional technical functions that are permittedin a hospital.Qualifications forAPRNs **APRNs follow RNrequirements.
RNFA Scope and Qualifications to PracticeLast update: April 2015AlaskaALASKA BOARD OF NURSING, SCOPE OF PRACTICEADVISORY OPINIONS, REGISTERED NURSEALASKA BOARD OF NURSING, SCOPE OF PRACTICEADVISORY OPINIONS, REGISTERED NURSEAPRNs follow RNrequirements.January 1992: A registered nurse may practice as Qualifications for RNFAs will be asa first assistant to a surgeon.recommended in the AORN RNFA positionstatement (based on the approval by the AlaskaThe practice must be done in accordance withBoard of Nursing in January 1992 and Augustthe Board’s position statement “Registered1993).*Nurse and Advanced Nurse Practitioner Scopesof Practice” and the “AORN Official Statementon RN First Assistants.” The surgeon must* Confirmed by email with Alaska Board ofdirectly supervise the nurse. A nurse may notNursing (Feb. 1, 2012).practice under standing orders or protocols thatrequire the nurse to make medical judgmentsoutside the nurse’s scope of practice.August 1993: Approved the Association ofOperating Room Nurses statement on RN asFirst Assistant as guidance to nurses on thisissue.ArizonaARIZONA STATE BOARD OF NURSING, ADVISORYOPINION, REGISTERED NURSE FIRST ASSISTANT –RNFA, LAST REVISED MARCH 2011ARIZONA STATE BOARD OF NURSING, ADVISORYOPINION, REGISTERED NURSE FIRST ASSISTANT –RNFA, LAST REVISED MARCH 2011It is within the scope of practice of a RegisteredNurse who can demonstrate the necessaryeducation, knowledge, judgment, certification,and skills, to practice as a RNFA, assisting thesurgeon during surgical procedures. The RNFA isnot authorized to independently perform asurgical procedure which is the primary purposeof a surgery, or to perform organ transplants.II. Qualifications:The minimum qualifications to practice as anRNFA are:A. Certification as a Certified Nurse of theOperating Room (CNOR)B. Successful completion of an approvedRNFA program that meets theAssociation of periOperative RegisteredNurses (AORN, 2010) criteriaAPRNs follow RNrequirements.
RNFA Scope and Qualifications to PracticeLast update: April 2015The Board of Nursing endorses the March 2010AORN official statement on RNFAs.ArkansasArkansas’ Nurse Practice Act and board ofnursing regulations are silent on RNFAs. Inquiresto the Board of Nursing regarding RNFA scopeare referred to the board’s Decision MakingModel.*C. Compliance with all statutes,regulations, and institutional policiesrelated to the role of the RNFA (AORN,2010).N/AAPRNs would also bereferred to theBoard’s DecisionMaking Model.STATE OF CALIFORNIA, STATE AND CONSUMER SERVICESAGENCY, BOARD OF REGISTERED NURSING, NPR-B-18,THE RN AS FIRST ASSISTANT TO THE SURGEON, LASTREVISED 06/16/2011STATE OF CALIFORNIA, STATE AND CONSUMER SERVICESAGENCY, BOARD OF REGISTERED NURSING, NPR-B-18,THE RN AS FIRST ASSISTANT TO THE SURGEON, LASTREVISED 06/16/2011APRNs would alsofall under theBoard’s The RN asFirst Assistant to theSurgeon statement.The role of RN first assistant to the surgeonrequires the performance of a combination ofnursing and medical functions. The RN firstassistant directly assists the surgeon bycontrolling bleeding, providing wound exposure,suturing and other surgical tasks. The RN firstassistant may provide other advancedassistance, such as mobilization of tissue,patient positions and directing other surgicalteam members with specific individual tasks.The RN first assistant, practices perioperativenursing and must have acquired the necessaryspecific knowledge, skills and judgment. The RNfirst assistant practices under the supervision ofthe surgeon during the intraoperative phase ofGuidelines for Developing StandardizedProceduresStandardized procedures are not subject to priorapproval by the boards that regulate nursingand medicine, however, they must be developedaccording to the following guidelines whichwere jointly promulgated by the Board ofRegistered Nursing and the Medical Board ofCalifornia * Confirmed by email with Arkansas Board ofNursing (Feb. 1, 2012).California(a) Standardized procedures shall include awritten description of the method used indeveloping and approving them and anyrevision thereof.(b) Each standardized procedure shall:
RNFA Scope and Qualifications to PracticeLast update: April 2015the perioperative experience. In order toperform those functions considered to be firstassistant to the surgeon, the RN must adhere tostandardized procedures. The RNFA may notperform the function of the scrub nurse whilefunctioning as the RNFA.* This Advisory Opinion links to AORN’sStandards for RN first assistant educationprograms.1) Be in writing, dated and signed by theorganized health care system personnelauthorized to approve it,2) Specify which standardized procedurefunctions registered nurses may performand under what circumstances.3) State any specific requirements whichare to be followed by registered nursesin performing particular standardizedprocedure functions.4) Specify any experience, training and/oreducation requirements forperformance of standardized procedurefunctions.5) Establish a method for initial andcontinuing evaluation of thecompetence of those registered nursesauthorized to perform standardizedprocedure functions.6) Provide for a method of maintaining awritten record of those personsauthorized to perform standardizedprocedure functions.7) Specify the scope of supervisionrequired for performance ofstandardized procedure functions, forexample, telephone contact with aphysician.8) Set forth any specialized circumstancesunder which the registered nurse is toimmediately communicate with apatient’s physician concerning thepatient’s condition.
RNFA Scope and Qualifications to PracticeLast update: April 20159) State the limitations on settings, if any,in which standardized procedurefunctions may be performed.10) Specify patient record-keepingrequirements.11) Provide for a method of periodic reviewof the standardized procedures.ColoradoColorado’s Nurse Practice Act and board ofnursing regulations are silent on RNFAs.Colorado’s board of nursing provides statementsto determine your scope of practice.N/AN/ADEPARTMENT OF HEALTH SERVICES, STATE OFCONNECTICUT, BUREAU OF HEALTH SYSTEMREGULATION, DIVISION OF MEDICAL QUALITYASSURANCE, DECLARATORY RULING ON REGISTEREDNURSES AS FIRST ASSISTANT IN THE OPERATING ROOM,NOVEMBER 7, 1988DEPARTMENT OF HEALTH SERVICES, STATE OFCONNECTICUT, BUREAU OF HEALTH SYSTEMREGULATION, DIVISION OF MEDICAL QUALITYASSURANCE, DECLARATORY RULING ON REGISTEREDNURSES AS FIRST ASSISTANT IN THE OPERATING ROOM,NOVEMBER 7, 1988APRNs follow RNrequirements. the Department adopts the standardsespoused by the Association of Operating RoomNurses. AORN Journal, December 1980, Vol.32,Qualifications1. Certification in perioperative nursing,In 2004, Colorado’s Department of RegulatoryAgencies Office of Policy, Research andRegulatory Reform released a reportrecommending that the General Assemblyshould not regulate the practice of surgicalassistants. This report recognized that healthprofessionals who perform the functions ofsurgical assistants include registered nurses,nurse practitioners, clinical nurse specialists, andcertified registered nurse first assistants.Connecticut
RNFA Scope and Qualifications to PracticeLast update: April 2015No. 6; September 1984, Vol. 40, No. 3; and May1987, Vol. 45, No. 5 (Exhibit No. 11). Should thestandards as espoused by the association ofoperating room nurses be modified by thatassociation, this declaratory ruling should beread to incorporate the standards as so modifiedby that association.2. Knowledge and skill in principles ofasepsis and infection control,3. Knowledge of anatomy, physiology andoperative technique,4. Ability to perform CPR.Scope of PracticeUnder the direct and constant supervision of theoperating physician:1. Tissue handling,2. Providing exposure,3. Using instruments,4. Suturing,5. Providing hemostasis.DelawareFloridaSTATE OF DELAWARE, DEPARTMENT OF STATE,DIVISION OF PROFESSIONAL REGULATION, BOARD OFNURSING MEETING MINUTES, JANUARY 11, 2012STATE OF DELAWARE, DEPARTMENT OF STATE,DIVISION OF PROFESSIONAL REGULATION, BOARD OFNURSING MEETING MINUTES, JANUARY 11, 2012RN First Assistant Position StatementIt is recommended that RNFAs follow thenational standards from their professionalorganization AORN.RN First Assistant Position StatementIt is recommended that RNFAs follow thenational standards from their professionalorganization AORN.FLA. STAT. § 464.027 – REGISTERED NURSE FIRSTFLA. STAT. § 464.027 – REGISTERED NURSE FIRSTASSISTANTASSISTANT(4) INSTITUTIONAL POWERS. –Each health careinstitution must establish specific procedures forthe appointment and reappointment ofregistered nurse first assistant staff members(3) QUALIFICATIONS. –A registered nurse firstassistant is any person who:(a) Is licensed as a registered nurse under thispart;(b) Is certified in perioperative nursing; andAPRNs follow RNrequirements.APRNs follow RNrequirements.
RNFA Scope and Qualifications to PracticeLast update: April 2015and for granting, renewing, and revising theirclinical privileges.(c) Holds a certificate from, and has successfullycompleted, a recognized program.(2) DEFINITIONS. –As used in this section, theterm:(a) “Perioperative nursing” means a practice ofnursing in which the nurse providespreoperative, intraoperative, and postoperativenursing care to surgical patients.(b) “Recognized program” means a programthat:1. Addresses all content of the Association ofOperating Room Nurses, Inc. Core Curriculumfor the Registered Nurse First Assistant, and2. Includes 1 academic year, defined as 45 hoursof didactic instruction and 120 hours of clinicalinternship or its equivalent of 2 collegesemesters.GeorgiaGeorgia’s Nurse Practice Act and board ofnursing regulations are silent on RNFAs.Georgia’s board of nursing provides a RN Scopeof Practice Decision Tree to assist Georgia RNswith scope of practice questions.N/AN/AHawaiiN/AA registered nurse assisting in surgery must havethe knowledge, skills, and competency to do thetasks required. HAW. REV. STAT. §457.2.*N/A* Confirmed by email with Hawaii Board ofNursing (Feb. 13, 2012).
RNFA Scope and Qualifications to PracticeLast update: April 2015IdahoIllinoisIDAHO ADMINISTRATIVE CODE, 23.01.01 – RULES OFTHE IDAHO BOARD OF NURSING, § 23.01.01.401.02(b)IDAHO BOARD OF NURSING, FREQUENTLY ASKEDQUESTIONS, 2005 – 2007b. Surgical First Assistants. A surgical firstassistant is a licensed professional nurse who,under direct supervision, assists the operatingsurgeon.i. Nurses acting as surgical first assistants maynot concurrently serve as scrub or instrumentnurses.ii. A licensed professional nurse surgical firstassistant in cardiovascular surgery may harvestsaphenous veins after completing additionaleducational instruction acceptable to the Boardand supervised practice under direct supervisionof the operating physician.Question: Can a licensed advanced practiceprofessional nurse function as a surgical firstassistant?Illinois’ Nurse Practice Act and the Board ofNursing rules do not address RNFA scope ofN/AAPRNs follow RNrequirements.Response: Registered nurses, including licensedadvanced practice professional nurses, mayfunction as surgical first assistants if they meetconditions established in administrative rules ofthe Board. The nurse functioning as a surgicalfirst assistant: Must successfully complete specificeducation, training and supervisedpractice in an organized program ofstudy and must demonstratecompetence in the functions to beperformed. Must conform to recognized standardsfor practice of the surgical first assistant. Must follow written protocols approvedby medical staff, nursing administrationand the employing agency. May not concurrently serve as scrub orinstrument nurse. May harvest saphenous veins aftercompleting additional educationacceptable to the Board, includingsupervised practice under directsupervision of the operating physician.N/A
RNFA Scope and Qualifications to PracticeLast update: April 2015practice or qualifications. Language in theHospital Licensing Act affirms that first assistingis within the RN scope of practice in Illinois:210 ILCS 85/10.7(2) – A licensed physician,dentist or podiatrist may be assisted by aphysician licensed to practice medicine in all itsbranches, dentist, dental assistant, podiatrist,licensed advanced practice nurse, licensedphysician assistant, licensed registered nurse,licensed practical nurse, surgical assistant,surgical technician, or other individuals grantedclinical privileges to assist in surgery at thehospital.IndianaN/AN/AN/AIowaIOWA BOARD OF NURSING, REGISTERED NURSE FIRSTASSISTANTS, LAST REVISED 2006IOWA BOARD OF NURSING, REGISTERED NURSE FIRSTASSISTANTS, LAST REVISED 2006APRNs follow RNrequirements.RN first assistant behaviors in the perioperativearena may include:The education and development of the RN firstassistant builds upon the educationalpreparation leading to licensure as an RN. TheRN first assistant must then acquire thenecessary knowledge, judgment and skillsspecific to the expanded role through a formalRN first assistant education program.* preoperative patient management with otherhealth care providers, including but not limitedto,- performing preoperative evaluation focusednursing assessment,- communicating/collaborating with other healthcare providers regarding the patient plan ofcare, and- writing preoperative orders according toestablished protocols of the physician and/orfacilityThe Iowa Board of Nursing has adopted thequalifications for entry into RNFA practice asdefined by the Association of Operating RoomNurses (AORN).
RNFA Scope and Qualifications to PracticeLast update: April 2015* intraoperative surgical first-assisting, includingbut not limited to,- using instruments/medical devices,- providing exposure,- handling and/or cutting tissue,- suturing; and- harvesting veinsWhen education and clinical requirements havebeen met, the RNFA is encouraged to obtain andmaintain certification (CRNFA).* postoperative patient management with otherhealth care providers in the immediatepostoperative period and beyond, including butnot limited to,- writing postoperative orders/operative notesaccording to established protocols of thephysician and/or facility,- participating in postoperative rounds, and- assisting with discharge planning andidentifying appropriate community resources asneeded.KansasN/AKansas Board of Nursing encourages certification N/Abut does not rule out on the job training.** Confirmed by email with Kansas Board ofNursing (Feb. 7, 2012).KentuckyKENTUCKY BOARD OF NURSING, ADVISORY OPINIONSTATEMENT #08, ROLE OF THE REGISTERED NURSEFIRST ASSISTANT, LAST REVISED 4/2007.KENTUCKY BOARD OF NURSING, ADVISORY OPINIONSTATEMENT #08, ROLE OF THE REGISTERED NURSEFIRST ASSISTANT, LAST REVISED 4/2007.1) It is within the scope of registered nursingpractice for a registered nurse who possessessubstantial, specialized knowledge and technical3) Registered nurses who perform first assistantacts should:APRNs follow RNrequirements.
RNFA Scope and Qualifications to PracticeLast update: April 2015skill to act as an RN first assistant to thephysician who is immediately available andonsite during surgical procedures.2) In no event should the RN first assistant beexpected to replace or assume theresponsibilities of the physician performing thesurgical procedure, but may accept appropriateresponsibility if the physician becomesincapacitated by protecting the surgical wound,maintaining homeostasis, and maintainingsterility of the operative field until thereplacement physician accepts responsibilitiesfor procedure’s completion.Further, it was the advisory opinion of the Boardthat handling and/or tissue cutting forperformance of small skin lesion excision andpunch biopsy are within the scope of registerednursing practice for the registered nurse whopossesses substantial, specialized knowledgeand current clinical competency in theperformance of the procedures. The proceduresshould be performed under the supervision of aphysician who is onsite and immediatelyavailable to the nurse.LouisianaA. Possess an in-depth knowledge ofperioperative and intraoperative nursingpractice;B. Be knowledgeable of the potentialcomplications and adverse reactions and to takeappropriate action as directed by the physician;C. Possess the knowledge and skill to recognizeadverse reactions and to take appropriate actionas directed by the physician;D. Perform acts which are in accordance with:1) the established written agency policies andprocedures, 2) the definition of “registerednursing practice” as stated in KRS 314.011(6),3) evidence-based practice, and 4) the scope ofpractice of RN First Assistants as established byAssociation of Operating Room Nurses.4) Registered nurses who perform first assistantacts should maintain documentation of theireducational preparation that provides for clinicalpractice and demonstration of competency inthe performance of such acts. The Boardencourages certification via a national nursingorganization and recognizes it as onemechanism for demonstrating knowledge andcompetency.LOUISIANA STATE BOARD OF NURSING, DECLARATORYSTATEMENT FOR REGISTERED NURSE FIRST ASSISTANTS,LAST REVISED 8/27/14LOUISIANA STATE BOARD OF NURSING, DECLARATORYSTATEMENT FOR REGISTERED NURSE FIRST ASSISTANTS,LAST REVISED 8/27/14The APRN practicing as a first assistant insurgery functions in an expanded perioperativenursing role. Perioperative nursing is consideredAPRNs seeking to function as first assistants insurgery must meet the requirements andqualifications for practice as a Registered NurseAPRNs must followAORN requirements***Exception to therequirement forcompletion of anRNFA educational
RNFA Scope and Qualifications to PracticeLast update: April 2015a specialized area of practice for the APRN. Theactivities included in first assisting in surgery asan APRN are further refinements ofperioperative nursing practice which areexecuted within the context of advancedpractice nursing. The assistant in surgerycollaborates with the surgeon to promoteoptimal patient outcomes and does notconcurrently function as a scrub nurse orcirculator. Intraoperative nursing behaviors arebased on an extensi
surgical first assistant according to standardized procedures as defined in 610-X-6-.12. The registered nurse first assistant has the duty to verify that standardized procedures are in effect before performing the functions of a surgical first assistant.
