Provides direct patient care perioperatively. Uses nursing process as foundation for practice when performing preoperative nursing assessments, intraoperative care, and postoperative evaluation of care delivered to surgical patients. Demonstrates proficiency in perioperative nursing practice and able to perform as scrub, circulator, and first or second assistant roles. Assists surgeons with procedure by carrying out assisting functions that will aid surgeons in assuring outcomes for surgical patients under the direction and supervision of surgeons.  Supervision shall mean that the surgeon is present in the operating suite.

Essential Responsibilities:

• Demonstrates proficiency in perioperative nursing practice and able to perform as scrub or circulator preoperatively, intraoperatively, and postoperatively using nursing diagnosis and nursing process to provide care


• Provides individualized nursing care planning on an ongoing basis. Evaluates outcomes, and adjusts plan according to patient needs


• Supervises and coordinates activities of other team members and ancillary staff as appropriate


• Participates in education and training of others by acting as teacher, coach and/or preceptor. Participates in the peer evaluation process


• Collaborates with the health care team (anesthesia, surgeon, scrub and circulating personnel) to assure continuity of care. Plans regimes perioperatively that will provide patients with optional surgical outcome


• Documents nursing process and care activities by using departmental flow sheets/forms, etc


• Demonstrates knowledge and skill in applying principles of asepsis and infection control. Understands principles of wound healing and wound classification system


• Demonstrates ability to recognize safety hazards associated with patients and/or staff and initiates, as appropriate, preventive or corrective actions. Documents all patients care incidents or adverse occurrences, and reports such to supervisory staff


• Participates in department quality assurance monitoring and care evaluation


• Demonstrates technical expertise in use of supplies, equipment and instrumentation required for care delivery


• Participates in inpatient teaching and discharge planning as appropriate


• Practices in compliance with Hawaii Nurse Practice Act, Association of Perioperative Registered Nurse ('AORN') standards of practice/position statements, and all organizational, departmental policies, procedures and protocols


• Performs efficiently and effectively in emergency patient care or unit situations


• Demonstrates ability to perform effectively and harmoniously as a member of the operative team


• Uses interpersonal and communication skills to problem solve, resolve conflicts and promote effective interpersonal relationships


• Demonstrates knowledge of surgical anatomy, physiology, operative technique, and knowledge of sequence of events related to specific operative procedures for which RNFA assists


• Provides intraoperative care to surgical patients by demonstrating skill in tissue handling, providing appropriate exposure, using instrumentation skillfully, suturing techniques and assisting with hemostasis


• Assists with operative site verification, patient positioning, skin preparation, and draping procedures


• Demonstrates manual dexterity. Provides hemostasis by use of surgical clips, electrocautery, clamping vessels and tying vessels and suctioning surgical fieldsa


• Provides exposure for surgeons by maintaining a dry operative field, retracting tissue. Uses retractors and instrumentation with awareness of tissue friability


• Demonstrates ability to close surgical wounds, at the direction and supervision of a surgeon, by layer (fascia, subcutaneous, and skin tissues) and provides appropriate tissue approximation


• Continues to develop cognitive and psychomotor skills necessary to perform in the role of first and second assistant


• Functions within scope of practice of RN First Assist according to legislative, AORN standards of practice/position statements, organizational and departmental standards


• Selects appropriate suture/needle/tie according to tissue or vessel type and surgeon preference. Suturing techniques are efficient and effective


• Assists with surgical site verification, patient positioning, skin preparation and draping procedures


• Handles tissue appropriately to prevent potential injury


• Participates in follow-up care and evaluation of patient condition as appropriate


• Provides retraction by observing operative field at all times, maneuvers instrumentation and surgical field to assure surgeon's view


• Provides homeostasis by use of electrocautery, clamping vessels and suctioning surgical fields as directed by the surgeon. Demonstrates ability to use hemoclips/ligaclips on vessels as directed


• Possesses knowledge of suture types, and basic suturing and knot tying techniques


• Assists with completion of procedure by stabilizing drains, cleaning wounds, and applying dressings. Assists with cast application, splints and other immobilization devices as appropriate


• Functions when required as second assistant by holding retractors, providing exposure, and suctioning


• Applies dressings to wounds


• Uses instruments and medical devices at the direction of the surgeon

Basic Qualifications:

Experience

• Minimum three (3) years' experience as a perioperative nurse in scrub and circulating roles

Education

• Graduate of an accredited school of nursing


• Graduate of an RNFA program that meets the AORN recommended education standards for RNFA programs meeting Competency & Credentialing Institute's criteria of program acceptability

License, Certification, Registration

• Valid Hawaii RN license (must meet education requirement(s) for Hawaii State licensure)


• Certified Nurse Operating Room (CNOR) by the National Certification Board Perioperative Nursing (CBPN)


• Current BLS for Healthcare Provider CPR or CPR/AED for the Professional Rescuer certification