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RN first assistants at RWJUH help coordinate OR


The first Robert Wood Johnson University Hospital nurse was in training to become an RN first assistant in the facility’s OR when New Jersey approved the role in 1996. The New Brunswick, N.J., hospital now has nine RNFAs — the largest number in one facility in New Jersey. Three RNs are in cardiac, one in orthopedics and five in general surgery.

RNFAs are trained in the use of Da Vinci robotics and perform endoscopic and laparoscopic surgeries. They assist in open-heart and kidney transplants; total-joint replacements; minimally invasive open-heart procedures, such as mitral and aortic valve replacements; and surgeries for left-ventricular-assist devices. RNFAs at RWJUH independently perform endoscopic vein harvesting. “In fact, two of our RNFAs were responsible for getting the system for vein harvesting here, learning it and then training RNFAs, physician assistants and nurse practitioners in using it,” said Daurie Ann McBrair, RN, BS, CNOR, CRNFA, first assistant in the OR.

Their experience as OR nurses helps the RNFAs effectively facilitate surgeries and communicate with the surgeons, other nurses in the OR and the anesthesiologists. RNFAs know what instruments are available if there is an unexpected situation, and they can predict what is needed for a particular surgery, McBrair said. “Really, it’s a matter of keeping the surgery going as efficiently as possible, and our role and relationships with the other OR team members help us do just that,” she said.

Initially, they had to prove to everyone the role could work well at the hospital. “Our previous experience in both the circulating and scrubbing roles at RWJUH as well as our understanding of the OR environment and the processes in place to run an efficient schedule helped us in establishing our nine-member team,” McBrair said. A pilot program was started in 1996 at RWJUH, and as the shortage of assistants in the OR increased, demand for RNFAs increased.

RNFAs at RWJUH are responsible for making sure every OR case that needs an assistant is covered, whether it be by a physician assistant, resident or an RNFA. Based on the OR schedule, the RNFAs work together to create their own schedules, working closely with residents and physician assistants.

The updated edition of AORN’s RN First Assistant Guide to Practice is expected to be released this fall, which will provide information for practicing RNFAS and those who work in other perioperative nursing roles who may be interested in pursuing the role of RNFA.

For information about RNFAs, visit and click on the practice resources tab.

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Janice Petrella Lynch, RN, MSN, is a regional reporter. Send letters to or post a comment below.

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