The Registered Nurse First Assistant (RNFA) is a clinically competent, professional registered nurse who demonstrates advanced expertise in the perioperative field. The per diem RNFA delivers comprehensive perioperative care to surgical patients through all phases of the nursing process, including assessment, planning, intervention, implementation, and evaluation.

With specialized RN First Assist training completed, the RNFA functions as an essential member of the surgical team, supporting safe, efficient, and evidence?based surgical care. This role integrates advanced clinical skills, critical thinking, and perioperative knowledge to optimize patient outcomes throughout the operative experience.

First Assisting Responsibilities

• Initiate appropriate intraoperative behaviors unique to first assisting: provide hemostasis to reduce potential for fluid volume deficit by clamping and/or legating vessels using ESU, direct pressure, applying chemical agents that promote coagulation and other means as directed by the surgeon.

• Provide exposure of the operative site through appropriate use of retractors, other instruments, and through suctioning and sponging.

• Use surgical instruments skillfully in ways consistent with their design and purpose as directed by the surgeon.

Scrub / Surgical Routines & Aseptic Technique

• Demonstrates competency in performance of scrub/surgical routines and aseptic technique.

• Utilizes proper scrub, gown and gloving technique for self, surgeon, and assistant.

• Ongoing monitoring of asepsis in all roles-scrub, circulator, and assistant.

• Anticipates needs of surgeon.

• Consistently recognizes sequence of procedures in all roles-scrub, circulator, and assistant.

• Passes instruments correctly.

• Appropriate review and preparation for assigned procedures.

Sterilization Processes & Instrument Handling

• Understands and utilizes established guidelines for operation of autoclaves and steris units.

• Performs daily A-Test/Biological tests as required.

• Performs proper care, handling, and assembly of instruments for processing.

• Ensures complete/thorough documentation of all flash and steris cycles as per protocol.

Supply, Instrument, and Equipment Accountability

• Accepts personal accountability for proper handling, judicious use, and optimum care of all department supply, instrument, and equipment inventory.

Perioperative Nursing Process

• Patient assessment: collecting, interpreting, recording, and communicating pertinent data relevant to patient care in surgery.

• Care planning: utilization of collected data to plan appropriately for intraoperative nursing care.

• Implementing: provides direct patient care to meet physical and psychological needs.

• Evaluating care: continuously evaluates patient response to nursing intervention and modifies care plan to achieve desired outcome.

Theoretical Knowledge & Clinical Competence

• Demonstrates and conveys theoretical knowledge and skills related to perioperative nursing care.

• Understands the "why" concept as well as the "how" process.

Intraoperative Documentation

• Thorough/Accurate/Complete documentation of intraoperative patient care.

Patient Positioning & Skin Integrity

• Understands/Demonstrates/Conveys knowledge related to proper intraoperative patient positioning.

• Universal skin care precautions.

• Prevention of nerve damage.

• Prevention of pressure-related skin breakdown.

Surgical Counts

• Assists with completion and accuracy of surgical sponge, sharps/miscellaneous items, and instrument counts as per established policies and guidelines.

Preference Sheet Management

• Assists with maintenance of up-to-date preference sheets in conjunction with Resource RNs and department Nurse Managers.

Critical Thinking, Prioritization & Time Management

• Effectively demonstrates critical thinking.

• Prioritizes duties appropriately.

• Demonstrates strong time management skills throughout the perioperative arena.

Charge Accuracy & Cost Efficiency

• Maintains accuracy with patient charge process.

• Uses case supplies cost efficiently.

• Ensures all pertinent data is provided to post?case data personnel to facilitate a time?efficient billing process.

Turnover Efficiency

• Strives to ensure efficiency in turnaround time between procedures.

• Readily available as needed.

• Communicates with OR Desk/Charge RN and/or department Nurse Manager.

• Performs gross cleaning of body fluid spills to confine contamination throughout the procedure.

• Prioritizes case completion process.

• Assists with room cleanup tasks as necessary.

• Prioritizes case setup process toward maximum efficiency.