RN First Assist

RN First Assistant

Responsible to the patient and the surgical team to assist, educate and otherwise facilitate an optimal outcome for the patient. Participate in preoperative assessment and planning for surgical patients specific to RNFA activities (eg, anatomical exposure, wound closure) in collaboration with perioperative team members. Develop an individualized perioperative patient plan of care. Implement the plan of care by: assisting with positioning, prepping and draping of the patient or perform there independently, if so directed by the surgeon. Protecting the patient from injury caused by extraneous objects and chemical, electrical, laser, mechanical, and thermal sources; participating in accounting procedures to protect the patient from unintended retained surgical items; performing interventions necessary to ensure that the patient's procedure is performed on the correct site, side, and level; delaying surgical procedure if any discrepancy among parties, patient history and physical, consents, or scheduled procedure occurs. Assisting with management of the patient's specimens as necessary; communicating the patient's current status to relevant parties throughout the continuum of care; administering medications safely and correctly; performing interventions to maintain the patient's wound and tissue perfusion at or above baseline levels; performing interventions to maintain the status of the patient's genitourinary, gastrointestinal, musculoskeletal, endocrine, respiratory, cardiovascular, and neurological systems and fluid, electrolyte, and acid-base balances at or above baseline levels; performing interventions to ensure the patient is at or returned to normothermia at the conclusion of the immediate postoperative period; performing interventions to protect the patient from surgical site infection; assessing the knowledge level of the patient or designated support person; demonstrates the ability to operate specialized equipment intra-operatively; i. e. stapling instrumentation, laparoscopic tools and equipment, orthopedic drills, and instrumentation, lasers, etc. per established procedures. Providing education regarding the expected psychosocial response, nutritional management, medication management, pain management, wound management, and expected responses to the operative or invasive procedure; acts as a resource person for the operating room staff.

Acts as a resource person for the operating room staff. Involve the patient or designated support person actively in decisions affecting his or her perioperative care and the rehabilitation process; protecting the patients' rights, dignity, and privacy; providing age-specific, culturally competent, ethical care within legal standards of practice; and providing consistent and comparable care regardless of the setting. Function as an RN first assistant during operative and other invasive procedures by: providing exposure through correct use of instruments, retractors, suction, and sponging techniques; placing and holding surgical retractors and demonstrating stamina for sustained retraction retaining manually controlled retractors in the position set by the surgeon with regard to surrounding tissue. Anticipating retraction needs with knowledge of the surgeon's preferences and anatomic structures packing sponges or laparotomy pads into body cavities to hold tissues and organs out of the operative field managing all instruments in the operative field to prevent obstruction of the surgeon's view. Considers anatomical and physiological implications when selecting, placing, and moving retractors to provide surgical site exposure and reduce tissue injury. Suctions surgical site as necessary to remove smoke, blood, and fluids from the site to improve visualization and decrease biohazard exposure. Provides hemostasis by: applying electrocautery tip to clamps or vessels in a safe and knowledgeable manner as directed by the surgeon. Sponging and utilizing pressure as necessary. Utilizing suction techniques. Applying clamps on superficial vessels and the tying off, electrocoagulation of them as directed by the surgeon. Placing suture ligatures in the muscle, subcutaneous, and skin layers. Placing hemoclips on bleeders as directed by the surgeon. Perform knot tying by: choosing suturing material and techniques (eg, knot tying, ligation of vessels, wound closure) based on physician preference, density of tissue, support for suture line, potential tissue necrosis, need to evert skin edges, and cosmetic effect. Having knowledge of the basic techniques. Tying knots firmly to avoid slipping. Avoiding undue friction to prevent fraying of suture. Carrying knot down to the tissue approximating tissue rather than pulling tightly to prevent necrosis.

Correctly approximating tissue layers under the direction of the surgeon demonstrates proficiency in skin stapling techniques by assessing blood supply of tissues to be stapled, inspection of staple line, and applying skin staples correctly. Handling and dissecting tissues in collaboration with the surgeon; clamping and severing tissue grasp and fixate with screws, staples and other devices performing specialized tissue handling, dissection, or cutting techniques under the direction of the operating surgeon clamping blood vessels, coagulating bleeding points, and ligating vessels in collaboration with the surgeon; suturing muscle, fascia, subcutaneous, and skin in collaboration with the surgeon. Placing drains as directed by the surgeon assist with applying casts, plaster splints or other devices as indicated serve as an educator, mentor, consultant, and resource to peers, colleagues, and others in relation to RNFA activities transfer care as applicable. Delegate tasks according to TN Nurse Practice Act and job descriptions. Document nursing care accurately, completely, and legibly. Collaborate effectively with other disciplines as applicable. Ability to be self-directed in accomplishing the coordination and decision making responsibilities of this position, and be resourceful in problem solving.

Listen attentively and responsively to information provided. Comprehend information, anticipate information needs of others. Keep others informed in a complete and accurate manner. Supply information requested by nursing personnel, patients, visitors, hospital departments, outside agencies and various health care institutions, using established policy and procedure. Establish and maintain effective working relationships with fellow employees, administrative staff and the general public. Communicates changes in the patient's situation to members of the healthcare team as intervention progresses to determine a need for new treatments or a change in existing treatments.

Takes appropriate action to address customer concerns and complaints. Implements innovative approaches to meet the needs of patients and families. Responsible for assessing, planning, implementing and coordinating patient care throughout the perioperative continuum. Ability to correlate clinical data with patient's medical and nursing care. Ability to handle difficult situations involving patients, physicians, or others in a professional manner. Supports perioperative patients' health care rights by involving individuals in their own care.

Reports illegal, incompetent, or impaired practices. Assumes a leadership role in the provision of quality nursing care for patients receiving care. Know the accurate standards of clinical competency for the safe care of the unit's patients. Understand key quality and safety improvement measures. Assist with safety survey scores and actions to improve. Remains informed of innovative clinical trends through benchmarking and evidence-based practice. Actively participates in preparation of regulatory agency reviews.

Assist in assuring operational cost, equipment and supply cost stay within the unit's budget. Collaborates with the surgeon and other members of the health care team to promote efficient use of time, supplies, equipment, and personnel.

Seeks opportunities and experiences to increase skills and maintain competency necessary to practice as an RNFA. Assist with orientation, training and developing of employees within the department as necessary. Identifies, initiates, and collaborates to provide needed educational programs. Ensures compliance with educational requirements through scheduling, planning, and support. Demonstrates current evidence-based practice. Recognized as an expert clinician and a leader within area of specialty. Maintains current licensure necessary for job requirements. Complete annual performance evaluation for self and employees and implement plans of correction when needed. Maintain required competencies for self. Pursue professional growth and participates in a professional organization.

Influences multidisciplinary relationships by enhancing collaborative processes, "corporate culture," institutional values, and professionalism. Practices first assisting in accordance with professional standards, state and federal laws and regulations, and accreditation standards. Adhere to dress code, appearance is neat and clean. Complete annual education requirements. Maintain patient confidentiality at all times. Ability to maintain confidentiality of all medical, financial, and legal information. Report to work on time and as scheduled. Wear identification while on duty. Maintain regulatory requirements, including all state, federal and local regulations. Represent the organization in a positive and professional manner at all times. Comply with all organizational policies and standards regarding ethical business practices. Participate in performance improvement and continuous quality improvement activities. Attend regular staff meetings and in-services. Follow through on commitments; accepts responsibility for personal actions; and adapt to change.

Healthcare/Medical - Nurse: Registered Nurse- Preferred. Two years perioperative RN or RNFA experience- Required. Additional Certification & Licensures details. Current and valid Registered Nurse licensure, RN First Assistant licensure in TN (CRNFA preferred but not required), Certified Nurse of the Operating Room (CNOR). BLS Required by hire date. ACLS and CPI Required within 90 days of hire date.