AORN first assistant survey finds no consensus among states Judging from responses to an AORN survey, the issue of nurses acting as first assistants is far from resolved. Earlier this year, AORN sent an inquiry to all state boards of nursing asking if they had a ruling on RNs acting as first assis- tants. Of 41 states replying, 20 said they had no such ruling. Among the 21 states that have a policy, opinions vary widely. (See summary on next page. Preliminary results of the survey were described in the May legislative column.)

Only two states, Idaho and Virginia, have specific guidelines for RN first assistants. The guidelines emphasize that the nurse have specialized preparation and that the institution have a well-defined process for credentialing first assistants.

Eight states said the function is not within the scope of their nursing practice acts. They are Alabama, Kentucky, Minnesota, Montana, Nebraska, New Jersey, New Mexico, and Pennsylvania. In these states, legal experts advise, nurses who choose to first assist would be practicing outside the law and perhaps in violation of medical practice acts.

In another seven states, deciding who may first assist is primarily a matter of hospital pol- icy. Utah is one example. “The board recom- mends that the registered nurse be used in situations where it seems appropriate to use someone other than a physician as first assis- tant,” Ann G Petersen, RN, executive secre- tary, wrote. “The consensus of the board was that such a practice should be evaluated and controlled by the individuals and institutions

involved,” with written policies and specific qualifications.

Other states relying on individual institu- tional policy are Hawaii, Kansas, Louisiana, New York, South Carolina, and Wyoming.

First assisting is regarded as a delegated medical act in Louisiana, Oklahoma, South Carolina, and Washington. Louisiana cau- tions, “This does not mean that all RNs may serve as first assistants but that the qualifica- tion to do so must be determined by the sur- geon and also through a credentialing process within the individual institution.” South Car- olina takes a similar view.

California, Nevada, and Oregon indicated that first assisting might be included within nursing practice under special conditions, such as the nurse having additional education and training. In Georgia and Missouri, the de- cision to first assist rests squarely with the nurse. For example, the Georgia board “rec- ognizes that registered nurses possess inde- pendent licenses. In this capacity, licensees are expected to use professional judgment and are accountable for ensuring that their practice is both competent and within legal boundaries.”

Is first assisting a nursing role? In these responses, there is no one answer. Opinions vary from state to state, hospital to hospital, and nurse to nurse. If there is any common thread, it is that the nurse bears professional responsibility and accountability for his or her own practice. Nurses who wish to act as first assistants would be well advised to explore the implications carefully.

Patricia Patterson Associate editor

218 AORN Journal, August 1982, Vo l36 , No 2

Does state have a policy?

States Yes No

State first assistant policies

Comments

Alabama

Arizona

Arkansas

California

Colorado

Delaware

Florida

Georgia

Hawaii

Idaho

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Minnesota

Missouri

Montana

X

X

X

X

X

X

X

X

X

X

X

X

Not within RN scope of practice

Not addressed in law; no requests for ruling

Can be done within standardized practice regulation

Has asked for advice from AORN and other state boards of nursing

Nurses expected to exercise professional judgment and accountability in ensuring their practice is competent and within legal boundaries.

Determined by institutional policy

Issued guidelines for RN first assistants

Question referred to medical society, state nurses association, and hospital association

An internal matter for surgical and nursing staff

Not within nursing practice act; considered practice of medicine

Acceptable if surgeon supervises and accepts responsibility for nurse. Qualifications determined by nurse and institution’s credentialing process.

Law does not address

Under study

Not an independent nursing function, so does not require a nursing license to perform

Each nurse may expand practice based on knowledge, competence, training, and education

RN has no legal authority under nursing law to act as first assistant if that requires practice of medicine or surgery

220 AORN Journal, August 1982, Vol36, No 2

Does state have a policy?

States Yes No Comments

Nebraska X

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

Tennessee

Texas

Utah

Virginia

Washington

Wisconsin

Wyoming

X

X

Not considered a nursing function; no training programs in state to prepare nurses for this

Not in scope of practice of average RN. Role could be expanded with additional education

Generally not considered within the nursing scope of practice, but in the absence of a qualified physician, board believes RN is best qualified to first assist

X Not within practice act

X No provision in law for such a practice

X

X

X

X

X

X

X

X

X

X

X

X

X

X

Practice act does not address; matter for individual institutional policy

(sent copy of practice act)

A medical responsibility but board policy would not preclude nurse from first assisting

Have no criteria for first assistant but could be part of nursing role with additional education, training, and demonstrated competency

First assistant functions are medical acts that require no knowledge of nor expertise in professional nursing

Acceptable under direct supervision of physician; policy must be set by individual institution

(sent copy of practice act; may be covered under rules and regulations)

(sent copy of practice act)

Not specifically addressed in practice act; suggest defining by institutional policy

Issued guidelines for RN first assistants

Within practice act as a delegated medical act, provided nurse is accountable and has proper education and experience

X Under study

X Matter for institutional policy

AORN Journal, August 1982, Vol36, No 2 223