Registered Nurse First Assist - ZION MOB - Orthopedics - FT (40) 7:00 AM - 3:30 PM

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Essential Duties:

RNFA STANDARDIZED PROCEDURE

I. Standard

The RN First Assistant renders direct patient care as part of the perioperative role by assisting the surgeon in the surgical treatment of the patient. The responsibility of functioning as first assistant must

be based on documented knowledge and skills acquired after 73pecialized preparation and formal instruction.

II. Policy

A. The safety and welfare of the patient should be given primary consideration in the selection of a first assistant in surgery. In the absence of a qualified physician, the registered nurse who possesses appropriate knowledge and technical skills is the best qualified non-physician to serve as the first assistant.

B. The RNFA practices under the direct supervision of the surgeon during the surgical intervention.

C. The RNFA must perform only as first assistant and not concurrently as scrub nurse.

D. Only in extreme emergencies should an RNFA be expected to assist on procedures that present an unusual hazard to life.

E. The RNFA must adhere to the policies of the institution and must remain within the scope of practice as stated by the Nursing Practice Act of the State of California.

F. The RNFA may perform technical functions:

1. Assist with the positioning, prepping and draping of the patient or perform these independently, if so directed by the surgeon.

2. Provide retraction by:

a. Closely observing the operative field at all times.

b. Demonstrating stamina for sustained retraction.

c. Retaining manually controlled retractors in the position set by the surgeon with regard to surrounding tissue.

d. Managing all instruments in the operative field to prevent obstruction of the surgeons view.

e. Anticipating retraction needs with knowledge of the surgeonspreferences and anatomical structures.

3. Provide hemostasis by:

a. Applying electrocautery tip to clamps or vessels in a safe and knowledgeable manner as directed by the surgeon.

b. Sponging and utilizing pressure as necessary.

c. Utilizing suctioning techniques.

d. Applying clamps on superficial vessels and the tying off, electrocoagulation of them as directed by the surgeon.

e. Placing suture ligatures in the muscle, subcutaneous, and skin layers.

f. Placing hemoclips on bleeders as directed by the surgeon.

4. Perform knot tying by:

a. Having knowledge of the basic techniques.

b. Tying knots firmly to avoid slipping.

c. Avoiding undue friction to prevent fraying of suture.

d. Carrying knot down to the tissue with the tip of the index finger and laying the strands flat.

e. Approximating tissue rather than pulling tightly to prevent tissue necrosis.

5. Provide closure of layers by:

a. Correctly approximating the layers under the direction of the surgeon.

b. Demonstrating a knowledge of different types of closure.

c. Correctly approximating skin edges when utilizing skin staples.

6. Assist the surgeon at the completion of the procedure by:

a. Affixing and stabilizing all drains.

b. Cleaning the wound and applying the dressing.

c. Assist with applying casts or plaster splints.

NOTE: The above specifications are general guidelines and do not reflect all duties in all specialty areas. Therefore, they should not preclude the performance of other duties which, in the judgment of the surgeon, can be successfully accomplished by the RN First Assistant. However, the RN First Assistant must know his/her limitations and may refuse to perform those functions for which he/she has not been prepared or which he/she does not feel capable of performing.

STANDARDIZED PROCEDURE

Procedure: Intraoperative Retracting

Personnel: Registered Nurse First Assistants

Purpose: To direct the RNFA in providing retraction of the surgical field

Desired Outcome: Adequate surgical exposure without subsequent tissue/organ compromise.

Supportive Data: Selection and placement of an appropriate retraction instrument will assist the surgeon by providing exposure and optimum visualization of the surgical site.

Process: The RNFA will assist the surgeon by providing intraoperative retraction using the following measures:

1. Retracting tissues or organs by the use of the hand.

2. Placing and holding surgical retractors.

3. Packing sponges or laporotomy pads into body cavities to hold tissues and organs out of the operative field.

4. Managing all ins