[CATHY RNFA]

Are there any RNFA's that are MAD or getting Mad about the Surgical scrub first assisting?
Maybe we should be! #1 This is a job we have worked very hard for, we went to school to get a degree and had to pass the Boards. Then we had to aquire a place in the O.R. and work many hard hours to be experienced in our jobs. We had to prove ourselves to the surgeons and our peers.We then moved on to being a CNOR again to prove our knowledge and ability. Then we chose to go to an RNFA program for which we put in 120 documented and audited hours with case studies etc..
To become a CRNFA we had to aquire 2000 documented hours buy books and take a test that cost about $500 all of this and now our jobs and licences are on the line for ST's that go to school for 9mo have no licenece and then proceed to skip 10 steps and want to be First Assistants I say it's time to get MAD and do something. I don't plan on watching someone take something I worked very hard for. If the techs want to First Assist then they can go to school and get the proper licence and degree and I will support them Does anyone have an opinion on this or Do I stand alone??

[BEG]

I have the same complaint as you. The ST's I work with have the attitude that since they've been there longer than me-they can do just as good of a job. The problem I have is they can be good technically but still not have the knowledge it takes to be a First Assistant.

[shodobe]

Are you refering to Techs or other RNs that have been on the job 20-30 years and can do it all any way? just curious.

[SkydivingRN]

From my experience some of the best first assists I have had the pleasure of working with have been Surgical Techs. I do respect your opinion that this is an area that nurses need to fight to keep a foot hold in as much as possible.

[KC CHICK]

The surgical tech can belly up to the OR table, but can't do pre-op interviews & evals or go on rounds to visit the post op patients.

If all the surgeon wants is a private scrub, then techs may be more cost effective in that regard. However, if the surgeon wants to employ a professional that can 'lighten' his/her load, lower overall cost of care, and have the knowledge to care for the patients during ALL aspects of their surgical experience...... then the RNFA IS THE WAY TO GO!!

In my opinioin, the surgeons should..and will.. realize who is a better benefit to their practice. Quite frankly, I don't think surgical technicians are a threat. They are decreasing in numbers all over the country as far as I know....there is definately a 'surgical tech' shortage in my area. (gosh darnit)

Anyway, from the research I've done on the position of RNFA, there is absolutely NO WAY that a surgical tech could possibly replace you....unless you only scrub in intra-operatively and do not participate in ALL aspects of the patient care involved.

My two cents.
Anne

P.S. This is what the AORN has listed as requirements for first assistants:

B. Specific, didactic: Specific didactic requirements may include the following.

Must be a registered nurse, graduated from an accredited school of nursing.
Must be licensed to practice as a registered nurse in the state in which the clinical internship will be accomplished.
Must provide proof of RN licensure.
Experience: The RNFA candidate must have a minimum of two years of recent perioperative nursing experience. This experience must include demonstrated competency in the scrubbing, circulating, or first assisting roles of the intraoperative nursing dimension.
CNOR: Must be CNOR, or CNOR eligible with CNOR status obtained before a certificate of program completion is awarded. All students must submit verification of CNOR status.
CPR: Cardiopulmonary resuscitation (CPR) or basic cardiac life support certification (BCLS) required, advanced cardiac life support (ACLS) preferred.
Recommendations: Must submit two letters of recommendation that validate:
a. One’s proficiency in the roles of scrubbing, circulating, or first assisting.
b. One’s ability to perform effectively in stressful and emergency situations.
c. One’s ability to perform effectively and harmoniously as a team member.
d. One’s ability to perform effectively as a leader.

****I don't see 'surgical technician' anywhere in here, do you??? I'm a little confused.

One must also now have BSN and have attended a formal RNFA program to become a CRNFA. The following website (www.certboard.org) is where one needs to go to find the criteria/eligibility to sit for the CRNFA or info on obtaining your CNOR.

I would highly recommend for anyone interested in pursuing a career as an CRNFA, that you 1)join AORN and 2) JOIN the RNFA speciality assembly group. You can do this at the same time of registration. It does cost I think an additional $15.00. This is where you can get the answers to your questions. Visit their web info by going to 'member groups' on the AORN (www.aorn.org) web page. You do have to be a member of AORN to access these member pages.

Most importantly, in the midst of this discussion, is the fact that we as nurses need to get more active on the legislative front! I encourage everyone to visit the AORN government affairs web section to see how you can make a difference. For example, have you written your senator of representative in support of HR 822 (To ammend title XVIII of the SSA to provide for coverage under the Medicare Program for surgical first assisting services of certified registered nurse first assistants.)? If not, please do.

As far as pay goes, some hospitals do not employ CRNFAs, others do. Some do and may pay a little more per hour. But, remember, you can practice as an independent contractor and file for your own insurance reimbursements (6, maybe 8 states have passed such legislation). That's what the RNFA's are fighting for. For specific pay answers, you need to network with those who do it.

If you are not a member of the aorn list server (called membertalk), it is a good place to throw out questions. Also, www. periop.org also maintains a list server.

This is too long. Apologies. But, lots of info out there and AORN has an excellent site to access. I encourage all to get involved, write those letters, and let's fight our own battles!

"K. Lynn" Kokiko, RN, BSN,CNOR

[donnasL&D]

I am experiencing this delemma now. I wanted to go to the RNFA program. I have been a nurse for 12 years. I work L&D we scrub circulate and recover for csections. I was told by AORN that I do qualifiy to sit for my CNOR and to be admitted to the RNFA class, however my employer has mostly scrub techs or other docs assisting. When I asked if i could assist if i go through this they said yes. But could not tell me how much they pay. They said something about the others being more experienced. But they are techs and I am an RN. Is this going to be worth it for me?

[stevierae]

Let me tell you what happened to me after RNFA school. I was all excited about getting to finally (legally!) tie a few knots or whatever. I was doing per diem at a couple of local hospitals. One day, I worked at one that I had been working at only when they called me in when there were sick calls, or whatever. I rarely worked a full shift; usually got sent home after lunches were done.
Anyway, this surgeon was going to be doing a very difficult incarcerated hernia repair on an obese patient; he asked for an assistant. As the only RNFA there, I thought it would be me. Guess what? The OR co-ordinator told me, as usual, that I would be going home early; that is, after lunches were done. I said, "Oh--I assumed I was going to be helping him." Her response--"Oh, no--whenever a surgeon asks for an assistant, we have Rocky (the housekeeper/orderly) scrub in-- he's been wanting to learn to scrub, and, since he is staff, we don't have to pay him as much as we would a per diem RN--and anyway, he's strong, and ANYBODY can hold retractors." I started realizing that that attitude was pervasive among OR supervisors where I live--anything to save a buck. She just gave me a blank look when i asked whether she was concerned about the hospital's liability.
I totally lost interest in working as an RNFA after that. None of the doctors wanted to pay an RNFA; they would rather have someone like that, who would feel flattered and important for the role they were playing--for free.
I know that some OR techs are perfectly comfortable working as first assistants; a lot of them learned to do so, very well, in OR school in the military--but, I think like you do--but, I also think if they want to do it on the outside, they should take the next step and become RNFAs.
I do know that, when I work in the OR on travel assignments in San Francisco, they do use RNFAs--most of them have sweet little practices going, working exclusively for one surgeon, and they are VERY appreciated. I've had more luck, entrepeneurial-wise, as a legal nurse consultant. I'm glad I did not put all my eggs in one basket; I'm getting tired of the operating room anyway--(have done it for over 20 years--too frustrating to try to deliver the standard of care we want to deliver, what with all these budget cuts--but that's ANOTHER subject...

[rnoflabor2000]

I am also a L&D RN training for an RNFA. I have run into several problems. I have only scrubbed C/S and Hysts. So when I take my practical, and they pick a AAA, I'm going to be lost. Should I go work in the main OR?

[ORJUNKIE]

I think that there has not been a good job in the education of what CRNFA really means. This is a big bone of contention where I work because a few people attended a TWO week course (and they really think they are qualified to be consultant assistants like an MD has been - get real!)and now think they should only have to scrub in as an assistant. Most doctors don't end up letting them do anything more than what we've always done as second scrubs! Why should we support an already burdened healthcare cost system and charge patients for services that truly aren't necessary? Come on folks, be honest with yourselves! This is another example of delusions of grandeur. The same people who insisted twenty years ago that you wouldn't be a good nurse unless you had a BSN or MSN, thus causing the demise of many a good ADN and Diploma program, are probably the same people who made up this nonsense about attending a two week course and then considering yourself qualified to work as a CRNFA! All of us who have worked with new BSN/MSN grads know that the ADN and Diploma nurses are generally better able to care for patients straight out of school.