An RN first assistant's guide to private practice - registered nurse

AORN Journal,  April, 2003  by Sheila Hughes

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Another way RNFAs can bring about change is by educating other health care professionals about the services offered by RNFAs. Although this type of health care provider is gaining recognition throughout the United States, many facilities and practitioners still are unfamiliar with RNFA practice and how to incorporate RNs as assistants in surgery. For facilities unfamiliar with this concept, an RNFA who wishes to gain privileges must institute a credentialing process and educate others about the benefits of using RNFAs.

Registered nurse first assistants can act as change agents in the surgical environment through communication. They provide consultation to circulating nurses regarding correct instruments and potential supplies needed based on patient pathology. Registered nurse first assistants also can diffuse intense situations and help avoid conflicts.

Nursing's future and the value of nursing practice depend on each nurse's dedication to being an agent of change. Nurses must eliminate sacred cows, including beliefs that nurses have no influence in regard to health care policy, economic issues, or roles and responsibilities in the health care system. (10) Nurses need to embrace change to enhance their personal and professional growth. It is important to consider aspects of the change process and implement strategies to bring about change.

Strategies for change include

* having a clear vision of what change will look like;

* creating an organizational culture that promotes and supports change;

* communicating clearly, concisely, and at the appropriate times to those involved in change; and

* involving those people who need to be involved in the change. (11)

Visionary changes in nursing may include

* establishing expanded roles in expanded practice settings with nurses providing competent, cost-effective health care;

* increasing knowledge and understanding of various cultures' customs, values, and beliefs and integrating appropriate behaviors into practice;

* implementing effective communication among hospital administrators, managers, surgeons, staff members, and patients; and

* involving legislators and insurance companies to help effect necessary changes in the delivery of health care.

GUIDELINES FOR PRIVILEGES

Self-employed RNFAs must apply for privileges to work in a facility. This process often is referred to as the credentialing process, and it is used to determine whether an RN qualifies to function as a first assistant. The American Nurses Association (ANA) guidelines for privileges suggest that a nurse apply for a specific type of appointment. A type B appointment allows an RNFA to collaborate with physicians to implement medical therapies in specified areas--it allows an RNFA to perform designated activities. (12) The credentialing process is a competency-based system that focuses on an RNFA's qualifications, role performance, and outcomes assessment.

If a credentialing process is not in place at the institution where an RNFA wishes to practice, he or she must implement one. Mechanisms for the process are listed in Table 4. One author offers the following tips for gaining privileges: