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Sample RNFA Job Description
Registered
Nurse First Assistant (RNFA)
Job Description| Job
Title: | Registered Nurse First Assistant
(RNFA)
| | Department: | Cardiac
Surgery
| | Accountable
to: | Department Head, Cardiac Surgery
Manager, Operating Room
| | Position
Summary: | The Registered Nurse First
Assistant (RNFA) is a registered nurse with specialized education. The development
of specific technical skills enables the RNFA to assist the surgeon with specific
intraoperative procedures that are beyond the scope of practice for registered
nurses without RNFA education and training. The RNFA may provide direct care to
patients using the nursing process preoperatively, intraoperatively and postoperatively.
Intraoperatively, the RNFA functions interdependently with the surgeon and applies
knowledge, skill, and judgment necessary to assist the surgeon in performing a
safe operation that yields optimal results for the patient.
Cauterizing
blood vessels involves the application of energy and is a controlled act. This
may be performed by the RNFA as a Delegated Controlled Act: Cauterizing.
| | ROLE
RESPONSIBILITIES: | Preoperative Role:
In
collaboration with the health team members in the preadmission clinic, CCU and
CSPU may participate in preoperative assessment and planning for selected cardiac
surgical patients.
Intraoperative Role:
1. Collaborates
with other health team members to develop, coordinate and implement a perioperative
plan of care unique to individual patient needs.
2. Maintains dignity of
the patient while assuming the responsibility of patient advocate.
3. Skillfully
applies principles of asepsis and infection control.
4. Has excellent knowledge
of surgical anatomy, physiology and operative technique specific to cardiovascular
procedures to work in collaboration with the surgeon.
5. Recognizes safety
hazards and initiates appropriate preventative and/or corrective actions to ensure
a safe environment for the patient and surgical team throughout the perioperative
experience.
6. Preparation and administration of medications perioperatively,
as directed by the surgeon and anaesthesiologist.
7. Provides exposure
through appropriate use of instruments, retractors, suctioning and sponging techniques.
8.
Handles and dissects tissues in collaboration with the surgeon.
9. Clamping
blood vessels, coagulating bleeding points, ligating vessels and other procedures
in collaboration with the surgeon to achieve haemostasis.
10. Sutures muscle,
fascia, subcutaneous and skin tissue in collaboration with the surgeon.
11.
Places drains as surgically indicated.
12. Assists with cannulation and
decanulation procedures.
13. Evaluates the outcomes of nursing care and
ensures continuity of care by communicating pertinent patient information to CSICU
staff.
Postoperative Role:
In collaboration with the interdisciplinary
team may follow selected cardiac surgery patients postoperatively to evaluate
the outcomes of perioperative nursing care e.g. positioning, wound healing surveillance
etc.
| | QUALIFICATIONS: | 1.
Licensed as a Registered Nurse with the College of Nurses of Ontario.
2.
Graduate of a recognized RNFA program.
3. Certified in perioperative nursing
- CPN (C).
4. Current ACLS certification.
5. Have excellent interpersonal
and communication skills that enhance team functioning in the operating room.
Maintains professional manner at all times, demonstrating flexibility, sound judgment
and adaptability in decision-making, problem solving and team building to function
as an effective team member.
6. Has demonstrated leadership skills that
enhance team functioning in an emergency situation.
7. Participates in
continuing education programs to maintain and enhance clinical competencies related
to both perioperative nursing and RNFA practice. Maintains ongoing certification
as a CRNFA, if applicable.
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Trillium
Health Centre Delegated Controlled Act
Registered Nurse First Assistant (RNFA) Delegated
Controlled Act:
Cauterizing Blood Vessels During Cardiac Surgery
Goal
of Designated Act:
To stop bleeding from blood vessels during surgery.
Description
of Medical Directive:
The RNFA identifies the indication for and skilfully
applies electrocautery to blood vessels minimizing necrosis to surrounding tissues.
Indications/Clinical
Criteria:
Bleeding from blood vessels in the operative field are identified
Contra-indications:
Absence of bleeding from blood vessels in the operative
field
Resources available to manage potential complications:
The
RNFA performs cauterization only in the presence of the surgical team who is immediately
available to manage any potential complications.
Required Documentation:
Specific
documentation concerning cauterization during surgery is not required. The RNFA
is listed by the surgeon in the operating room record as the first assistant.
Any complications associated with cauterization by the RNFA are documented in
the operative note by the surgeon.
Tracking, Monitoring and Evaluation
Plan:
The RNFA evaluates the effectiveness of cauterization at the time
of application and continues as necessary to control bleeding during surgery.
The RNFA receives feedback from the operating surgeon as to the adequacy of cauterization
and extent of tissue damage during each case.
Education Plan:
The
RNFA successfully completes a recognized educational program which prepares the
registered nurse for the role of the RNFA. This educational program provides the
RNFA with the necessary knowledge, skills and judgement to perform cauterization
to blood vessels during surgery. Each RNFA is responsible for identifying their
own learning needs related to performing this delegated controlled act and for
developing a learning plan to meet these needs.
Communication Plan:
Prior
to approval of this delegated controlled act, the cardiac surgery RNFA will meet
with key administrative individuals and nursing / physician groups. Processes
and implications of implementing this delegated controlled act will be discussed
and reviewed.
Cauterization Skills Checklist:
Cauterization Verbalizes
understanding of principles of performing safe effective cauterization. Correctly
identifies bleeding areas in the operative field Applies just enough cautery to
control bleeding Protects the surrounding tissue while cauterizing.
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