As defined by the American College of Surgeons, the first assistant provides aid in exposure, hemostasis, and other technical functions, that will help the surgeon carry out a safe operation with optimal results for the patient. The RNFA performs, under direct supervision, intraoperative technically advanced functions as stated in the job functions. Responsible for aiding the professional nurse or physician in providing optimal patient care, addressing age-specific needs, in the assigned single operating room in a surgical assistant capacity or assisting the physician on the floor or clinic as an extender. The assistant performs these functions during the operation, on the floor, or in the clinic under the direction and supervision of the surgeons and in accordance with hospital policy, appropriate laws and regulations and stated job functions. Responsible for providing patient care for an assigned shift as scheduled full time or part-time. Reporting is under the supervision of the Clinical Manager. The employee is subject to call back, call coverage, and overtime as required by the hospital.

Demonstrates thorough knowledge of principles of asepsis ensuring that proper techniques and practices are maintained, in providing age-specific patient care.
Preoperatively perform nursing assessments, educate the patient and offer emotional support.
Evaluate the needs of the patient and the surgical team on a continuum, throughout the surgical encounter.
Collaborating with the surgeon and other health care professionals for an optimal surgical outcome.
Assisting with anesthesiologists when applicable.
Assisting with patient positioning, skin preparation, and draping.
Providing wound exposure by suctioning, sponging, and retracting.
Harvesting of the saphenous vein for grafting purposes under the direction of the operating surgeon.
Arterial conduit for grafting purposes under the direct supervision of the physician and only if RN has holds a certificate demonstrating training.
During endoscopic procedures, it may advance the rigid endoscope to provide optimal visualization under the direction of the operating surgeon.
Providing hemostasis by applying hemostatic clamps, or clips, coagulating bleeding points and ligating bleeding vessels.
Surgical wound closure under the direction of the surgeon; may facilitate the closure of the skin layer by proper handling of the tissue with forceps.
Suturing fascia, subcutaneous, and skin tissues.
Insertion of urethral catheters.
Scrubs, gowns and gloves self for surgical procedures.
Using and manipulating surgical instruments.
Handles and uses instruments correctly and insures their proper functionality and storage.
Actively participates incorrect sponge, needle and instrument count.
Handling tissue appropriately to reduce the potential for injury.
Participates in the proper handling of all lab and tissue specimens according to established protocol.
Assumes responsibility for the proper handling of supplies.
Selecting and applying the appropriate wound dressings.
Assisting in securing drainage systems to tissue.
Relieves on cases at or during a change of shift, breaks, or mealtimes, following correct protocol, to ensure continuity of care.
Has access and handling of medications deemed necessary for procedures in the operating room.
Records progress of patient on Progress Notes which will be countersigned by the physician in the hospital and clinic setting.
May accept verbal orders from the physician, recording and then reading back to the physician for confirmation.
May be responsible postoperatively for assisting in the safe delivery of the patient to the recovery room; communicating to the appropriate health care personnel and family members; performing follow-up care to evaluate the patient’s condition; performing post-operative activities, which may include removing sutures, chest tubes, drains, and pacing wires; and participating in discharge planning and providing discharge instructions.
Performs related responsibilities as required or directed.

EDUCATION: Completion of a diploma, associate, or baccalaureate degree in nursing required. Has successfully completed a registered nurse first assistant education program that meets the education standard of the Association of perioperative Registered Nurses for a registered nurse first assistant.  
LICENSURE, REGISTRATION, CERTIFICATION: Current Tennessee license as a Registered Nurse required. Current Tennessee license as Registered Nurse First Assist required. Current certification in perioperative nursing (CNOR) obtained through the Competency and Credentialing Institute required. Current BLS Certification required. CRNFA (Certified Registered Nurse First Assistant) desired, but not required. This certification is obtained through the National Institute of First Assisting, Inc.  
EXPERIENCE: Ability to scrub during surgical cases as acquired through three months of departmental education.