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UTHSC’s New Registered Nurse First Assistant Program Only One in Tennessee

Diane Pace, left, and Nancy Appling are leading the new RN First Assistant Program in the UTHSC College of Nursing. The program, which prepares nurses to provide care to surgical patients, is one of only a few in the country.

A new Registered Nurse First Assistant (RNFA) program in the College of Nursing at the University of Tennessee Health Science Center (UTHSC) is the first in Tennessee, and one of only a few nationally.

The new program will prepare nurses with the skills needed to provide evidence-based care to surgical patients before, during, and after surgical procedures. BSNs or RNs enrolled in an accredited RN to BSN program who are certified perioperative nurses, and advanced practice registered nurses seeking to advance their skills, are eligible to apply to the RNFA program. The first students in the new program begin their training in August.

According to the Competency and Credentialing Institute, which recommends RNFA programs, there are 17 in the United States, and only 1,260 certified CRNFAs in the country.

The program is a major milestone in the College of Nursing’s ongoing efforts to meet local and statewide health care needs, expand educational and practice opportunities for nurses, and increase marketability of its graduates. Because there are so few programs in the country and the need for formally educated RNFAs is so critical, the College of Nursing plans to expand the availability of this program to nurses across the country and even globally, as the need is identified and resources are available.

Diane Pace, PhD, APRN, FNP-BC, NCMP, FAANP, associate professor and director of Special Academic Programs in the College of Nursing, said the college constantly considers what programs it needs to develop to meet the nursing educational needs in the health care community it serves. “One of the areas that quickly came to the top was the registered nurse first assistant,” she said. “Several clinical partners identified the need to offer this program, because this role has become much more engaged in the community.”

Also, recent action by the state legislature reinforced interest in offering the program. “Even though this role has been developed in the past through an on-the-job sort of training, the state of Tennessee passed legislation giving this role title protection,” Dr. Pace said. “In the state, if you want to identify yourself as an RN first assistant, you must go through a formalized educational program and receive a certificate of completion. On-the-job training no longer is accepted in the state as validation for this highly specialized area of practice.”

The College of Nursing looked to one of its own to lead the program. Nancy Appling, MSN, APRN, ACNP-BC, CNOR, CRNFA, is a graduate of the college’s Acute Care Nurse Practitioner program and a certified RNFA. She has more than 30 years of experience in the operating room, 25 of them at Memphis Veteran’s Affairs Medical Center. Appling joined the College of Nursing as lead faculty for the program in February.

“I am so excited about this, as the University of Tennessee Health Science Center’s College of Nursing, with its long history of exemplary education, brings a new academic level of validation to the role of the RNFA,” Appling said. “The resources that will be available to incoming students in this program, with the new simulation center on campus and the use of the Medical Education and Research Institute, are state of the art.”

Appling said, as an RFNA/ACNP she is able to bring  nursing critical-thinking skills to work collaboratively with the entire operative team. “I assist with tissue handling, cutting, hemostasis, and so much more,” she said, including coronary artery bypass grafting, valvular repair and replacement, great vessel repair and replacement, and pulmonary resections. “My role encompasses the entire perioperative experience with preoperative evaluation and assessment, intraoperative assisting, and postoperative clinical management. This role gives continuity of care that increases patient safety.”

The RFNA role is based upon the nurse’s scope of practice and licensing, credentialing, and privileging within the state and within the institution of the nurse’s clinical practice. According to the Association of periOperative Registered Nurses (AORN), the role “may vary depending on patient populations, practice environments, service provided, the accessibility of human and fiscal resources, institutional policy, and state nursing regulations.”

The program includes three academic courses (two online didactic courses and one clinical course), which can be completed in two to three semesters. Students completing the three graduate courses (nine credit hours) will be awarded a certificate of completion from the College of Nursing. They will be eligible to sit for the national certification exam after completing an additional 2,000 hours of clinical practice.

“We have spent a great deal of time exploring the need for this program and developing the curriculum for it,” Dr. Pace said. Theresa Wadas, PhD, DNP, ACNP-BC, FNP-BC, CCRN, an assistant professor at the University of Alabama College of Nursing, is serving in a consultant role. Dr. Wadas has not only developed and directed an RNFA program, but has consulted nationally and internationally.

“We believe it will be a unique and high-quality program,” Dr. Pace said. “We will have learning opportunities that many other programs do not have available. In the first course, students will have a 40-hour, on-campus simulation workshop, where they will have interprofessional opportunities to learn the RNFA role within a safe experiential learning environment, and will be able to practice and validate skills competencies prior to starting their 180-hour clinical practicum course.”

The simulation workshops will be conducted in the Patient Safety Center soon to open on campus. One of the few freestanding facilities in the country built for multidisciplinary simulation training, it includes a simulated surgical suite.

The high-level simulation workshop will include additional learning opportunities available for students at the Medical Education and Research Institute, which conducts hands-on educational courses for health care professionals from across the country and around the world. For the clinical practicum, faculty will assist students in arranging clinical placements in their area of residence with board-certified surgeons.

“The UTHSC College of Nursing RNFA Certificate of Completion program will increase the marketability of our graduates who choose to work in a surgical environment,” Appling said. “At the very core of nursing is taking care of the patient. The education and certification of RNFAs will provide for better patient care in the state and around the country, and serve as another layer of safety and protection for the perioperative patient.”