Description:
Title :  RN First Assistant
Shift :  Full Time, Days
This position will be located in the Operating Room at The Christ Hospital main campus, 2139 Auburn Ave., Cincinnati, OH 45219.
Job Overview :  Primary responsibility involves performance of specific tasks, as a Registered Nurse First Assistant, during surgical procedures to permit the surgeon to perform an efficient and safe operation.  Assists with identifying anatomy within the operative field.  Maintains positive customer relations.  Shall demonstrate competency and possess the technical skills appropriate for his/her assigned cases and utilizes that knowledge in assisting others. Performs various duties within his/her scope of responsibility. Other responsibilities involve functioning in the role of a perioperative nurse to assist in carrying out the plan of care for patients undergoing surgery. This can be done functioning in the role of the Circulating Nurse or Scrub Nurse. This position, RNFA/ Perioperative Nurse, is accountable to the OR Assistant Clinical Manager and Director of Operations.
The RN First Assistant may perform the following duties :
• Performs RNFA interventions under the direction and supervision of the operating room surgeon.
• Performs first assistant responsibilities in accordance with the state scope of practice requirements.
• Applies knowledge of surgical anatomy, physiology, and operative techniques relative to operative procedures.
• Initiate appropriate intraoperative behaviors unique to first assisting.
• Establish and maintain a safe environment to protect the patient and the healthcare team by monitoring the patient (physiologically and psychologically) and the environment and by implementing safety procedures.
• Clinical skills performed under direct supervision of the Surgeon including:
• Positioning the patient, providing visualization of the operative site, utilizing appropriate techniques to assist with hemostasis, utilizing appropriate techniques to assist with closure of body planes, selecting and applying appropriate wound dressings and providing assistance in securing drainage systems to tissue.
• The Surgeon shall convey the exact position that will give the best exposure for the surgical procedure.  The RNFA will provide exposure through appropriate use of instruments, retractors, suctioning, and sponging techniques. Consideration will be given to the patient’s comfort and safety.
• Points of pressure shall be padded; elbows, heels, knees, eyes, face and axillary region.
• Circulation shall not be impaired.  (A tourniquet may be required for some procedures.)
• Nerve damage shall be avoided.
• The temperature of the patient should be discussed with the Anesthesia Personnel and methods employed to maintain the desired temperature range.
• The RNFA shall be familiar with common positions as they relate to the surgical procedure and will be able to use the equipment necessary to provide the position.  Competencies will include the following:
• Using instruments
• Fracture tables
• Head stabilizers
• Body stabilizers
• C-Arm extensions
• Any other equipment needed
• Upon completion of the procedure, the patient shall be evaluated for any possible damage from positioning which shall include assessment of the skin.  If an abnormal condition exists, it shall be reported to the Surgeon and treatment and documentation shall be carried out.
• Providing visualization of the operative site by the following:
• Proper use of body mechanics to prevent obstruction of the surgeon’s view.
• Provides exposure through appropriate use of instruments, retractors, suctioning and sponging techniques.
• Uses surgical instruments skillfully in ways consistent with their design and purpose.
• Handles tissue appropriately to reduce the potential for injury, sutures tissue and applies dressings to the wound under the direction of the surgeon.
• Utilizing appropriate techniques to assist with hemostasis:
• Provides hemostasis by clamping blood vessels, coagulating bleeding points, ligating vessels, and by other means as directed by the surgeon.
• Utilizing running or interrupted subcutaneous sutures with absorbable or non-absorbable material
• Utilizing subcuticular closure technique with or without adhesive skin closure strips
• Closing skin with method indicated by Surgeon (suture, staples, etc.)
• Postoperative subcutaneous injection of local anesthetic agent as directed by the Surgeon
• Other as directed
• Selecting and applying appropriate wound dressings under the direct supervision of the surgeon, including the following:
• Liquid or spray occlusive materials
• Absorbent material affixed with tape or circumferential wrapping
• Immobilizing dressing (soft or rigid)
• Providing assistance in securing drainage systems to tissue
• Perioperative registered nurse provides surgical patient care by assessing,    planning, and implementing the nursing care patients receive before, during and after surgery.
• These activities include:
• Patient assessment
• Creating and maintaining a sterile and safe surgical environment
• Pre-operative and post-operative patient education
• Monitoring the patient’s physical and emotional well-being
• Integrating and coordinating patient care throughout the surgical care continuum
• Make critical decisions based on valuable information concerning the patient
• Direct others
• Accept responsibility
• Collaborate with physicians and other healthcare professionals
• During surgery, the perioperative registered nurse may assume either of the following responsibilities:
• Scrub Nurse- works directly with the surgeon within the sterile field by passing instruments, sponges, and other items needed during the surgical procedure
• Circulating Nurse- works outside the sterile field. Responsible for managing the nursing care with in the O.R. and assisting the team in creating and maintaining a safe, comfortable environment
• Performs other related duties as requested or required:
• Participates in quality improvement process
• Participates in education of Surgical Team
Education :
• TCH requires that all nurses hired receive their BSN within 5 years of the date of hire.
• A MSN or DNP are not required but supersede the requirement for the BSN.
• Has successfully completed a Competency and Credentialing Institute (CCI) RNFA program that meets the criteria set out in the AORN Standards for RN First Assistant Education Programs
License & Certification :
• Current RN licensure
• CRNFA certification desired (must obtain within one year of employment)
• CNOR certification required
• Basic Life Support (BLS) required
• Advanced Cardiac Life Support (ACLS) and Pediatric Life Support (PALS) required
Experience :  Minimum 3 years of Perioperative nursing experience in both the scrub and circulating role.
Required Skills & Knowledge :  Possesses the knowledge of anatomy and surgical procedures, demonstrates surgical skills necessary to support the surgeon, and displays the professional demeanor and attitude necessary for one making an important contribution to excellence in care of the surgical patient. Able to apply principles of asepsis and infection control.
Requisition Type: Clinical Support
Job Schedule: Full time
Job Shift: Day