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Survey shows state board positions on first assistant
Survey shows state board positions on first assistant
States’ policies on first assisting vary widely. To help clarify whether registered nurses may act as first assistants to the surgeon, AORN has conducted a survey of each state’s board of nursing. A summary of the responses as of Dec 20, 1982, is printed with this article. This is an update of a chart printed in the August 1982 Journal. The chart shows whether the state board of nursing has made an interpretation on the issue, whether the board believes the RN may first assist, and a summary of commentsor conditions that must be met. Other states may be issuing rulings in the near future. In some cases, you may question your state boards response to the survey. What can you do in such cases? Nancy Davis, RN, AORN Board member, advises that you contact your board of nursing directly for clarification. She was chairman of the AORN committee that developed AORNs first assistant guidelines. “We believe this is an individual professional responsibility,” she said, emphasizing that each nurse is accountablefor the legality of his or her own practice. She encouraged nursesto take the initiative in seeking further clarification, rather than relying on their hospital, supervisor, or AORN. What is the best way to contact your state board of nursing? A simple phone call may not be enough. Instead, you should submit your request to the board in writing. Be as specific as possible. The board will want to know exactly what you mean by first assisting, since there is no universal definition. Be sure to include your address and telephone number, so
428
the board can contact you for more information. If the board decides to place the item on its agenda, you may be asked to appear at the meeting to provide further information. Do not be concerned if you do not receive an immediate reply to your inquiry, because the board may need to consult others for advice. In some cases, it may seek an opinion from the attorney general’s office. What is AORNs position? When defining the perioperative role in 1978, the Association decided it was prematureto includefirstassisting within the role. In 1979, delegates approved an amendment stating, “However, in the absence of a qualified physician, the registered nurse who possesses appropriate knowledgeand technical skills is the best qualified nonphysician to serve as the first assistant.” AORN believes that “as an advocate of the patient, we are obligated to continue defining the role of the first assistant and establishing assurance of minimal competency.” In 1980, the Association approved guide linesfor RNs choosingto function as first assistants. They recommended qualifications and other provisions for those who are performing these functions. Among these is the statement that “the individual must be familiar with state statutes and regulations relevant to this role, particularly nurse and medical practice acts.” No specific action on the first assistant is expected at Congress. For more information on the survey results or AORNs position, contact Dorris Davis, RN, consultativg specialist at Headquarters in Denver.
AORN Journal, February 1983, Vol37,No 3
First assistant survey Ruling interpretation
RN may first assist
Alabama Alaska Arizona
yes
no
Not within RNs scope of practice No response Not addressed in law and has not been discussed by board of nursing. No first assistant training programs
Arkansas California
no yes
Yes
Colorado
no
Considered an expanded role; can be done within “standardized procedures.” Practice must be within limits of educational preparation; however, board has not set education or practice standards Nurse practice act does not address. Board is seeking information from other states and has sent memo to medical board
Connecticut Delaware District of Columbia
no
Yes
Not defined by nurse practice act. Standards and practices established by institutional policy
Florida
no
Georgia
no
Yes
Hawaii
no
Yes
Illinois
no
Must be within limitsof education, preparation, demonstrated competence, and institutional protocols Standards and practice established by institutional policy RN may first assist when qualified MD not available. Must havedocumentedpreparation, knowledge, skills and supervised practice. Requires permission of hospital credentialing committee Not addressed by nurse practice act. Has requested opinion of state department of registration and education
Indiana Iowa
no no
Kansas
no
State
430
no
Comments
no no
Yes
Referred to state medical society, nurses association, and hospital association Not addressed by nurse practice act. To be determined by hospitals’ surgical staff and nursing service
AORN Journal, February 1983, Vol37, No 3
Flrst assistant survey
State
Ruling interpretation
RN may first assist
Kentucky
yes
no
Louisiana
yes
Yes
Maine no Maryland no Massachusetts Michigan Minnesota yes
no
Mississippi
no
Missouri
no
Montana
yes
no
Nebraska
yes
no
Nevada
Yes
no
New Hampshire
yes
no
New Jersey yes New Mexico yes
no no
New York North Carolina North Dakota
432
no
Comments Not authorized in nurse practice act. Considered practice of medicine Surgeon must supervise RNfirst assistant and accept responsibility. Qualifications determined by physician and institution’s credentialing process Nursing practice act does not address Under study No response Nurse practice act does not address Considered a delegated medical function. RN may first assist under medical direction and is accountablefor own actions. Boardhas not set training, credentialing requirements Under study; nurse practice act does not address. RN is responsible for performing within safe limits in all nursing activities RNs are referred to persons, institutions, or specialty organizations for qualifications, credentialing, and training programs RN has no legal authority under practice act if role requires practice of medicine or surgery Not included in practice act. No training programs within state Not in scope of practice of average RN. Role could be expandedwith additional preparation RN should not act as first assistant, but in absence of MD, an RNwith appropriate skills is best qualtfied person Not considered within limits of nursing No provision in law for such practice; no RN may be employed in this capacity Practice act does not address; considered a matter of hospital policy
no Yes
no
A delegated medical act, not nursing as authorized by practice act
AORN Journal, February 1983, Vol37, No 3
First assistant survey
State
Ruling interpretation
RN may first assist
Ohio Oklahoma
no yes
Yes
Oregon
Yes
Yes
Pennsylvania yes Rhode Island
no
no
Comments Board has not been asked to rule Medical responsibility, but policy statement would not preclude nurse from first assisting. Each person may be held liable for own actions Have no criteria, but could be part of nursing role with additional education, training, and demonstrated competency. Role would need to be defined and included in institutional policy and procedures A medical responsibility; not within permissible scope of R N s practice Nursing practice act does not address
South Carolina
yes
Yes
South Dakota
no
Tennessee
no
Texas
no
no
Utah
Yes
Yes
Yes
Yes
Vermont Virginia
494
A medical practice; can be done under direction and in presence of physician by person with needed training. Individual institutions must set policy on RNs as first assistants Not addressed by practice act. No applicable standards or training programs within state RNs in expanded role assume personal responsibility for their acts. RNs who manage medical aspects of care must have written protocols by nurse administrator and sponsoring MD and have documentation of training Not included in practice act; interpreted that RNs may not first assist Not included in practice act. Recommends such practice be controlled by institutional policy, including specific qualifications. Recommends use of RNs be limlted to minor cases No response RNs may first assist in cases compatible with their preparation and experience. Hospitals must have policies with RN qualifications and procedures in which RNs may or may not assist
AORN Journal, February 1983, Vol37,No 3
First 8SdSt8nt SUNeY
State
Ruling interpretation
RN may first assist
Washington
yes
Yes
West Virginia Wisconsin Wyoming
Yes no no
Yes no no
Comments
RN must have necessary education, training and competence. RN ackountablefor carrying out acts as directed by physician
Under study Not addressed in practice act. Interpretation requested from attorney general. Each hospital must determine policy, conditions, type of surgery, and required training and credentials for RN to first assist
Guard your badge; it's your key to Congress Once you receive your Congress badge, computer scan sheets, and plastic name card at the registration area, guard them carefully. They're worth money, and you need them throughout the week. Congress badges will be required for admission to all Congress sessions, the exhibit area, the exhibitors party, and exhibitor hospitality suites. Attendees must wear their badges at all times during these activities. In addition, you will need your badge-with a special validation-to ride the Congress shuttle bus during daytime hours beginning Sunday of Congress week. No stamp is required to ride the evening buses. You can have the validation stamped onto your badge for a cost of $10 at a special booth in the registratlon area of the Astrohall. To replace a lost Congress badge or other registration material during the week, you should go to the registration information area. The replacement badge charge is 510. A new Congress bus stamp costs an additional $10. To receive credit for each education session you attend, you need to tum in a
436
completed Activity Evaluation and Record of Attendance computer scan sheet. Your registration packet contains all the sheets you will need for the time you are registered. Lost sheets may be replaced for $1 a sheet. The replacement cost of the plastic name card, which you can use to register to receive product and service information, is also $1. In addition, you should note that only Congress registrants may attend official Congress functions, including the exhibitors party and hospitality suites. Congress attendees are requested not to ask exhibitors to admit nonregistered friends or spouses.
Message center The message center will be located in the registration area by the bus ticket booth. The telephone number of the message center is (713) 791-9999, ext 525. Messages left at the center will be listed alphabetically. Tentative hours for the message center will be from 9 am to 6 pm on Sunday, April 10, and from 8 am to 5 pm from Monday, April 11, to Thursday, April 14.
AORN Journal, February 1983, Vol37, No 3
States’ policies on first assisting vary widely. To help clarify whether registered nurses may act as first assistants to the surgeon, AORN has conducted a survey of each state’s board of nursing. A summary of the responses as of Dec 20, 1982, is printed with this article. This is an update of a chart printed in the August 1982 Journal. The chart shows whether the state board of nursing has made an interpretation on the issue, whether the board believes the RN may first assist, and a summary of commentsor conditions that must be met. Other states may be issuing rulings in the near future. In some cases, you may question your state boards response to the survey. What can you do in such cases? Nancy Davis, RN, AORN Board member, advises that you contact your board of nursing directly for clarification. She was chairman of the AORN committee that developed AORNs first assistant guidelines. “We believe this is an individual professional responsibility,” she said, emphasizing that each nurse is accountablefor the legality of his or her own practice. She encouraged nursesto take the initiative in seeking further clarification, rather than relying on their hospital, supervisor, or AORN. What is the best way to contact your state board of nursing? A simple phone call may not be enough. Instead, you should submit your request to the board in writing. Be as specific as possible. The board will want to know exactly what you mean by first assisting, since there is no universal definition. Be sure to include your address and telephone number, so
428
the board can contact you for more information. If the board decides to place the item on its agenda, you may be asked to appear at the meeting to provide further information. Do not be concerned if you do not receive an immediate reply to your inquiry, because the board may need to consult others for advice. In some cases, it may seek an opinion from the attorney general’s office. What is AORNs position? When defining the perioperative role in 1978, the Association decided it was prematureto includefirstassisting within the role. In 1979, delegates approved an amendment stating, “However, in the absence of a qualified physician, the registered nurse who possesses appropriate knowledgeand technical skills is the best qualified nonphysician to serve as the first assistant.” AORN believes that “as an advocate of the patient, we are obligated to continue defining the role of the first assistant and establishing assurance of minimal competency.” In 1980, the Association approved guide linesfor RNs choosingto function as first assistants. They recommended qualifications and other provisions for those who are performing these functions. Among these is the statement that “the individual must be familiar with state statutes and regulations relevant to this role, particularly nurse and medical practice acts.” No specific action on the first assistant is expected at Congress. For more information on the survey results or AORNs position, contact Dorris Davis, RN, consultativg specialist at Headquarters in Denver.
AORN Journal, February 1983, Vol37,No 3
First assistant survey Ruling interpretation
RN may first assist
Alabama Alaska Arizona
yes
no
Not within RNs scope of practice No response Not addressed in law and has not been discussed by board of nursing. No first assistant training programs
Arkansas California
no yes
Yes
Colorado
no
Considered an expanded role; can be done within “standardized procedures.” Practice must be within limits of educational preparation; however, board has not set education or practice standards Nurse practice act does not address. Board is seeking information from other states and has sent memo to medical board
Connecticut Delaware District of Columbia
no
Yes
Not defined by nurse practice act. Standards and practices established by institutional policy
Florida
no
Georgia
no
Yes
Hawaii
no
Yes
Illinois
no
Must be within limitsof education, preparation, demonstrated competence, and institutional protocols Standards and practice established by institutional policy RN may first assist when qualified MD not available. Must havedocumentedpreparation, knowledge, skills and supervised practice. Requires permission of hospital credentialing committee Not addressed by nurse practice act. Has requested opinion of state department of registration and education
Indiana Iowa
no no
Kansas
no
State
430
no
Comments
no no
Yes
Referred to state medical society, nurses association, and hospital association Not addressed by nurse practice act. To be determined by hospitals’ surgical staff and nursing service
AORN Journal, February 1983, Vol37, No 3
Flrst assistant survey
State
Ruling interpretation
RN may first assist
Kentucky
yes
no
Louisiana
yes
Yes
Maine no Maryland no Massachusetts Michigan Minnesota yes
no
Mississippi
no
Missouri
no
Montana
yes
no
Nebraska
yes
no
Nevada
Yes
no
New Hampshire
yes
no
New Jersey yes New Mexico yes
no no
New York North Carolina North Dakota
432
no
Comments Not authorized in nurse practice act. Considered practice of medicine Surgeon must supervise RNfirst assistant and accept responsibility. Qualifications determined by physician and institution’s credentialing process Nursing practice act does not address Under study No response Nurse practice act does not address Considered a delegated medical function. RN may first assist under medical direction and is accountablefor own actions. Boardhas not set training, credentialing requirements Under study; nurse practice act does not address. RN is responsible for performing within safe limits in all nursing activities RNs are referred to persons, institutions, or specialty organizations for qualifications, credentialing, and training programs RN has no legal authority under practice act if role requires practice of medicine or surgery Not included in practice act. No training programs within state Not in scope of practice of average RN. Role could be expandedwith additional preparation RN should not act as first assistant, but in absence of MD, an RNwith appropriate skills is best qualtfied person Not considered within limits of nursing No provision in law for such practice; no RN may be employed in this capacity Practice act does not address; considered a matter of hospital policy
no Yes
no
A delegated medical act, not nursing as authorized by practice act
AORN Journal, February 1983, Vol37, No 3
First assistant survey
State
Ruling interpretation
RN may first assist
Ohio Oklahoma
no yes
Yes
Oregon
Yes
Yes
Pennsylvania yes Rhode Island
no
no
Comments Board has not been asked to rule Medical responsibility, but policy statement would not preclude nurse from first assisting. Each person may be held liable for own actions Have no criteria, but could be part of nursing role with additional education, training, and demonstrated competency. Role would need to be defined and included in institutional policy and procedures A medical responsibility; not within permissible scope of R N s practice Nursing practice act does not address
South Carolina
yes
Yes
South Dakota
no
Tennessee
no
Texas
no
no
Utah
Yes
Yes
Yes
Yes
Vermont Virginia
494
A medical practice; can be done under direction and in presence of physician by person with needed training. Individual institutions must set policy on RNs as first assistants Not addressed by practice act. No applicable standards or training programs within state RNs in expanded role assume personal responsibility for their acts. RNs who manage medical aspects of care must have written protocols by nurse administrator and sponsoring MD and have documentation of training Not included in practice act; interpreted that RNs may not first assist Not included in practice act. Recommends such practice be controlled by institutional policy, including specific qualifications. Recommends use of RNs be limlted to minor cases No response RNs may first assist in cases compatible with their preparation and experience. Hospitals must have policies with RN qualifications and procedures in which RNs may or may not assist
AORN Journal, February 1983, Vol37,No 3
First 8SdSt8nt SUNeY
State
Ruling interpretation
RN may first assist
Washington
yes
Yes
West Virginia Wisconsin Wyoming
Yes no no
Yes no no
Comments
RN must have necessary education, training and competence. RN ackountablefor carrying out acts as directed by physician
Under study Not addressed in practice act. Interpretation requested from attorney general. Each hospital must determine policy, conditions, type of surgery, and required training and credentials for RN to first assist
Guard your badge; it's your key to Congress Once you receive your Congress badge, computer scan sheets, and plastic name card at the registration area, guard them carefully. They're worth money, and you need them throughout the week. Congress badges will be required for admission to all Congress sessions, the exhibit area, the exhibitors party, and exhibitor hospitality suites. Attendees must wear their badges at all times during these activities. In addition, you will need your badge-with a special validation-to ride the Congress shuttle bus during daytime hours beginning Sunday of Congress week. No stamp is required to ride the evening buses. You can have the validation stamped onto your badge for a cost of $10 at a special booth in the registratlon area of the Astrohall. To replace a lost Congress badge or other registration material during the week, you should go to the registration information area. The replacement badge charge is 510. A new Congress bus stamp costs an additional $10. To receive credit for each education session you attend, you need to tum in a
436
completed Activity Evaluation and Record of Attendance computer scan sheet. Your registration packet contains all the sheets you will need for the time you are registered. Lost sheets may be replaced for $1 a sheet. The replacement cost of the plastic name card, which you can use to register to receive product and service information, is also $1. In addition, you should note that only Congress registrants may attend official Congress functions, including the exhibitors party and hospitality suites. Congress attendees are requested not to ask exhibitors to admit nonregistered friends or spouses.
Message center The message center will be located in the registration area by the bus ticket booth. The telephone number of the message center is (713) 791-9999, ext 525. Messages left at the center will be listed alphabetically. Tentative hours for the message center will be from 9 am to 6 pm on Sunday, April 10, and from 8 am to 5 pm from Monday, April 11, to Thursday, April 14.
AORN Journal, February 1983, Vol37, No 3