Providers of first assisting services

AORN Journal, June, 2004 by Frederick P. Franko

WHO MAY BE A FIRST ASSISTANT?

There are a number of different names or titles given to individuals, other than the scrub person, who are not physicians and who assist surgeons during surgery or an invasive procedure. These include

* assistant at surgery,

* surgical assistant, and

* first assistant.

The number of associations representing first assistants and the number of certifying bodies are surprising.

Some of the licensed professionals practicing in the role of first assistant include RNFAs, certified RNFAs (CRNFAs), advanced practice nurses (APNs), certified physician assistants, and surgical physician assistants. More specific and current information on these roles is available on the web sites of their respective certifying bodies and member associations.

RNFA. Registered nurse first assistants and CRNFAs first must meet state licensure requirements to become licensed registered professional nurses. They must complete a state-approved professional nursing education program, pass the National Council of State Boards of Nursing NCLEX-RN examination, and meet any other state-specific requirements. Licensed registered professional nurses also must meet qualifications for entry into practice as outlined in the "AORN statement on RN first assistants." These include

* certification in perioperative nursing (ie, CNOR);

* successful completion of an RNFA program that meets AORN's "Recommended education standards for RN first assistant programs" and that is accepted by the Certification Board Perioperative Nursing (CBPN); and

* compliance with statutes, regulations, and institutional policies relevant to RNFAs.

CRNFA. Certified RNFAs are licensed registered professional nurses who have met CBPN's CRNFA eligibility requirements and have passed the CRNFA certification examination. These include that they must

* be an RN,

* have CNOR certification,

* have a bachelor's or master's of science in nursing degree,

* have at least 2,000 documented hours of practice as an RNFA, and

* complete a formal and acceptable RNFA program.

APNs. Advanced practice nurse is an umbrella term that includes nursing specialties such as clinical nurse specialist and certified RN anesthetist. Education and training for an APN are beyond that required for RNs. (5)

Physician assistant-certified (PA-C). Physician assistants are first trained in education programs under the medical model. They then must pass the physician assistant national certifying examination (PANCE), which is administered by the National Commission on Certification of Physician Assistants (NCCPA).

Surgical physician assistant. To be eligible to take the NCCPA's surgery examination, physician assistants must hold a valid NCCPA certificate or register for the PANCE examination. To gain special recognition as a surgical physician assistant, physician assistants must pass both the PANCE examination and the surgery examination. (6)

UNLICENSED PERSONNEL IN THE FIRST ASSISTANT ROLE

There also are a number of types of unlicensed personnel who may serve in the first assistant role. These include the following categories.