RN First Assistant (RNFA), PER DIEM, Ambulatory Surgery Center
83 Days Old
- Applies nursing knowledge as the basis for effective problem solving and decision making when providing perioperative patient care
- Reviews and uses history, physical assessment, and preoperative test results to establish a physiologic baseline.
- Implements patient safety standards as the patient, equipment, and environment are prepared.
- Accepts delegated medical functions as defined within the RNFA scope of practice.
- Demonstrates situational monitoring, attention to detail, thoroughness, and concentrated focus during the surgical procedure.
- Recognizes anatomical abnormalities that may affect the surgical intervention.
- Uses safe methods for exposure of the surgical site, including use of retractors and other instruments, retraction sutures, and packing materials as dictated by procedural need.
- Uses effective problem- solving techniques and decision making abilities when encountering unfamiliar situations.
- Maintains flexibility and adaptability when emergencies or unanticipated events occur.
- Implements conservative surgical techniques when hemoglobin (Hgb), hematocrit (HCT), and blood availability are compromised.
- Uses acquired knowledge to anticipate, prevent, and respond to circumstances that could compromise the patient's well being.
- Verifies operative procedure, surgical site, and laterality.
- Follows health care organization policy for preoperatively identifying correct surgical site.
- Participates in the Universal Protocol (eg, preoperative verification, time out) for each operative or invasive procedure.
- Verifies that prophylactic antibiotic medication (if required) is administered at the correct time to maximize effectiveness.
- Delays surgical procedure if any discrepancy among parties, patient history and physical, consents, or scheduled procedure occurs.
- Participates in positioning the patient in collaboration with the surgeon, anesthesia professional, and other members of the perioperative team.
- Uses safe positioning principles during preparation, application and removal of positioning devices.
- Assists with transferring the patient safely (eg, locks transport vehicle wheels; secures IV lines, catheters, feeding tubes; protects patient's extremities; uses transfer devices correctly).
- Functions as first assistant to the primary surgeon during operative or other invasive procedures and throughout the perioperative continuum in accordance with scope of practice, credentials, privileges, education, and experience.
- Demonstrates physical capacity, visual acuity, dexterity, and fine motor skills necessary to provide first-assisting behaviors to the surgeon.
- Uses surgical instruments safely and correctly.
- Applies safe tissue handling, dissection, or cutting techniques based on assessment of tissue location, type, and patient's health status.
- Performs specialized tissue handling, dissection, or cutting techniques under the direction of the operating surgeon. (eg, trocar placement, preparation of allografts, saphenous vein harvesting).
- Considers anatomical and physiological implications when selecting, placing, and moving retractors to provide surgical site exposure and reduce tissue injury.
- Chooses suturing material and techniques (eg, knot tying, ligation of vessels, wound closure) based on physician preference, density of tissue, support for suture line, potential tissue necrosis, need to evert skin edges, and cosmetic effect.
- Demonstrates proficiency in knot-tying techniques with various suture materials.
- Demonstrates proficiency in skin stapling techniques by assessing blood supply of tissues to be stapled, inspection of staple line, and applying skin staples correctly.
- Suctions surgical site as necessary to remove smoke, blood, and fluids from the site to improve visualization and decrease biohazard exposure.
- Packs wound if applicable.
- Initiates actions according to policy if surgeon becomes incapacitated (eg, protecting the surgical wound, maintaining hemostasis, ensuring sterility of the surgical field) until a replacement surgeon accepts responsibility.
- Minimizes the length of the operative or invasive procedure and maximizes surgeon's efficiency of movement within the surgical wound.
- Takes measures to become familiar with surgical procedure, surgeon's approach, and relevant anatomy and physiology.
- Anticipates wound exposure needs by positioning retractors, controlling bleeding, suctioning, and using counter-traction techniques.
- Demonstrates manual dexterity when handling surgical instruments within the wound.
- Recognizes anatomical abnormalities that may affect the surgical intervention. Implements and maintains sterile technique to prevent patient exposure to microorganisms and other particulates.
- Maintains a sterile field, and isolates the operative site from the surrounding non-sterile environment.
- Identifies breaks in sterile technique and communicates to surgeon and preoperative team.
- Corrects breaks in sterile technique.
- Protects patient from thermal, electrical, chemical, or mechanical injury throughout the perioperative continuum.
- Verifies that instruments function properly (eg, vascular jaws intact and aligned, hemostat clamps close properly).
- Recognizes untoward patient responses or sensitivities to chemical agents used.
- Identifies the correct mode (ie, monopolar or bipolar) and function (ie, cut or coagulation) for electrosurgery.
- Activates ESU electrode after assessing for proximity of nerves and adjacent critical structures.
- Recognizes need to adapt surgical technique to prevent injury caused by laser sources.
- Applies casting materials, dressings, and immobilizing devices properly and in accordance with the health care organization policy, scope of practice, privileges, clinical guidelines, education, experience, and manufacturer's instructions for use.
- Participates in intraoperative fire assessment.
- Implements hemostasis techniques.
- Assesses and monitors hemostasis and blood loss
- Applies pressure to control hemorrhage as indicated.
- Uses instrumentation to control bleeding vessels.
- Coagulates bleeding vessels with electrosurgical devices.
- Assesses blood flow to determine if chemical hemostasis is indicated.
- Applies the chemical hemostat based on the specific situation, patient's sensitivities or allergies, and according to the manufacturer's instructions for use.
- Implements measures to prevent injury related to retained surgical items.
- Uses only radiopaque surgical items in the surgical wound.
- Verbally acknowledges awareness of the start of the closing count process and removes unneeded soft goods and instrumentation from the surgical field.
- In collaboration with the surgeon, performs a methodical wound exploration when closing counts are initiated.
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- Location:
- Bryn Mawr
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