RN/Registered Nurse First Assistant - Part-time - Days

The RNFA is a perioperative registered nurse who works in collaboration with the surgeon and the health care team members to achieve optimal patient outcomes. The RNFA must have acquired the necessary knowledge, judgment, and skills specific to the expanded role of the RNFA clinical practice. Intraoperatively, the RNFA practices under the direction and guidance of the surgeon and does not concurrently functions as a scrub nurse.
The RNFA has the obligation and responsibility to refuse to perform any delegated act, whether oral or written, if not within the parameters of his/her defined role and licensure.

Education:
Successful Completion of an accredited course in RN first assisting program that meets the 'AORN standards' Equivalent work experience as a RN First Assistant may be substituted for completion of accredited RNFA course.

Licensures/Certifications:
• Current registration with the Maryland State Board of Examiners of Nurses as a Registered Nurse.
• Healthcare Provider (CPR Certification).
• ACLS preferred
• Current CNOR certification.
• CRNFA certification preferred

Experience:
Minimum of 5 years diversified Perioperative nursing experience: both scrubbing and circulating proficiency.

Skills:
• Advanced knowledge of anatomy, physiology, surgical interventions, surgical techniques and surgical hazards relative to operative procedures wherein the RNFA assists.
• Advanced knowledge and skill in handling surgical instrumentation, in aiding in exposure, retraction, hemostasis, suctioning, tissue handling including dissecting, suturing, tying, stapling and stab wound.
• Analytical ability to conduct pre-operative and post-operative patient assessment, to evaluate physical and laboratory findings and to conduct patient teaching appropriate to age, background, psycho-social needs, medical/physical condition of the surgical patient.
• Ability to communicate effectively and appropriately with surgical patients and their significant others to enlist their involvement and cooperation in the entire treatment process.
• Ability to perform effectively in stressful and emergency situations with behaviors that are unique to functioning as a first assistant.

Principal Duties and Responsibilities:

* Clinical competency- Provided a safe, therapeutic core by collaboration with the surgeons and healthcare team in performing a safe operation with optimal outcomes for the patient. The RNFA practices perioperative nursing and must have acquired the necessary knowledge, skills, and judgment specific to clinical practice.
Teamwork - Communicates effectively and works cooperatively with others. Has respect for and understanding of clinical disciplines. Uses an integrated approach toward patient outcomes.
1. Demonstrates effective communication skills.
2. Delegates patient care activities to other healthcare team members and redirects unit activities a patient acuity and census changes.
3. Using evidence based practice model to works with a multidisciplinary team to implement practice changes and other initiatives in a positive and productive manner.
4. Assists the clinical partner/charge nurse by coordinating the staff and surgery schedule and handling day-to-day issues with positive outcomes.
5. Assists as needed with the staffing schedule coverage to meet daily department needs.
6. Assists with room set-up, opening supplies and room turn-over. Helps with lunches and breaks. Assists with patient positioning and safe transport of patient to the PACU.
7. Assists staff to indentify learning needs and helps to educate and train as needed. Acts as a preceptor.
8. Collaborates with the team in keeping costs under control and controls wastage in the room with regard to supplies; promotes maximum productivity.
9. Assists team leader, clinical partner, charge nurse in updating and developing physician preference cards.
Quality/Best practices - Utilizes standards, guidelines, and pathways for care delivery. Incorporates data and information to continuously improve care and practice to enhance outcomes.
1. The RNFA acts as a leader or participates in quality improvement process. Actively identifies variances and explores alternatives to care or practice.
2. Evaluates staff on practice delivery and recommends additional education if needed. Assists with implementation of practice initiatives.
Professional development- Ensures improvements in practice settings by assuming responsibility for self-development in life-long learning. Provides direction and guidance to others regarding practice, serves as a resource, preceptor, and mentor. Leadership skills demonstrated in decision making and problem solving.
Clinical and Technical Skill
1. Demonstrates knowledge of procedures to which assigned.
a. Participates in clinical decision making and modifies techniques based on clinical findings.
b. Identifies normal and abnormal anatomy.
c. Anticipates the needs of surgeon, steps in surgical procedure.
2. Assesses, plans, implements, and evaluates patient care needs.
a. Interviews the patient and family preoperatively to assess patient care needs.
b. Collaborates with the surgical team members to plan perioperative patient care.
3. Communicates relevant date to team members.
a. Reports lab results, x-rays. Diagnostic tests.
b. Discusses procedures and special techniques to be implemented during surgery.
c. Indentifies any unusual instrumentation required.
4. Analyzes critical situations and initiates appropriate corrective or preventative action.
a. Applies principles of aseptic technique and reports any variances.
b. Identifies and reports safety hazards.
c. Monitors changes in patient's condition and reports concern to appropriate team members.
d. Prioritizes calmly and efficiently in emergency situations.
5. Demonstrates the following skills:
a. Preparation of the surgical site
i. Shaving
ii. Positioning
iii. Surgical Prepping
b. Draping
c. Surgical Site Exposure - under the direction and guidance by the surgeon
i. Retraction
ii. Wound Exposure - i. e. Dissection, initial surgical incision/stab wound, secondary trocar insertion
iii. Tissue Handling
d. Suctioning
e. Manual dexterity in appropriate use of surgical instrumentation
f. Hemostasis
i. Electrosurgery
ii. Bipolar cautery
iii. Sponging
iv. Clamping
v. Collagens
vi. Bone wax
vii. Other: _________
g. Suturing skills
i. Knot-tying
ii. Stapling
iv. Cutting
v. Approximation
vi. Ligating vessels
vii. Skin closure
viii. Subcuticular closure
ix. Securing wound drains
h. Application of wound dressing
i. Assists in post-op care and transfer of the patient from the operating room.

Intra-operative phase (under the direct supervision and direction of the operating surgeon. )
Positions, preps, and drapes patient.
Provides hemostasis by clamping blood vessels, coagulating bleeding points, ligating vessels, and by other means as directed by the surgeon.
Provides exposure through appropriate use of instruments, retractors, suctioning, and sponging techniques.
Handles tissue as directed by the surgeon (i. e. dissecting, stab wound (nick) for lap.