British Columbia’s Underutilization of Registered Nurse First Assists: A Barrier to Achieving the Quadruple Aim
Keywords:
health service delivery, Registered Nurse First Assist, perioperative careAbstract
Registered Nurse First Assists (RNFA) increase surgical efficiency and improve patient care. They have been widely utilized within the United States of America, but utilization in Canada has not been consistent. Currently, Ontario, Quebec, Nova Scotia and select sites in Newfoundland and Labrador have included RNFA as members of their surgical team.1 Through critical analysis, the author discusses how underutilization of this role impacts on healthcare system costs and patient outcomes. Recent surgical strategy policy documents2 have acknowledged the RNFA but full implementation has yet to occur. The aim of the paper is to discuss this role as part of the interdisciplinary team and highlight related policy issues to be addressed prior to increased integration. The author utilizes the Institute for Healthcare Improvement’s “Quadruple Aim”3 as an argument for prioritizing the integration of RNFA and delivering a method of outcome measurement. This discussion provides important rationale for implementing the RNFA role within healthcare facilities and systems to improve health service delivery at all levels. The recommendations present important considerations to improve outcomes at all levels when introducing these roles within individual health authority settings.
References
British Columbia Ministry of
Health. Nursing policy secretariat.
Surgical (RN) first assist
consultation; 2020.
British Columbia Ministry of
Health. BC Ministry of Health and
the provincial surgical executive
committee cross sector policy
discussion paper; 2015.
Bachynsky N. Implications for
policy: The triple aim, quadruple
aim, and interprofessional
collaboration. Nursing Forum;
;55(1):54-64.
AORN. AORN position statement
on RN first assist; 2018.
Canadian Nurses Association.
Exploring new roles for advanced
nursing practice; 2005.
British Columbia College of Nurses
and Midwives. Scope of practice for
registered nurses; 2020.
College of Registered Nurses of
Nova Scotia. Policy statement
registered nurse first assistant;
Association of Registered Nurses of
Newfoundland and Labrador.
Registered nurse first assist (RNFA);
Rothrock J. How are registered
nurse first assistants in surgery faring
in the U.S.? Journal of Perioperative
Practice; 2018;9(28):213-214.
HealthForceOntario. Registered
Nurse: Surgical First Assist (RNSFA)
pilot project update; 2019.
Nova Scotia Health. Hip and knee
action plan; 2017.
White T. The nurse practitioner as
surgical assist. AACN Advanced
Critical Care; 2016;3(27):263-265.
Quick J. The role of the surgical care
practitioner within the surgical team.
British Journal of Nursing;
;13(22):759-765.
Mohawk College. Registered nurse -
first assistant – 92;2020.
The Université du Québec à Trois-
Rivières. Certificate of first aid
nursing practice in surgery; 2020.
Hains T, Turner C, Strand H.
Practice audit of the role of nonmedical
surgical assistant in
Australia, an online survey.
International Journal of Nursing
Practice; 2016;6(22):546-555.
Rozakis M. The role of the RNFA in
anterior cruciate ligament graft
preparation. AORN Journal;
;5(100):500-510.
Petrosyan Y, Thavorn K, Maclure
M, Smith G, McIsaac D, Schramm
D, Moloo H, Preston R, Forster A.
Long-term health outcomes and
health system costs associated with
surgical site infections. Annals of
Surgery, Published Ahead of Print;
Canadian Patient Safety Institute.
Canadian surgical site infection
prevention audit month February
; 2016.
Doctors of BC. Response to BC
Ministry of Health Policy Papers;
Bryant T. Health policy in
Canada (Second ed.). Toronto:
Canadian Scholars’ Press Inc; 2016.
Lynch S. The lived experience of
newly qualified registered nurse first
assistants (RNFA) who have
transitioned to the hospital
operating room surgical setting: A
phenomenological perspective (Order
No. 13424155). Doctoral
dissertation, Villanova University.
ProQuest Dissertations & Theses
Global; 2018.
Blake N. Joy in work and reducing
nurse burnout: from triple aim to
quadruple aim. AACN Advanced
Critical Care; 2019;2(30):185-188.
Sutherland J, Kurzawa Z,
Karimuddin A, Duncan K, Liu G, &
Crump T. (2019). Wait
lists and adult general surgery: is
there a socioeconomic dimension in
Canada? Bmc Health Services
Research; 2019;19(1):161-7.
Roche-Nagle G, Hazel M, Rajan D.
Financial impact of PEVAR compared with standard
endovascular repair in Canadian
hospitals. Canadian Association of
Radiologists Journal; 2018:215-219.
Pear SM, & Williamson TH. The
RN first assistant: An expert
resource for surgical site infection
prevention. AORN Journal;
;89(6):1093-1097.
Association of periOperative nurses.
Periop 101: a core curriculum;
British Columbia Nurses
Association. Staffing the Operating
Room; 2017.
British Columbia Ministry of
Health. A commitment to surgical
renewal in B.C; 2020.
Agency for Healthcare Research and
Quality. Training Guide: Using
Simulation in TeamSTEPPS®
Training; 2020.
