UTHSC College of Nursing Faculty Member Key in Getting Nursing Legislation Passed

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UTHSC College of Nursing faculty member Nancy Appling watches as Gov. Bill Lee signs legislation clarifying the Registered Nurse First Assistant designation in Tennessee. (Photo courtesy of Nancy Appling)

Tennessee Gov. Bill Lee signed legislation Tuesday aligning the state’s requirements with national standards for recognizing the role of nurses who practice as first assistants in the operating room. It was a special moment for UTHSC College of Nursing faculty member Nancy Appling, MSN, APRN, ACNP-BC, CNOR, CRNFA, who led the push for the legislation.

Appling heads the Registered Nurse First Assistant (RNFA) Program in the UTHSC College of Nursing. She has been a first assistant in cardiothoracic surgery for more than three decades, and was the primary proponent of the legislation that allows advanced practice nurses to use the title of RNFA, if they have successfully completed a formal RNFA education program.

The RNFA Program at UTHSC launched in 2017. It is the first of its kind in Tennessee and one of only a few in the country. The program gives nurses additional high-level skills to assist surgeons before, during, and after surgery in a role that in the past was reserved for physicians and often was learned on the job.

The academic program educates nurses to work alongside surgeons performing procedures, including suturing, tissue handling, and controlling bleeding. UTHSC’s program is approved by the National Assistant at Surgery Certification, the credentialing body that administers the Certified Registered Nurse First Assistant (CRNFA) credential. The UTHSC RNFA Program has graduated its third cohort since it launched.

Appling said the RNFA works cooperatively with the operative team. In this role, she has assisted with tissue handling, cutting, hemostasis, and has been involved with multiple surgeries, including coronary artery bypass grafting, endovascular vein harvesting, valve repair and replacement, great vessel repair and replacement, and pulmonary resections. “This role gives continuity of care that increases patient safety,” she said.

In 2014 the state legislature passed a law creating protection for the use of the title of RNFA. To use the RFNA title, nurses had to be an RN with an Operating Room Nurses (CNOR) certification, which requires two years of experience in the OR, and have completed an approved RNFA educational program.

National standards established by the Association of periOperative Registered Nurses (AORN) recognized either the RN with a CNOR certification or a board-certified Advanced Practice Registered Nurse (APRN), who had completed an approved RNFA course of study.

Many advanced practice nurses in graduate-level RNFA programs do not have the CNOR certification. Under the previous Tennessee RNFA title protection statue, graduates of the UTHSC program could not use the RNFA title if practicing in Tennessee, though the credential met all national standards.

State Rep. John DeBerry and Senator Sara Kyle sponsored the 2019 legislation. Appling testified before the House of Representatives in support.

“I am very happy to see this role recognized for what it is,” Appling said. “What we’ve done now is we’ve helped increase patient safety.”

Appling recently was asked to serve as national chairman for the RNFA Specialty Committee for AORN. She said the use of the RNFA title provides another layer of patient safety, as facilities and surgeons who hire APRNs to first assist will know they have been educated to provide safe patient care.

“The title of RNFA provides evidence of educational preparation for surgeons and facilities that employ first assistants. We have helped identify well-educated providers for the surgical patient,” Appling said.

“Nancy Appling has been a great leader for nursing and our College of Nursing,” said Dean Wendy Likes, PhD, DNSc, ARNP-BC, FAANP. “The passage of this bill to support APRN practice as an RNFA is essential to our health care systems. RNFA’s are valuable members of the health care team and we are thankful for her diligence in ensuring they are recognized as such.”