RNFA Question

Published

Have you seen an RN first assist work "solo" without the surgeon being in the OR or even having left the building. According to guidelines they are to function under the direct supervision of the surgeon.

We experienced this first hand. Patient was on general anesthesia for other 1/2 hour without the surgeon. The surgeon left the OR, spoke with the spouse, and left the ASC for his office. The patient had not been informed that this would be done nor were they informed of who else would be performing significant surgical tasks.

The patient was lied to as to who would be doing a genital prep. It was an issue and they specifically asked. They were told it would be a male and they learned afterwards that a female did it. To say they were upset is an understatement. Why do OR's function this way? Isn't genital based procedures a sensitive enough issue that it should be discussed with a patient? Certainly, if the patient needed this done while alert it would be addressed and consent would be obtained. Why is it done without discussion and consent just because a patient is unconscious or sedated? That doesn't make it okay in a patients' mind.:o

Up Vote Up Vote ×
Specializes in ICU, Surgery.

Just from reading your other posts, it appears you are seeking opinions about something that personally happen to a family member.

You seem to get very upset with any answers you get on the board differing from your own thoughts, and especially if someone trys to explain what really happens in the OR. You seem to think we are "defending" immoral unprofesional health care workers.

We do have 1st assists that will close for the surgeon while he/she speaks with the family and maybe even makes rounds. I have never known of any that actually leave the building.

9 times out of 10 it is the circulator that does the prep. That is a part of her/his job. There is usually only one circulator per case. If a patient requested a certain gender for the prep and the staff agreed to this, then YES it should have happened, barring any unforeseen circumstance that might have occured. Maybe the intended prepper was called away on another case or had to be sent to relieve someone else. Lots of reasons for this to happen. I seriously doubt that anyone purposely lied or intended to mislead you. Your surgical consent covers any prep done for the specified surgical procedure including possibly genital prepping for a foley insertion.

I hope that you can make peace with whatever occured and that your family member came through their surgery okay.

Up Vote Up Vote ×

If a patient was not sedated for a genital prep wouldn't it be standard for the procedure to be discussed prior to a female doing such a personal and sensitive (genital) procedure?

It was a family member and we were told a male would be doing it. No one was called away. I understand "NOW" that it is the circulator that does this prep. We did not know this information then nor were we informed. It was UNACCEPTABLE to us. If you go to the Bioethics blog board you can see there are many, many patients and family that are very upset with these types of issues. Yes, as a wife I was more than upset that two women handled and viewed my husband while he laid totally exposed for whatever length of time----10 minutes or more? I understand it is a job and routine for a nurse in the OR, but it is not routine for a patient.

Up Vote Up Vote ×
Specializes in OB, M/S, HH, Medical Imaging RN.

I'm not an OR nurse. Just noticed your user ID and wanted to say Dag!;)

Up Vote Up Vote ×
Have you seen an RN first assist work "solo" without the surgeon being in the OR or even having left the building. According to guidelines they are to function under the direct supervision of the surgeon.

The RNFA's finish closing the suture line and put on the dressings where I work, without the surgeon present. What guidelines are you referring to ?

Up Vote Up Vote ×

The guidelines for California were downloaded from the website from the Board of Nursing listing the duties/responsibilites for a RNFA in CA.

No where does it state that it is permissable for what occurred in this surgical experience. It was learned long after sugery through investigation by the patient in contacting the corporate offices of the ASC that the surgeon has equity ownership of the ASC and the RNFA is his employee, not an employee of the ASC. The surgeon left the OR and the patient remained on general anesthesia for another 35 minutes with only the RNFA in the room (along with the anesthesiologist and circulating nurse of course). So she (RNFA) did much more than just close the skin and clean and dress the wound. According to recommended guidelines issued by the AORN a patient is to be informed of all persons participating in their care in which significant surgical tasks will be performed. We were not informed of anything!!! The surgeon spent 15 minutes in the OR and the patient was under general anesthesia for 70 minutes. That was extremely upsetting to the patient and their family. Certainly as a patient you think that the surgeon will be doing the procedure and be present.

Up Vote Up Vote ×
Specializes in Nephrology, Cardiology, ER, ICU.

I too am familiar with your postings. While I know this was very upsetting for you and your family, I do not think we can help you - you have several very realistic answers. Take care.

Up Vote Up Vote ×
The surgeon spent 15 minutes in the OR and the patient was under general anesthesia for 70 minutes.

Not sure what you are getting at here. There are many surgeries where the surgeon isn't in the room from the minute the patient gets to the OR until the patient leaves. The patient is brought to the room and placed under anesthesia. Depending on what type of positioning, scrub, etc. The patient could be under for many minutes until the surgeon is even ready to begin the operation. Some scrubs I do for instance are a 10 minute scrub. You then have to place the drapes, position equipment, etc. Many times the surgeon leaves after the surgery is finished, and it takes a while for the patient to come out of anesthesia. Each patient is different. You can't realistically think that the surgeon is going to stand there while I do a 10 minute scrub, and then stand there while the patient wakes up and is extubated. It simply doesn't work that way. I'm sorry if your family member feels that they weren't informed, but the bottom line is did your family member suffer any problems from the surgery.

Up Vote Up Vote ×

Yes. 48 hrs post op he had a contusion that was all over his abdomen, around his hip, half way on the buttocks and down his thigh several inches and part way down his genital area. He looked like he had been hit by a truck or a train.

In addition, besides the healing ridge a mass was present almost immediately. I was afraid something like a sponge had been left in the incision. It has been evaluated with multiple ultrasounds and ct scans(done by males) which did not yield a definitive answer as to its etiology. Much time has passed and the surgical site is still puffy and does not look right. He is unwilling at this time to have it surgically opened.

Lets put it this way, the experience no where came close to meeting our expectations. Patients deserve to be informed. I certainly understand what you state about everything that needs to be done and the surgeon need not be standing there. Granted.

Up Vote Up Vote ×
Specializes in Education, FP, LNC, Forensics, ED, OB.

Since this is a personal family issue, we cannot possibly advise you properly. If you think these issues need to be pursued, please seek out the proper avenue(s).

Good luck.

Up Vote Up Vote ×
+ Join the Discussion