Definition of RNFA Role and Educational Requirements
Every profession is guided by a set of rules, standards, and values to ensure that the professionals involved execute their duties diligently and competently. The nursing is one such profession where a nurse’s actions are guided by a comprehensive legislative and ethical framework. A registered nurse first assistant (RNFA) is a type of nurse within the perioperative nursing docket and who is expected to abide by the ethical principles, theoretical knowledge, specialized clinical skills, guidelines for care practice, and research that govern the docket. However, the RNFA is a newly developed expanded nursing practice whose foundation is in America, and Canada has embraced this expanded nursing role in a professional manner to improve the surgical experience of patients as a way of enhancing the quality of care. Thereby, this paper aims to discuss the recommended scope of practice, standards of practice, and codes of ethics governing RNFAs in Toronto because they all have implications for this nursing profession.
The registered nurse first assistant (RNFA) is an expanded role of the registered nurse in the department of perioperative nursing in Toronto and not an advanced form of nursing practice Canadian Nurses Association (CNA), 2002; (MacDonald, Schreiber, & Davis, 2005). The Ontario legislative and ethical structures for RNFA are also applied to Toronto; hence, the reason why the Ontario and associated bodies are mentioned herein often. The RNFA acts as an assistant to the surgeon and the associated surgical team to during surgical procedures to ensure the provision of quality care (Operating Room Nurses Association of Canada (ORNAC), n. d.). The RNFA has additional education in perioperative nursing and this makes him or her to be the most suited candidate to collaborate and practice following a surgeon’s directives. The RNFA is a more desirable person to help in performing surgical procedures given the growing complexities of patient condition, and associated diagnostic and surgical procedures (Operating Room Nurses Association of Canada (ORNAC), 2004; ORNAC, 2007).
The role of the RNFA is a dimension of nursing that is developing over the years in Toronto; hence, educational preparation began on the job, but recently, formal programs have been developed like those found at the British Columbia Institute of Technology (ORNAC, 2004). The scope of nursing guiding the typical registered nurse are also applicable to the RNFA in view of the fact that an RNFA is an expanded role, but the difference is that the RNFA has additional roles that tend to widen his or her scope of practice. The RNFA areas of practice include, but not limited to clinics, operating rooms, physician’s office, and ambulatory care setting in the different phases of surgical experience that include pre-operation, intra-operation, and post-operation (ORNAC, 2011). The competencies for the RNFA in Toronto are in alignment with those of the American Association of Operating Room Nurses (AORN), and this can be attributed to the fact that the RNFA was founded by the AORN (Registered Nurses Association of Ontario (RNAO), 2004).
RNFA Scope of Practice
The guidelines of perioperative nursing have an implication on the RNFA in Toronto as he or she is expected to show the capability of responding to the complex and versatile needs of a patient during a surgical procedure. The ORNAC, guided by the nursing acts for Ontario, establishes, maintains, and promotes the standards that guide the practice of registered nurses in Toronto. The standards of perioperative nursing are applied to registered nurses first assistant (RNFA) because the RNFAs are expected to fulfill all the requirements of perioperative nursing that governs nursing practice in an operating room. There are four standards that govern the nursing practice of all perioperative nurses, but the additional is specific to the RNFA. The first standard dictates that a perioperative registered nurse requires that a perioperative nurse should be knowledgeable in the sciences, nursing, and humanities fields of knowledge to develop a relevant conceptual model that should guide the nurse in fulfilling all that is required of him or her as per the standards, policies of an organization where he or she works, scope of practice, and surgical procedures (Operating Room Nurses Association of Canada (ORNAC), 2011).
The second standard expects nurses to utilize the nursing process effectively to guide in clinical decision-making. The nurses should gather all the relevant and required data needed to guide the decision-making processes pertaining to the care that should be provided to patients, guiding nurses’ actions, and ensuring that the nursing care process governs provision of care. The third standard stipulates that the RNFA shows professional responsibility and accountability by complying with the nursing legislature and policies. The fourth standard requires the perioperative nurses to be assigned to units and associated roles that are commensurate to their level of competency, and thereby, act in accordance to the requirements in these units by displaying responsibility and accountability. The fifth standard requires that the RNFA demonstrates evidence of his or her ability to collaborate with the physician during a surgical procedure (Operating Room Nurses Association of Canada (ORNAC), 2011).
A RNFA scope of practice extends to his or her patient, the nursing profession, and the employer. An RNFA is allowed to practice if he or she meets the training and educational requirements. Even though additional education and training qualifications are expected of a registered nurse to become an RNFA, he or she does not qualify to become an advanced practice nurse (ORNAC, 2011). The duties and responsibilities of a RNFA are directed by the employment guidelines of a particular facility; hence, these might differ from one facility to another. Nonetheless, the RNFA is obliged to display competencies in nine dimensions. As explained by the ORNAC (2011). First, they should display professionalism and competency in all areas of their clinical practice as stipulated by the relevant guidelines and models outlined by the various governing nursing associations in Toronto. Secondly, they should be able to provide physical care to a patient across the different phases of the perioperative structure and can modify the care as deemed fit to meet the needs of the patients. Thirdly, the RNFA is required to provide supportive care to both the patient and the fellow staff. The patient’s and family’s views and needs should be addressed in a professional manner so that they feel that they are part of the care process and their concerns are addressed. Staff that are part of the perioperative tea require support in the form of knowledge, collaboration, and a positive working environment. Fourthly, the RNFA is expected to aid in the development of a safe environment to both the patient and fellow staff by meeting particular stipulations of the governing quality/improvement program. The fifth competency stipulates that the RNFA should be able to respond during urgent and emergency situations while lastly, the sixth competency indicates that the RNFA should indicate impeccable skills at managing resources to ensure that patient care is not lacking. These competences have implications for the RNFA as he or she is expected to comply with them, and failure of doing so is considered to a deviation of behavior, which requires punitive measures (ORNAC, 2011).
Standards of Perioperative Nursing Guiding RNFA Practice
In view of the fact that the RNFA is an expanded and not an advanced role, it is paramount that the RNFA complies with the legislative framework for all nurses because the extended role will be based on the principle rules and ethics that govern all nurses (MacDonald et al., 2005). The Canadian Nurses Association code of ethics for 2017 is the pinnacle guiding RNFAs in Toronto to act in an ethical manner. The code stipulates the ethical values and associated responsibilities of all nurses irrespective of their scope of practice; hence, they are relevant to the RNFA. The code is important in guiding nurses to adopt behavior that produces the best possible positive outcome. The first code of ethics requires all nurses to provide safe care based on compassion and provided in a competent and ethical manner. Nurses, therefore, should interact with others while upholding ethical values like respect and honesty and their language and demeanor should show concern for others (Canadian Nurses Association (CNA), 2008; Canadian Nurses Association (CNA), 2017).
Secondly, the nurses should promote the health and well-being of their patients by ensuring that there are measures in place to ensure the highest possible quality of care is provided, for example, by adopting evidence-based practice. Thirdly, the nurses are meant to help patients and their caregivers to make informed decision. Thereby, the nurses is mandated with the responsibility of ensuring that patients and their caregivers have access to information pertaining to treatment and alternative options to aid in making appropriate decisions in reference to a patient’s conditions and sociocultural values (CNA, 2017).
Fourthly, nurses are also obliged to preserve the dignity of their patients and that of themselves through professional conduct as stipulated by the Registered Nurses Act. Nurses are able to maintain this dignity by setting clear and professional boundaries between themselves and their patients. Maintaining privacy and confidentiality is another ethical value that nurses must uphold. A nurse is not supposed to reveal his or her patient’s information to a third party that is not part of the care process. Also, a RNFA is meant to promote justice and be accountable (Canadian Association of Nurses, 2008).
The conduct of RNFAs in Toronto is regulated by the Nursing Act of 1991, the Regulated Health Professions Act of 1991, supplemental regulations, and regulations set out by the College of Nurses of Ontario (College of Nurses of Ontario, 2011). A nurse is liable for punitive action against him or her if there is a complaint that shows violation of the standards of practice, code of ethics, and nursing professionalism. A Discipline Committee is developed and the discipline process falls in two categories. The first is the prehearing conference, and if the issue is not resolved, a disciplinary hearing, which is the second category, is organized (College of Nurses of Ontario, 2011). An RNFA found guilty can be reprimanded, orally, suspended from office for a certain period of time, fined, asked to undergo remedial courses, restricted to perform some roles, and his or her registration can be revoked.
It is, therefore, apparent that RNFA is an extended role of the RN; hence, the laws and standards that bind RN are also applicable to the RNFA. However, the core competencies are subtly different because the RN should apply distinct competencies to the perioperative procedures. The RNFA is obliged to adhere to the stipulated regulations that outline the conduct, values, and behavior that the nurses should display, failure to which the nurse is presented to a relevant disciplinary measure. The gravity of the offense defines the sanctions and disciplinary measures taken against the RNFA.
References
Canadian Nurses Association (CNA). (2002). Advanced nursing practice: A national framework. Ottawa, ON: Author.
CNA. (2008). Code of ethics for registered nurses. Ottawa, ON: Author.
CNA. (2017). Code of ethics for registered nurses. Ottawa, ON: Author.
College of Nurses of Ontario. (2011). Professional conduct: Disciplinary proceedings. Retrieved from https://www.cno.org/globalassets/docs/ih/42010_fsdiscproceed.pdf.
MacDonald, M., Schreiber, R., & Davis, L. (2005). Exploring new roles for advanced nursing practice: A discussion paper. Ottawa, ON: Canadian Nurses Association.
Operating Room Nurses Association of Canada (ORNAC). (n. d.). RNFA programs. Retrieved from https://www.ornac.ca/en/education/rfna-programs.
Operating Room Nurses Association of Canada (ORNAC). (2004). Canadian RN first assistant. Retrieved from https:www.ornac.ca/rnfa/rnfa-contacts.htm.
ORNAC. (2007). Recommended Standards, Guidelines, and Position Statements for Perioperative Nursing Practice. Ottawa: Author.
ORNAC. (2011). Standards, guidelines and position statements for perioperative registered nursing practice (10th ed.). Ottawa: Author.
Registered Nurses Association of Ontario (RNAO). (2004). Advanced clinical/practice fellowships. Retrieved from https://ww.rnao.org/projects/acpf/topics/operating_room.asp.
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