RNFA or CSFA in the OR

[staceyp413]

Hi,

If you have CSFAs and RNFAs in your OR, would you share with me the type of duties they perform. If you have CV (open hearts), what are some of the primary duties and tasks performed in those cases?

We are growing our program and looking to add the RNFA role.

Thank you in advance!

[Rose_Queen, BSN, MSN, RN]

Well, they first assist. They can do more than the scrub person who is in the "assist" role when the surgeon doesn't have a PA or NP for the case, such as place the tricked on a robotic case, fire staplers under direct supervision, and do wound closure. We do not have RNFAs or CFSAs in cardiac- each surgeon has a PA who is the first assistant.

[staceyp413]

Thank you-we've had (and my former employer had) them in the OR but not a RNFA....yet. Just trying to find out how far their roles and abilities/competencies extend as the scope of practice isn't very detailed and I want them to reach their full potential with the right training while ensuring the patient is safe.

[SurgerySiren]

Check with your state's legislation regarding what CSFAs can do in your state. For some time now, each state had their own do's and don'ts, however that is currently in the process on the federal level. Quite a few states now require CSFAs to be licensed advanced care practitioners and in 2018 this will become an official requirement on the federal level. The CSFA role is completely different than the Certified Surgical Technologist role and now since dividing the roles on a federal level is happening, hopefully this profession will begin to receive the acknowledgement it deserves. The one difference I wanted to point out between RNFA and CSFA is that CSFAs work directly under the surgeon and his license with the Board of Medicine, or at least they do in my state. CSFAs do not answer to any Board of Nursing because, well, they are not nurses. So, that being said, CSFAs do not have to follow AORN guidelines on whatever AORN deems the CSFA's role is in the OR. They simply do not answer to nursing or nursing bylaws. In my state, CSFAs simply work through delegated tasks directly from the surgeon. If the surgeon wants the CSFA to close any layer of tissue, fire any type of stapler, make incision, place trocars, wound care, harvest veins, etc then the CSFA can do it and does do it. There really isn't much that the CSFAs in my state cannot do when delegated directly from the surgeon, including of course, being the First Assist during surgery.

[staceyp413]

Thank you very much

[Rose_Queen, BSN, MSN, RN]

SurgerySiren, do you have a source for the 2018 federal regulations you mention? This is the first I'm hearing anything about it.

[SurgerySiren]

I do. The change for regulation is listed on a few Federal websites. The US Department of Health and Human Services, The US Department of Labor, and The US Department of Labor Statistics. I had the actual docket number written down that it is listed under for the upcoming 2018 mandated changes but I cannot find it anywhere! I'll keep looking and post when I find it however, if you go to these websites you'll be able to find the info with a bit of digging around.