Competency Assessment and Competence Acquisition: The Advanced Practice Nurse as RN Surgical First Assistant

Jane Rothrock, DNSc, RN, CNOR, FAAN


Topics in Advanced Practice Nursing eJournal. 2005;5(1) 

In This Article

Abstract and Introduction

The present as well as the future holds exciting opportunities for advanced practice nurses (APNs), not the least of which is participation during surgery as a first assistant. In 1990, when the United States Congress included first-assisting and reimbursement for APNs performing this task, faculty in programs that educate registered nurse first assistants (RNFAs) have explored curricular redesign and strategies to prepare APNs for this role.

Traditionally, the RNFA has been defined as a perioperative nurse who is board-certified in the specialty of operating room nursing (CNOR). Matriculation of APN students in RNFA programs, often without such experiential preparedness, required that curricula adapt educational programs to prepare the APN as a safe and qualified assistant-at-surgery. Using competency assessment and remediation, along with a curricular model that includes knowledge and skill development in basic perioperative nursing techniques, RNFA programs are preparing APNs with a broad knowledge of surgical patient care, an expanded skill base in perioperative routines, and critical thinking skills to fulfill role expectation as a first assistant during surgery.

In her May 3, 1900, address to the Third Annual Convention of the Associated Alumnae of Trained Nurses, Mrs. Cadwalader Jones reminded the delegates that "When I was a girl, nursing was either considered a gift, like a good voice, or an occupation, like cooking. Every family had some member or friend who was always known as a 'born nurse' and whose help was called for in any emergency. In many cases she certainly deserved her name, and the care she gave was much better than none at all, but it was anything but scientific."[1]

As the science of nursing began to mature, the nursing profession was impelled to develop curricula that educated nurses rather than "trained" them. Early in the history of operating room (OR) nursing, there were numerous chronicles of registered nurses that assisted at surgery. Often functioning as such during times of war, they were highly skilled and valued for their contributions to the successful outcomes of military surgery. Nonetheless, as the specialty of operating room nursing grew and became more sophisticated, the need to develop a definition of the OR nurse as assistant-at-surgery along with recommendations for role preparation and credentialing became obvious. This article will present an overview of the development of recommendations for educational preparation and then focus on the APN as assistant-at-surgery.


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