What's It Like to Be an RN First Assistant in Surgery?

James D. Smith Jr, BSN, RNFA


July 20, 2017

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First, What Is an RNFA?

I am a registered nurse first assistant (RNFA).

Figure 1. James Smith, BSN, RNFA.

Chances are, unless you work in the operating room, you are wondering what in the world that is. When I introduce myself to a patient in the preoperative area, they often ask me what I actually do. I like to explain my job by pointing out how surgery in movies and on TV often shows two surgeons working together, with one surgeon assisting the other. In real life, that assisting role can be filled by an assisting surgeon or a physician assistant, but it is most often performed by an RNFA.

I began my career the way a lot of RNFAs do—by accident. I started out as a surgical (scrub) tech because I had always wanted to work in surgery, and it was the quickest way to get there. That was when I learned about the RNFA role. Working as a scrub tech while I went to nursing school allowed me to work with our chief of surgery, who sponsored me for the position in 1990, just 3 months after passing my nursing boards. Currently, there are basic skills courses for RNFAs, but at that time, the training was all on the job and conducted by a combination of veteran RNFAs and surgeons. The combination of multidisciplinary education and skills training took 8 months, with almost another year of practice to become comfortable in the position.

One Case at a Time

My job is done one surgical case at a time, usually from beginning to end. I work at a hospital where the RNFAs do cases across all surgical disciplines. On any given day, I can be assigned to hernia repairs, cholecystectomies, hysterectomies, total joint replacements, thyroidectomies, or craniotomies, among other cases. We assist with open, laparoscopic, robotic, and endovascular cases and are trained to use all of the equipment. When I am assigned to a case, I am responsible for knowing all aspects of the surgical procedure, the pertinent anatomy and physiology, the potential complications, and the equipment and instruments needed to perform the surgery.

The first step in a case is to meet with the circulating and scrub nurses to assemble everything we need and open the sterile field. I then go to the preoperative area, review the chart, and introduce myself to the patient. A thorough review of the history and physical, lab results, and allergies, along with a patient interview, are necessary to determine the individual needs of each patient.


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