UTHSC’s Registered Nurse First Assistant Program Features State-of-The-Art Simulation Training

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The inaugural class of the Registered Nurse First Assistant Program at UTHSC recently took part in simulation training in the university’s new Center for Healthcare Improvement and Patient Safety. Dina Darby, FNP/AG-ACNP DNP, an RNFA first assistant student, right, participates in a surgical simulation, as Anthony Holden, MD, medical director for the program, observes. (Photos by Brandon Dill/UTHSC)

A new program in the College of Nursing at the University of Tennessee Health Science Center educates nurses to work alongside surgeons in the operating room performing surgical procedures, including suturing, tissue handling, and controlling bleeding.

The Registered Nurse First Assistant (RNFA) Program, the first of its kind in Tennessee and one of only a few in the country, admitted its first class in August 2017. The program gives nurses additional high-level skills to assist surgeons in a role that in the past was reserved for physicians.

The first class recently completed a 40-hour, on-campus simulation workshop, during which they participated in interprofessional opportunities to learn the RNFA role in a safe learning environment and to practice skills prior to starting their 180-hour clinical practicum course.

Students observe a simulation from a control room in UTHSC’s new Center for Healthcare improvement and Patient Simulation. “The resources that will be available to students in this program … are state of the art,” said Nancy Appling, program director.

Simulation workshops were conducted in the new Center for Healthcare Improvement and Patient Simulation on campus. The students were joined by surgical residents, faculty from the College of Medicine, and faculty and students from the College of Nursing. The workshop included additional learning opportunities at the Medical Education and Research Institute.

There are only 17 RFNA programs and 1,260 certified RNFAs (CRNFAs) in the in the United States, according to the Competency and Credentialing Institute (CCI), which recommends RNFA programs. UTHSC’s program is approved by the CCI.

The UTHSC program prepares nurses with the skill set needed to provide evidence-based care to surgical patients before, during, and after surgery. In addition to playing a hands-on role during surgery, RFNAs assess patients prior to surgery, and evaluate and manage the patient’s condition following the procedure.

“Even though this role has been learned in the past through on-the-job training, the state of Tennessee passed legislation giving this role title protection,” said Diane Pace, PhD, APRN, FNP-BC, NCMP, FAANP, associate professor and director of Special Academic Programs in the College of Nursing. “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.”

Nancy Appling, MSN, APRN, ACNP-BC, CNOR, CRNFA, a graduate of UTHSC’s Acute Care Nurse Practitioner Program and a certified RNFA with more than 30 years of experience in the operating room, leads the program. Anthony Holden, MD, serves as medical director.

“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 students in this program, with the new simulation center on campus and the use of the Medical Education and Research Institute nearby, are state of the art.”

Appling said the RFNA works cooperatively with the entire 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.

The program includes three academic courses (two online courses and one clinical course), which can be completed in two to three semesters. Students completing the three graduate courses (nine credit hours) will receive 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.

“We believe it is a unique and high-quality program. We have learning opportunities that many other programs do not have available,” Dr. Pace said.

“Completion of the UTHSC College of Nursing RNFA Program will increase the marketability of our graduates who choose to work in a surgical environment,” Appling said.

The RNFA Program is now accepting applications for its fall 2018 cohort. For more information, visit https://www.uthsc.edu/nursing/academic-programs/rnfa/index.php, or call 901.448.6125. BSNs or RNs enrolled in an accredited RN to BSN program, who are certified perioperative nurses (CNOR/CNOR-eligible), as well as advanced practice registered nurses (APRNs) seeking to advance their skills, are eligible to apply.