New role benefits the patient, surgeon, and nursing

One of the many changes that the health-care system has seen over the last few years is the introduction of the Registered Nurse First Assistant (RNFA). The RNFA role, which is well established in the United States, is now gaining momentum across Canada. There are seven hospitals in Ontario currently using RNFA’s.

The RNFA is an extended role of the operating room nurse. It will directly benefit patient care, the surgeon and nursing. In several areas of the province there has been a shortage of physician assistants. This expanded role gives perioperative nurses an opportunity to increase their knowledge and skills, while enhancing their quality of work life. An RNFA is an experienced operating room nurse who has completed additional formal education. Nurses who are interested in applying for the RNFA program must have two-five years operating room experience, along with other stringent admission criteria. The RNFA program consists of a theoretical foundation, classroom and laboratory experience as well as a surgeon mentored clinical internship.

This unique position encompasses all phases of surgical care – from the time the patient enters the hospital until time of discharge. Prior to surgery, in conjunction with other members of the surgical team, the RNFA may be responsible for preoperative nursing assessment and health teaching provide patient/family support, initiate the perioperative nursing plan of care, and communication of the plan of care with other health-care professionals.

The main focus of the RNFA in Ontario seems to be within the operating room. The role of the RNFA in surgery may include assisting for all types of surgical procedures, working in collaboration with the surgeon as the surgical assistant, assisting anesthesia and nursing. The RNFA also applies principles of asepsis, knowledge of anatomy, physiology and operative technique. The RNFA assists with patient preparation, positioning, prepping, and draping. In collaboration with the surgeon, using knowledge, skills and judgement the RNFA provides exposure of the surgical site with the use of retractors, suction, and sponges. The RNFA handles tissue, maintains hemostasis and performs wound closure.

After surgery, the RNFA helps to transport the patient and communicates pertinent patient information to the post anesthetic care unit (PACU), intensive care unit (ICU) or ward staff. The RNFA performs postoperative nursing assessments, wound surveillance, educates patient/family with discharge planning and is involved with patient follow-ups. In addition, the RNFA may participate in nursing and medical research projects.

In 2000 a dedicated group of RNFA’s started the Operating Room Nurses Association of Ontario (ORNAO) RNFA Interest Group. This group is steadily growing in numbers and at present has 58 members. One of the main focuses of this group is promoting the RNFA role in hospitals across Ontario. Five years ago there was only one RNFA employed in Ontario. As of July 2003, that number has grown to 17. Provincially, there seems to be a growing awareness and need for the services that an RNFA can provide. These positions have been created and supported by administrators, surgeons, and nurse managers who are innovative and envision the need for this enhanced nursing role. They recognize that the role of the RNFA is to provide quality care, working effectively as a member of a multi-disciplinary team towards better patient outcomes.

For further information email: Grace Groetzsch Chair, ORNAO RNFA Interest Group