Registered Nurse-First Assist (RNFA) FTE 1.0

FTE/Scheduled Weekly Hours:

PRIMARY FUNCTIONS
1.    The Registered Nurse First Assistant (RNFA) is a Registered Nurse who works in collaboration with the surgeon and other health care team members to achieve optimal patient outcomes. 
2.    Has the necessary knowledge, judgment, and skills specific to the expanded role of RNFA clinical practice. 
3.    Intraoperatively practices at the direction of the surgeon.
4.    Does not function as the scrub person or circulator while practicing as the RNFA. 
5.    In keeping with Chapter 6 of the Iowa Nursing Practice Act for Registered Nurses, the ANA Scope and Standards of Practice for Nursing and the ANA Code of Ethics for Nursing, the professional nurse assumes
responsibility and accountability for the delivery of nursing care at Waverly Health Center. The Registered
Nurse is responsible for assessing, delegating, and coordinating nursing care based on the patient’s problem
and needs, by initiating the nursing process in the everyday practice of nursing. 
6.    Utilizes substantial specialized judgment and skill in providing direct and indirect patient care, observation,
and counsel to patients and family and accepts responsibility for the total nursing care of assigned patients.
7.    Communicates with providers, manager, and/or other healthcare team members about changes in patients’
clinical condition, including results of diagnostic studies and symptomatology.
8.    Assists with the clinical development of other nursing department staff members by serving as both mentor and consultant. 

ESSENTIAL DUTIES AND RESPONSIBILITIES
1.    Preoperatively performs a focused nursing assessment in reference to planned procedure.
•    Intraoperatively assesses the patient, wound, and sterile field.
2.    Monitors and assesses patient’s postoperative status to determine progress toward expected outcomes or signs and symptoms of postoperative complications.
3.    Formulates and modifies nursing diagnoses based on relevant patient data throughout the perioperative continuum as applicable to RNFA interventions.
4.    Establishes individualized outcomes in collaboration with the patient, designated support person or health care providers based on the identified nursing diagnoses and applicable to RNFA interventions. 
•    Analyzes and modifies postoperative patient outcomes compared to baseline nursing assessment. 
5.    Selects, analyzes, and interprets relevant data to develop a plan of care based on the nursing process that meets individual patient needs, is age specific, and reflects professionally recognized standards of care. 
6.    Applies nursing knowledge as the basis for effective problem solving and decision making when providing perioperative patient care. 
•    Coordinates and manages patient care throughout the perioperative continuum consistent with RNFA practice.
7.    Functions as first assistant to the primary surgeon during operative or other invasive procedures and throughout the perioperative continuum in accordance with scope of practice, credentials, privileges, education, and experience. 
•    Uses surgical instruments and equipment safely and correctly. 
•    Verifies operative procedure, surgical site, and laterality following organizational policy and Universal Protocol.
•    Plans care to minimize wasted supplies and reduce the length of the operative or other invasive procedure. 
•    Participates in positioning the patient in collaboration with the surgeon, anesthesia professional, and other members of the perioperative team. 
•    Applies safe tissue handling, dissection, or cutting techniques based on the assessment of tissue location, type, and patient’s health status. 
•    Performs specialized tissue handling, dissection, or cutting techniques under the direction of the operating surgeon. 
•    Minimizes the length of the operative or invasive procedure and maximizes the surgeon’s efficiency of movement within the surgical wound. 
•    Implements and maintains sterile technique to prevent patient exposure to microorganisms and other particulates. 
•    Protects the patient from thermal, electrical, chemical, or mechanical injury throughout the perioperative continuum. 
•    Implements hemostasis techniques. 
•    Implements measures to prevent injury related to retained surgical items. 
•    Practices first assisting in accordance with professional standards, state and federal laws and regulations, and accreditation standards
•    Accepts delegated medical functions as defined within the RNFA scope of practice.
•    Evaluates patient’s progress towards attaining outcomes. 
8.    Provides individualized patient, designated support person, or health care provider education regarding identified needs related to RNFA interventions. 
•    Involves the patient, designated support person, and health care providers in the evaluation process whenever possible. 
•    Plans for patient discharge, accessing community resources when necessary. 
9.    Participates in quality monitoring and performance improvement activities to improve patient outcomes related to RNFA practice. 
•    Participates in activities directed towards improving patient care.

MINIMUM QUALIFICATIONS
1.    Education, Experience, and Training
a.    Must be a graduate of an accredited school of nursing and currently licensed to practice as a Registered Nurse in Iowa.
b.    Minimum of 2 years of recent surgical nursing experience
c.    Baccalaureate degree in nursing preferred. 
d.    Maintains certification in perioperative nursing (CNOR)
e.    Successful course completion of additional educational preparation specific to the role of RNFA including a supervised clinical component. 
f.    Completes credentialing process and maintains clinical hospital privileges 
g.    Demonstrated proficiency in the scrub and circulating roles
h.    Demonstrated knowledge and skill in applying principles of aseptic technique
i.    Demonstrated knowledge of surgical anatomy, physiology, and operative technique related to first assisting
j.    Demonstrated ability to recognize safety hazards and to initiate appropriate preventative and corrective action
k.    Demonstrates competence in the intra-operative performance of the following surgical first assisting techniques:
i.    Handling, dissecting, or cutting of tissue under the direction of the operating surgeon
ii.    Safely using and handling of surgical equipment and instruments
iii.    Providing hemostasis
iv.    Wound management
v.    Suturing under the direction of the operating surgeon
vi.    Providing appropriate surgical site exposure
l.    Must be able to read, speak, and write fluent English. 
m.    Ability to learn and navigate computer systems including the online training modules, the employee timesheet and the performance appraisal system. Job specific systems are also required.
2.    Physical Requirements
a.    Sitting – Approximately 25% of shift.
b.    Standing – Approximately 50% of shift.
c.    Walking – Approximately 50% of shift.
d.    Lifting – Approximately 35 pounds. Must use, and require staff to use, when in hospital and/or pre-hospital settings, proper body mechanics and ergonomics and, as applicable, lifting/moving devices. 
e.    Twisting – Infrequent.
f.    Bending – Moderate.
g.    Squat/Kneel – Approximately 25% of shift.
 

This job description in no way states or implies that these are the only duties to be performed by the employee occupying this position.  A review of this description has excluded the marginal functions of the position that are incidental to the performance of fundamental job duties.  All duties and responsibilities are essential job functions.  Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by his/her manager.

Requirements are representative of the minimum levels of knowledge, skills, and/or abilities.  To perform this job successfully, the employee will possess the abilities or aptitudes to perform each duty proficiently.  Some requirements may exclude individuals who pose a direct threat or significant risk to the health and safety of themselves or other employees.  All requirements are subject to possible modification to reasonably accommodate individuals with disabilities.

This document does not create an employment contract, implied or otherwise, other than an "at will" employment relationship with the Waverly Health Center.