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Clinical Practice > RN First Assist Role (RNFA)

Frequently Asked Questions

What is an RN First Assistant (RNFA)?

What is the Scope of Practice of an RNFA?

What are the Qualifications of the RN First Assistant?

Is additional credentialing or licensure required in New Hampshire?

How does a RN become a First Assist?

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What is an RN First Assistant (RNFA)?

The RNFA is a licensed RN who has acquired the necessary qualifications including the knowledge, skills and judgements necessary to serve in this capacity. The RNFA practices in collaboration with, and as directed by the surgeon during the intraoperative phase of the perioperative experience.

What is the Scope of Practice of an RNFA?

The decision by a RN to practice as an RNFA must be voluntary and deliberated with an understanding of the professional accountability the role entails. The intraoperative nursing behaviors of the RNFA may include:

  • handling tissue,
  • providing exposure,
  • using instruments,
  • suturing, and
  • providing hemostasis

Note: An RNFA should not concurrently function as a scrub nurse.

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What are the Qualifications of the RN First Assistant?

Current licensure as a registered nurse in New Hampshire

  • Successful completion a post basic nursing education program whose intent is the preparation of registered nurses to practice as first assistants at surgery
  • Documentation of proficiency in perioperative nursing practice as both a scrub and circulating nurse
  • Ability to apply principles of asepsis and infection control;
  • Knowledge of surgical anatomy, physiology, pathophysiology, and operative technique related to the operative procedures in which the RN assists
  • Ability to perform cardiopulmonary resuscitation
  • Ability to perform effectively in stressful and emergency situations
  • Ability to recognize safety hazards and initiate appropriate preventive and corrective action;
  • Ability to perform effectively and harmoniously as a member of the operative team;
  • Ability to demonstrate skill in behaviors unique to the RNFA (as defined by the American Operating Room Nurse Association)

Is additional credentialing or licensure required in New Hampshire?

The RNFA scope of practice is a further refinement of perioperative nursing practice and is included within the nursing practice governed by the RN licensure. Additional credentialing establishing the RNs qualifications, competency and proficiency should be done by the institution or agency granting this clinical privilege to the RNFA. This credentialing should occur prior to the RN's performance of first assisting functions.

How does a RN become a First Assist?

There are educational programs to prepare experienced RNs who have achieved proficiency in the OR. Formal RNFA education is provided in many colleges throughout the country which involves the equivalent of one academic year of both classroom and supervised clinical education with oversight by a surgeon preceptor. For additional information regarding this nursing specialty, contact AORN at (800) 755-2676 ext 1 or www.aorn.org.

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New Hampshire Board of Nursing
121 South Fruit Street   |  Concord, NH 03301
Nursing (603) 271-2323  |  Nursing Assistant (603) 271-6282
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