Registered Nurse First Surgical Assistant case study
The Registered Nurse First Surgical Assistant (RNFSA) is a key role in theatres, supporting and enabling surgeons to carry out safe and efficient operations. It is already well established in the United States, the United Kingdom and Canada, and nurses commonly undertake the dedicated first surgical assistant role in New Zealand private hospitals.
The University of Auckland and Health Workforce New Zealand have established the RNFSA demonstration, which provides the first formal postgraduate training programme for the RNFSA role in New Zealand. The advanced role builds on the theatre nurse role and the training programme prepares registered nurses with the scientific concepts, knowledge and skills to carry out the role in the operating theatre.
Amelia Howard-Hill, based at Southern Cross Hospital in Palmerston North, is one of the first cohort of 13 nurses training to be an RNFSA in New Zealand.
The opportunity it offered her to remain with the clinical work she loved rather than change professions to further her career was the catalyst for her decision to become an RNFSA. ‘The surgeon I assist for inspired me. Before I started working for him I was at a crossroads and was exploring options to leave nursing due to feeling that I had got as far as I could. He convinced me that becoming an RNFSA was a great career move so I moved back to New Zealand from Australia to work with him.’
A couple of options Amelia considered included dentistry and medicine but with her introduction to the RNFSA role, an alternative challenging and rewarding career path began to take shape. It is a role that requires specialist training: in addition to her initial Bachelor of Nursing, she has a postgraduate certificate in peri-operative specialty nursing, and is currently completing her final year of a Master of Nursing, specialising in RNFSA.
Amelia spreads her time between the private and public sectors, working in the operating theatre as registered nurse and RNFSA.
‘A usual working day often starts at 6.30 am at the private hospital as an RNFSA where I go early to ensure that everything is ready for the list ahead. When the surgeon arrives we ward round together on any inpatients, then we see any patients that are being admitted for our morning operating list. I would have already been in contact with these patients, arranged their pre-operative work-up, and made necessary admission and surgical arrangements. When we get into theatre my role varies depending on the case. For large cases I am his assistant and for the smaller ones I’m his scrub nurse.’
The intra-operative role of an RNFSA includes the traditional surgical assistant roles, with extended practice roles of bone graft harvesting, removing metal ware, suturing, tissue dissection, haemostasis (a process that prevents excessive blood loss in the body) and infiltration of local anaesthetic.
Often Amelia is working independently on one area of the patient while the surgeon is working on another. Her afternoon may involve a list at the DHB or at the private hospital or a clinic. ‘After this list has finished, I meet my boss for another ward round of our patients before going home.’
Amelia says the most enjoyable part of her role as an RNFSA is developing relationships with patients, seeing them pre- and post-op and having the privilege to assist them through their peri-operative journey.
‘There is nothing more rewarding than seeing a patient who had previously been troubled with an orthopaedic problem presenting to our clinic at their six-week check with a spring in their step and a smile on their face.’
Amelia’s plans for the future are already in place, ‘I will complete my Master’s this year and then I intend to attain nurse practitioner status with prescribing rights in 2012.’ Running alongside that, Amelia wants to build on the extended RNFSA role and find more surgeons who see the benefit in working with an RNFSA.
