Avoiding Liability Bulletin – April 2014

You may have been practicing in the Perioperative nursing area for some time and have decided to take on a “new” role, that of RN First Assistant. RN First Assistants function in an expanded role and work in collaboration with the surgeon and other Perioperative health team members. The RNFA practices at the direction of the surgeon. RN First Assistants do not function as a scrub nurse nor the “instrument nurse” at the same time they perform in the role of RNFA.1

As you have probably heard, you cannot just “declare” yourself an RN First Assistant. You must complete an educational, formal post-basic nursing course that is approved by the state board of nursing, whether through a private entity or through an approved course in an accredited college or university. Certification as a CNOR or APRN is also required.2 And, by January 1, 2020, the Association of peri-Operative Registered Nurses will require that the educational level for entry into an RNFA program, and subsequent practice, be the baccalaureate degree.3

The Association has also defined the RN First Assistant’s scope of practice. Although the scope will vary depending on state nurse practice act requirements, patient populations and an institution’s policy, some of the RNFA’s functions include preoperative patient management in collaboration with other health care providers, intraoperative techniques such as suturing, handling and/or cutting tissue, and postoperative patient management in collaboration with other health team members.4

Clinical privileges for the RNFA is also recommended. The clinical privileging process should include verifying individual RNFA qualifications, defining lines of accountability, and verifying the RNFA’s physical ability to perform the role.5

If you decide to undertake the role of the RNFA, there are a number of guidelines to consider, including:

• Be certain to carefully analyze any educational program for the role, ensuring that it meets AORN requirements;
• Determine the need for this role in the state in which you practice or one to which you are considering relocating;
• Carefully consider obtaining your baccalaureate degree before beginning your education as a RNFA;
• Obtain certification as required for the RNFA;
• When practicing in this role, carefully review your state nurse practice act and its rules for established requirements for the role and your role as an RN generally;
• Purchase professional liability insurance for your practice as an RNFA;
• Stay within the parameters of your scope of practice;
• When in the RNFA role, do not undertake any other roles in the operating room, including the scrub or instrument nurse role;
• Keep up to date with certification and continuing education requirements of the role and of your state nurse practice act;
• Apply for clinical privileges in the facility in which you function as a RNFA;
• Understand reimbursement processes for your role as a RNFA; and
• Join and be an active participant in the Association of per-Operative RNs.

FOOTNOTES

1. Association of peri-Operative Nurses. Registered Nurse First Assistant. Available at http://www.aorn.org/Clinical_Practice/RNFA-Resources/First-Assisting_(RNFA).aspx . Accessed March 31, 2014.
2. Association of peri-Operative Nurses (2013). AORN Position Statement on RN First Assistants. ( Available at above link).
3. Id.
4. Id.
5. Id.

THIS BULLETIN IS FOR EDUCATIONAL PURPOSES ONLY AND IS NOT TO BE TAKEN AS SPECIFIC LEGAL OR OTHER ADVICE BY THE READER. IF LEGAL OR OTHER ADVICE IS NEEDED, THE READER IS ENCOURAGE SEEK ADVICE FROM A COMPETENT PROFESSIONAL.