The Massachusetts Board of Registration in Nursing issues this Advisory Ruling on Nursing practice pursuant to Massachusetts General Laws, chapter 30A, section 8 and chapter 112, section 80B.

Date Issued: February 26, 1986
Date Revised: July 1992, April 1995, August 1998, and September 1998, May 2002

To guide the practice of a registered nurse who is practicing as a First Assistant on the healthcare team.

Scope of Practice: Registered Nurse

The RN First Assistant (RNFA) is a Registered Nurse who through additional extensive education and training practices in collaboration with and interdependently with a surgeon licensed in the Commonwealth, in providing an optimal perioperative experience for the patient. Current Massachusetts registered nurse license in addition to documented competency in perioperative nursing practice is required. Competencies include but are not limited to:

  • Ability to apply the principles of asepsis and infection control;
  • Knowledge of surgical anatomy, physiology, and pathophysiology;
  • Operative techniques related to the operative procedures in which the RNFA assists;
  • Ability to perform CPR;
  • Ability to perform effectively in stressful & emergency situations;
  • Ability to recognize safety hazards and initiate appropriate preventive and corrective action; and
  • Successful completion of a post-basic nursing education program whose intent is the preparation of registered nurses to practice as first assistants at surgery.

The RNFA scope of practice includes the;

  • Pre-operative Phase including but not limited to:

Pre-admission assessment
Patient & Family Education
Patient & Family Interview
Immediate preoperative assessment
Review of patient data
Collaboration & Communication with the OR staff

  • Intra-operative Phase including but not limited to:

Handling tissue
Providing exposure
Using instruments
Suturing and providing hemostasis
* The RNFA shall not concurrently function as a scrub nurse

  • Post-operative Phase including but not limited to:

Communication to the PACU staff
Assist with PACU monitoring
Writing transfer notes
Daily rounds (may include wound management, dressing changes, suture and/or drain removal, other type of catheter & IV removal and as ordered by the duly authorized prescriber)

> This information is provided by the Division of Health Professions Licensure within the Department of Public Health.