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Marketing the RN First Assistant Role

AORN Journal, August, 2000 by Timothy Homan, Althea Dunscombe

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Table 1

RNFA REQUIREMENTS FOR PRACTICE, CERTIFICATION, AND REIMBURSEMENT

To practice

* License to practice as an RN.

* Check with the state board of nursing, which may have additional requirements (eg, CNOR certification, additional education preparation)

* If the state board of nursing endorses AORN's official RN first assistant (RNFA) statement, you should meet the requirements in that document.

* Certificate of completion from an RNFA program that includes didactic and supervised clinical instruction in the RNFA role.

* Facility endorsement of the role.

For certification

* Bachelor of science in nursing.

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* CNOR.

* Completion of an RNFA program accepted by the Certification Board Perioperative Nursing.

* 2,000 hours of RNFA experience.

For reimbursement

* Meet the criteria stated in insurance company policies for payment of "assistants at surgery."

* Only one entity--the hospital, the physician, or the RNFA--may bill for the service.

* At this time, Medicare does not reimburse RNFAs unless they are clinical nurse specialists or advanced practice nurses. There is a bill being sponsored in the House of Representatives that would allow Medicare payment for certified RNFAs.

Contracting RNFA services back to the hospital saves the hospital the cost of an employee benefit package. This allows RNFAs to request a higher hourly pay rate. Additionally, RNFAs may consider requesting a schedule change so that instead of a specific shift, they are scheduled when there are cases requiring a first assistant. It is important to evaluate all options to prevent a decrease in pay, however.

If an hourly increase in pay is not possible, consider extra paid time off. When introducing the role into the health care setting, RNFAs should be creative--the point is to understand and be empathetic with the health care setting's budgetary concerns. This helps determine a negotiating basis to get a foot in the door. Once there, it is easier to demonstrate the many benefits of providing RNFA services.

CREDENTIALING

Hospital administrators must ensure that all nonphysician health care professionals are compliant with their credentialing process, which is a legal requirement.(11) The Joint Commission on Accreditation of Healthcare Organizations requires that health care settings have a credentialing process for clinical privileges. Clinical privileges grant permission to provide patient care services within the health care setting. There are defined limits to these clinical privileges based on an individual's professional license and his or her experience, competence, ability, and judgment. Nurses functioning in the RNFA role must meet established credentialing requirements (eg, licensure, experience and education preparation, job description requirements) and assemble the appropriate documentation.

Licensure. The RN role is rooted in individual state boards of nursing's nurse practice acts. When addressing the issue of overlapping areas of practice between physician and nursing disciplines, the physician is recognized as the expert on medical aspects of health care, and the nurse is the expert on nursing aspects of health care.(12) Delegated medical acts performed by RNFAs also have been mutually agreed on by collaboration between individual state boards of nursing and state boards of medicine. The RNFA role is recognized by nursing boards in all 50 states. Each state board, however, may have specific and different requirements for this role. It is important the individuals comply with all the requirements of the state board of nursing to prevent jeopardizing their nursing licenses. If multistate licensure--which presently is being considered in many states--is approved, it will be easier for nurses and health care settings to understand the requirements.(13)

Health Care Industry

Marketing the RN First Assistant Role

AORN Journal, August, 2000 by Timothy Homan, Althea Dunscombe

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