By Christina Orlovsky, senior writer
Registered nurses in the perioperative setting are faced with
a challenging role on a daily basis. Many are even choosing to take that
challenge one step further by becoming trained as RN First Assistants.
RN First Assistants (RNFAs) are trained to function as the
assistant to the surgeon during an operation, as well as to provide nursing care
management before and after surgery. According to the Association of
Perioperative Nurses (AORN), the responsibilities of an RNFA during surgery
include: collaborating with the surgeon and other health care professionals for
an optimal surgical outcome; assisting the anesthesiologist when applicable;
assisting with patient positioning, skin preparation and draping; providing
wound exposure; handling tissue appropriately to reduce the potential for
injury; using and manipulating surgical instruments skillfully; controlling
blood loss and suturing tissue.
Since 1991, the University of California Los Angeles (UCLA)
Extension has offered an RNFA Training Program that caters to perioperative and
advanced practice nurses seeking further certification. The added skill set is
attractive to a wide variety of nursing professionals, according to Robert
Salsameda, RN, MSN, FNP-C, CNOR, CRNFA, a perioperative neurosurgical nurse
clinician and course chair at UCLA Extension.
“I’m seeing more and more advanced practice nurses, including
nurse practitioners, pediatric nurse practitioners and certified nurse midwives,
who need to be RN First Assistants because of the job requirements,” he said.
“Hospitals are requiring that today’s nurse be academically prepared to move
into that role in surgery. It’s been a real evolution.”
The UCLA Extension program consists of 52 hours of lecture and
lab, plus a required 120-hour independent preceptorship. Students learn about
various topics and techniques necessary to become a RNFA, including: surgical
emergencies; pharmacology; wound closure and healing; anesthesia concepts;
medical and legal aspects of expanded practice; neurosurgery and general
Although the UCLA Extension RN First Assistant Training
Program requires an RN license and three years of operating room experience in
both scrubbing and circulating, as well as CNOR and ACLS certification,
Salsameda asserted that there are steps student and new-graduate nurses can take
now toward the goal of receiving RNFA certification in the future.
“I would advise students to take a post-graduate course in
both scrubbing and circulating, even though many programs are limiting their
population to just circulating,” he said.
“To be a good perioperative nurse is to be well-rounded,” he
added. “The scrub person is only as good as the circulating person and vice
versa, and to be well-rounded you need both.”
Salsameda concluded that a lot of larger medical centers
provide their own post-graduate training for perioperative nurses who sign a
two-year contract with the facility—which, he asserted, is a good idea for any
perioperative nurse who wants to be prepared to care for patients over the long
“I always think about who’s going to be caring for me when I
can’t anymore. I’m in the aging population,” he laughed, adding that he wants
well-rounded and well-trained nurses at his bedside when he needs them. “I
belong to AARP now—who’s going to be taking care of me?”
For more information about the RN First Assist Training
Program, visit the UCLA Extension or AORN Web sites.
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