RNFAs in C-Sections - Pro/Con

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I would like to hear from other facilities as to whether or not your hospital provides first assists for C-sections, and also if you know where I can find information on whether or not one is actually needed for all, or even the majority, of c-sections. Thank you in advance for taking the time to respond.

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I have worked OR for years, and I have never seen an RNFA used for a C-section. Usually a second set of hands is not needed for the delivery. Normally they do not have the training to cover other deliveries, and unless your facility would be doing that many procendures, I can't see where it would be effective.

I have also attended C-sections as the NICU nurse, and really do not think that an RNFA is needed. (p.s. I am an RNFA.)

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Thanks Suzanne. What you are saying is what I have suspected. Our issue is actually our docs. They are spoiled, ill mannered, and throw tantrums when they don't get their way. Hopefully I will hear from others providing me with the ammunition I need to deny our docs their request. Do you know if there is a "guideline" regarding necessity that I can get? I know the docs will accept our denial if we can provide some formal documentation supporting our stand. Thank you again for the info. :p

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How many C-sections are you actually doing per shift? Is it cost effective for you to pay the RNFA salary for them to be sitting there?

If they are assigned for C-sections, then they have to be available only to your dept and can't be doing any other cases in the OR, etc.

So it is a physician request? Too funny................most RNFAs do not have Labor and Delivery experience. Your CST in the room should be able to assist the physician. That is also one of the reasons that they are there.

There is a team for the baby, so what else does the OB have to do?

First time that I have heard of RNFAs being requested for a C-section.

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:) We average 50-60 per month. That is our point, there is no way we can do this in a cost effective manner. Hence, the research to give me the "meat and potatoes" to tell them "NO". Your points were the same ones I made. We have spoiled these docs for so long, that they just expect us to give them whatever they ask for. At least this once I want to be able to say NO and have the backing to support me. Thanks again.

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Invite them to pay for it out of their fee and then you will be very happy to provide the services. If they need hand-holding on call, then they will need to pay for the service.:)

What do they expect the RNFA to do, that they are unable to do? C-sections have been done for years and years without the help of the RNFA and will continue to do so. The incision is small to begin with, what do they want the RNFA to do? Hold a retractor or cut suture?

Too funny.:chuckle

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At our facility we use an RNFA for almost all C/S, though this fee is paid out of the physicians' pockets. The RNFA is called in for the C/S. She doesn't remain in house. THe RNFA serves two local hospitals. Our facility does approximately 400 deliveries per month.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Our dr's primarily use other MD's (their partners) or a couple of RNFA's (whom are employed with our hospital) and even one who is a PA. They choose and arrange for their assistance; we just circulate and use a CST to set up the OR.

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We use RNFA's for scheduled sections during the day. At night or for stats if the RNFA or another OB doc is not available, the ped Dr's are all trained as first assist. The ped, is not available after delivery as he/she is caring for baby. If it gets complicated, the ob doc will have us call another ob doc for them. The RNFA's are hospital employees and are paid for by the hospital.I think things vary region by region and facility by facility. We are a small level one unit. We provide a baby nurse only. OR staffs scrub and circulator.

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:p Thank you to everyone for all your information. This is invaluable to me as I look at how to proceed with our physicians' requests. I have a couple questions regarding some responses.

For those of you who use your own RNFA staff, are they called in for the c-sections only, and then sent home, or do they do regular nursing when not in the OR? If you pull your own RN staff to function as RNFA, how do you adequately cover them while they're in the OR?

For those where the physician pays the RNFA. Who provides the RNFA? If this is a hospital employee, how do the docs pay? If not an employee, are the docs responsible for obtaining, just like any other assistant?

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You cannot pull your own staff to function as the RNFA. That is a certification given thru AORN, which includes going thru an approved program, as well as having so many hours in training, as well passing a Certification exam.

They must hold the Certification to be reimbursed by insurance companies in most areas of the country.

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Our staff are trained RNFAs. Currently I believe only 1 is actually certified. Reimbursement is a whole other issue that we haven't even started tackling yet.

My biggest concern was whether this person was even necessary, which I have gotten mixed reviews on, and if necessary, isn't the physicians obligation to provide, not the hospital's.

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