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REGISTERED NURSE FIRST ASSISTANTS (RNFA).
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Discusses job redesign for an RNFA.... More...
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Paper Abstract:
Discusses job redesign for an RNFA. Job redesigning strategies and approaches for a hospital setting. Components of the RNFA role. Focuses on two major position components after job redesign. Recommends an implementation strategy of educational courses. Discusses four categories of design and redesign of work. Qualifications needed, and functions of an RNFA.

Paper Introduction:
Job Redesign for an RNFA Registered nurse first assistants (RFNAs) are educated to collaborate with surgeons and health care team members in performing surgical procedures with optimal outcomes for patients. RNFAs must acquire the necessary knowledge, skills, and judgment needed for clinical practice and must function in collaboration with and at the direction of the surgeon during the intraoperative phase of the perioperative experience (Homan & Dunscombe, 2000). In the changing health climate of today, patients need the continuity of care that an RNFA can provide. This brief report will discuss job redesigning strategies for the RNFA in the hospital setting. It will first identify job redesign approaches that could be used for the position and then identify the present components of the RNFA role. Finally, the report will describe

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To implement the redesign describedabove, it is necessary to ensure that the RNFA will receive additionalprofessional training and also successfully complete a licensure andcertification process. M. Functions include, but are not limited to preoperative skinpreparation, positioning and draping the patient, providing homeostasis andexposure, properly handling tissue and using instruments, suturing,cleansing the surgical area and the application of dressings, and otherduties that fall within the scope of licensure. The valuable aspect offlexibility that an expanded RNFA role in preoperative surgical preparationwould combine the operating room with the preoperative and postoperativecare areas. A. By expanding this set of responsibilities to include front-linepatient education in both the hospital and the clinical setting, the RNFAposition could significantly be enriched and enhanced. As Forsythe (1997) has pointed out, the need for RNFAs is growingrapidly and its particularly acute in underserved rural areas andunderstaffed urban trauma centers. In thethoracic and cardiovascular surgical and cardiology theaters, the RNFA cantake a lead role in coordinating heart and lung transplants, leftventricular assist devices, and extra corporeal life support programs.Additionally, qualified RNFAs who have received training can and perhapsshould begin to assist in new surgical techniques, conducting researchstudies, evaluating cost containment issues, and improving patient care andoutcomes. BecauseMedicare and Medicaid are reducing reimbursement distributions and limitingmanaged care, hospitals are constantly searching for ways to reduce costswithout compromising standards of patient care. Following a clinical internship, a surgeon preceptor shouldcomplete an evaluation of the student's newly skills. Further, this would speak directly to improving the autonomy of theRNFA. They aretherefore not applicable with respect to the RNFA. Job Redesign for an RNFA Registered nurse first assistants (RFNAs) are educated to collaboratewith surgeons and health care team members in performing surgicalprocedures with optimal outcomes for patients. Ivancevich, J. These are the experiencedmeaningfulness of work and the experienced responsibility for outcomes ofwork. Kurkowski, C. References Forsythe, L. Perspectives on the design and redesign of work are classified byIvancevich (1998) into four major categories: 1) the perceptual-motorapproach; 2) the biological approach; 3) the mechanistic approach; and 4)the motivational approach. Orthopaedic Nursing, 18(1), 43-48. Hlozek, C. (1998). By providing the RNFA withenhanced task significance and a greater degree of autonomy, the RNFA willexperience two important psychological states. The motivational approach, incontrast, emphasizes job enrichment that helps incumbents satisfy needs forgrowth, recognition, and responsibility (Ivancevich, 19998). Human Resource Management. C., Zacharias, W. AORN Journal, 72(2), 234-24 . Homan, T., & Dunscombe, A. (1999). This brief report willdiscuss job redesigning strategies for the RNFA in the hospital setting.It will first identify job redesign approaches that could be used for theposition and then identify the present components of the RNFA role.Finally, the report will describe two major position components after jobredesign and recommend an implementation strategy for redesigning theposition. The RN first assistant: Professionaladvancement in an expanded role. Both the perceptual-motor approach and thebiological approach are rooted in human factors engineering and their majorfocus is on the integration of human and machine systems. Kurkowski (1999) contends that the certificationprocess provides a means for the RNFA to be recognized for having achievedexcellence. This strategy willsignificantly expand both the tasks of the RNFA in a clinical setting andincrease the autonomy and job satisfaction of the RNFA. As this listing of the components of the RNFA position and jobdescription demonstrates, the tasks assigned to the RNFA are extensive atthe present time. Ivancevich (1998) maintains that when the job characteristics modelof job design/redesign is considered, skill and task variety identity, tasksignificance, and autonomy must be emphasized. Boston: IrwinMcGraw-Hill. Finally, it willreduce selected costs and result in higher levels of quality care. M., & Mizener, K. In addition to the qualifications contained in theforegoing job description, RNFAs in the rural setting are being asked toconduct preoperative patient interviews that go beyond the standardsdescribed above. In a rural setting, RNFAs have a vitally important function(Forsythe, 1997). RNFAs must acquire thenecessary knowledge, skills, and judgment needed for clinical practice andmust function in collaboration with and at the direction of the surgeonduring the intraoperative phase of the perioperative experience (Homan &Dunscombe, 2 ). Homan and Dunscombe(2 ) contend that the basic intraoperative function of the RNFA includesassisting surgeons or senior residents and working interdependently undertheir direction. However, as Hlozek, Zacharias, and Mizener (1999) havenoted, over the 25-year history of RNFAs in the United States, surgicalstaff members have consistently expanded the roles of these professionalsto include activities once reserved entirely for physicians. In the preoperative and intraoperative phases, for example, theRNFA's role can be expanded to move beyond its current limits. The two remaining approaches more clearly highlight the potentialtrade-offs that must be frequently made by organizations. AORN Journal, 65(1), 45-46. In the changing health climate of today, patients needthe continuity of care that an RNFA can provide. Marketing the RN first assistantrole. Both of these psychological states lead to high internal workmotivation, high quality work performance, high satisfaction with work, andlow absenteeism and turnover (Ivancevich, 1998). It is therefore recommended that the strategies be implemented bymeans of didactic educational courses providing theoretical knowledge ofthe two tasks identified above, followed by clinical internships of no lessthan 5 hours. The RNFA can be the lead professional in surgicalprocedures such as harvesting the radial artery of patients requiringpreoperative procedures such as arterial conduit revascularization. (1998). RN firstassistants expand their perioperative role. This brief report has identified ways in which the RNFA role andresponsibilities can be redesigned and enhanced. M. Of the two, themechanistic approach systematically studies the structure of jobs, breakingthem down into simple and repetitive tasks. The RNFA, with an expanded role, would then provideconsistency and continuity in these complex procedures and set standardsfor high-level results (Hlozek, et al, 1998). AORN Journal, 67(3), 56 -565. RNFAs, working underphysician supervision, perform preoperative patient assessments, dischargesummary dictation, surgical preparatory procedures, and take patienthistories while also reviewing charts and pharmacological matters andperforming an abbreviated physical examinations. RNFAs also assistsurgeons with daily rounds, observe surgical incision and subsequent woundcare, remove catheters, drains, and sutures, and communicate to surgeonsany deviation from normal clinical progress (Homan & Dunscombe, 2 ). (1997). A certificate ofcompletion should then be granted, with continued surgeons' oversight ofthe RNFA in the clinical setting. (2 ). It is thisstrategy of job enrichment that will be employed herein. At the present time,the tasks of the RNFA tend to focus on simple discharge planning andinstructions involving around medications, wound care, and follow-upvisits. RN first assistants increase access to qualitysurgical care in a rural setting. Usingthe RNFA in such a capacity would allow residents and fellow or staffsurgeons to focus on other surgical tasks (e.g., harvesting internalthoracic arteries, heart dissections, or cannulations). This would saveproviders an estimated $1,3 per hour in operating room time. Currently, the RNFA must present certain qualifications, includingcertification in perioperative nursing, documentation of proficiency in thefield, nursing practice as both a scrub and circulating nurse, the abilityto apply principles of asepsis and infection control, and a knowledge ofsurgical anatomy, physiology, and operative techniques related to operativeprocedures in which the RN assists (Kurkowski, 1999). These professionals also could play an expanded role inpatient education beyond simple discharge planning. A specific example of how the RNFA role can be enriched is provided byHlozek, et al (1998).

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