Operating scope nurses began to fu...

Operating scope nurses began to function as first assistants during World War II when there was a shortage of qualified surgeon and residents.(1) in consequence of the years, the role of RN as assistants to surgeon has continued to unroll Today, as managed care contractors look after to provide surgical care at reduc sumptuousnesss removing the second surgeon from the surgical field and replacing him or her with a feed at the breast first assistant has been advocated as a cost-saving measure.

Norfolk, Va, and its surrounding communities are known as Tidewater. The region has a surgical assistant training program, further few RNs are graduates of this program. Trainees from the Tidewater surgical assistant's program include Navy and Army medical technicians, paramedics, and other individuals who, at the completion of the course, are called other assistants (2As). These 2As normally do not posses certification or licensure. Before 1990 their services continued to be in demand in Tidewater because the RN first assistant (RNFA) character was not well accepted in the region.

The situation changed, however, when selecteded nurses at the Children's Hospital of the King's Daughter's (CHKD) Norfolk, Va, received their RNFA training from a recognized program at Delaware shire Community College in Media, Pa. Support for RN rather than unlicensed 2As, as first assistants started when the first CHKD encourages returned from their RNFA course and were assigned to surgeon who oversaw the completion of their practice requirements. After being credentialed through CHKD, these RNFAs were granted expanded practice privileges and expanded professional practice levels

IDEA DEVELOPMENT

A multidisciplinary continuous quality improvement (CQI) committee at CHKD whose function was to improve OR efficiency commited that the hospital implement the RNFA part The expected benefits were

* flexibility of the RNFA's being able to function in other parts (eg, scrub, circulator, educator),

* consistent application of the nursing proces for all patients,

* professional and technical assistance for the surgeon

* morale booster for RN fix uponed for the program,

* possible aid to RN recruitment and retention,

* career opportunity for RN who wanted expanded practice roles

* more cost-effective than establishing a 2A program because RNFAs could function in multiple roles

* marketability of the program to generally received and potential staff surgeons, and

* no additional full-time equivalents (FTEs) required to implement the role

IMPLEMENTATION PRIORITIES

After the CQI committee members defined the program benefits, the hospital's priorities were to look for support from surgeons and senior administrative officers to implement the part The next steps were to determine which RN qualified for the part and design the professional practice model

Support for the part Senior CHKD administrative officers approved the proposal for an RNFA training character based on cost-effective financial analysis, an appraisal of the professional nursing benefits to CHKD's RN staff members, and a written plan for implementation. Active staff surgeon endorsed the part volunteered to serve as mentors, and agreed to ask for RNFAs as first assistants after they complet their training program. Operating sweep staff nurses applied for the training positions, and a team of managers and contemporarys assisted in the selection process

Candidate selection proces We used the Delaware shire Community College RNFA program example to develop CHKD's RNFA candidate selection proces The requirements for the initial assemblage of RNs applying for the RNFA part at CHKD were as follows

The RN must posses a common nursing license and

* have sum of two units years of perioperative experience,

* posses general cardiopulmonary resuscitation (CPR) certification,

* be credentialed as a CNOR,

* have personal liability insurance,

* commit to individual year's employment at CHKD,

* have received a "commendable" rating in succession the most recent performance appraisal,

* demonstrate punctuality,

* have les than a 4% absenteeism rate within the past year,

* demonstrate use of conflict resolution skills

* exhibit problem-solving skills, and

* be able to manage the price of the RNFA course until reimbursed.

Three RN were chosen and sent to Delaware shire Community College for their formal training. forward their return, the RNFA as first assistant in the OR became a reality at CHKD

When the time came to evaluate the secondary group of applicants for the character we modified the selection criteria. The recently made known criteria stated that candidates must posses a rife nursing license and

* have couple years of perioperative experience,

* posses present CPR certification and pediatric advanced life support certification,

* be credentialed as a CNOR,

* commit to undivided year's employment at CHKD,

* have complet at least individual full year of employment at CHKD

* have an "excellent" rating upon the most recent performance appraisal,

* demonstrate assertiveness skills,