Registered Nurse - Operating Room First Assist

First Assist RN

First Assist RNs function in an expanded perioperative nursing role. When performing delegated medical functions, First Assist RNs are practitioners who are agents of the supervising physician(s)/independent licensed practitioner(s) who are responsible for the First Assist RNs actions within the agreed upon scope of practice. The supervising physician/independent licensed provider is to direct and review the work and practice on a continuous basis to ensure that appropriate directions are given and understood, and appropriate care is rendered.

The First Assist RN must have acquired the necessary knowledge, judgment, and skills specific to the expanded role of clinical practice. Intra-operatively, the First Assist RN practices at the direction of the attending surgeon. The First Assist RN shall not concurrently function as a scrub nurse with responsibility as a surgical first assistant. Verifies standardized procedures in effect before performing the functions of a surgical first assistant.

Maintains knowledge of current Association of peri-Operative Registered Nurses (AORN) Standards, VHA Directives, and service level standard operating procedures. When directed by the attending surgeon, the First Assist RNs expanded role permits the performance of intra-operative functions including, but not limited to: positioning the patient, preparing and draping the surgical site, administering local anesthetic, providing exposure and retraction, providing hemostasis;

utilizing electrosurgical cautery (ESU), bipolar and ultrasonic devices, suture ligation, hemostatic agents and argon beam, use and handling of surgical instrumentation, tissue manipulation, dissection, suturing, and stapling, making the skin incision or stab wound for laparoscopic surgery or drains and placement of trocar (based on State Board of Nursing) for laparoscopic access, robotics insertion and removal of instrumentation, securing drains, closure of wounds and application of dressings, including wound vac therapy, application and removal of casts and splints, harvest of vein and arteries for bypass conduit, cleansing the surgical area, including superficial, subcutaneous, muscle and fascia, bone and abdominal and pelvic cavities, removal of surgical drains (chest tubes, knee drains).