Perioperative nursing is a specialized area of practice. Registered nurses practicing as first assistants in surgery are functioning in an expanded perioperative nursing role. First assisting responsibilities are further refinements of perioperative nursing practice and are executed within the context of the nursing process. These responsibilities include certain delegated medical functions that can be assumed by the RN who is qualified to practice as an RNFA. Registered nurse first assistant responsibilities may vary depending on patient populations, practice environments, service provided, accessibility of human and fiscal resources, institutional policy, and state nursing regulations.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

Clinical Practice/Care Delivery

1. Under the direct supervision of a surgeon, assists with the performance of surgical procedures and general patient care in the operating room in accordance with established nursing protocol, policy or with established nursing protocol and the policies and procedures. Observable duties may include:
   1. Assisting with positioning, prepping and draping of the patient.
2. 1. Tissue handling including making incisions, retracting, dissecting, tying, ligating, stapling, suturing and providing hemostasis.
3. 1. First assisting with endoscopic or open procedures specific to the surgical service assigned.
4. 1. First or second assisting with all general surgical, thoracic and vascular surgical procedures as assigned.
5. 1. Installation of, femoral arterial lines, radial artery lines and femoral venous lines as required.
6. 1. Chest tube insertion.
7. 1. Wound closure and readiness of patient for post-operative phase of procedure
8. 1. Defibrillation (external) of patient as needed.
9. 1. Assisting with emergency procedures and resuscitation as needed.
10. 1. Acts as an assistant for robotic procedures as required by assigned service.

For Robotic procedures:

1. 1. The RN First Assist must have completed a Robotic First Assist training program followed by observation by a proctor for 10 training cases.
3. 2. Once training is complete the RN First Assist may under the direct supervision of the attending surgeon;
   1. Set up and connect system components**,
   2. Drape and position arms**,
   3. Balance and calibrate endoscope and camera**,
   4. Inspect set up for functionality and defects**,
   5. Place trocars when attending surgeon present in surgical field providing direct supervision
   6. Place and exchange instruments in the robotic arms,
   7. Insert instruments into the trocars,
   8. Removal, exchange, cleaning and re-introduction of endoscope,
   9. Steps to safely and quickly move the system components in an emergency**,
   10. Proper cleaning, disinfection and sterilization of reusable instruments, accessories and endoscopes**, and
   11. Troubleshooting**

** Represents duties that are part of basic robotic training provided to general OR staff thereby allowing those having received this training to perform.