Introduction
This essay examines the scope of practice for Registered Nurse First Assistants (RNFAs) under the Pennsylvania Nurse Practice Act and Medical Practice Act, with a specific focus on how the Pennsylvania Board of Nursing (BON) defines nursing and addresses the RNFA role. It also explores the concept of delegated medical acts, regulations surrounding advanced nursing practice, and the potential alignment of the RNFA role with the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation. Utilising official resources, including state legislation and guidelines from authoritative bodies, this paper provides a detailed analysis of the regulatory framework governing RNFAs in Pennsylvania. Furthermore, it evaluates the position of professional organisations like the Association of periOperative Registered Nurses (AORN) and offers recommendations on integrating the RNFA role into broader nursing regulation models. The essay is structured to address the legal definitions, scope of advanced practice, delegated acts, and the future positioning of RNFAs within the evolving landscape of nursing regulation.
Definitions and Scope of Nursing in Pennsylvania
The Pennsylvania Nurse Practice Act, administered by the Pennsylvania Board of Nursing, provides the foundational legal framework for nursing practice within the state. According to the Act, nursing is defined as “the performance of tasks and responsibilities within the framework of casefinding; reinforcing the patient and family teaching program through health teaching, health counseling and provision of care supportive to or restorative of life and well-being” (Pennsylvania State Board of Nursing, 1987). This definition, while broad, underscores the nurse’s role in patient care, education, and support, but does not explicitly mention perioperative roles such as the RNFA.
A deeper analysis of the BON’s guidelines reveals limited specific mention of the RNFA role. The Board has not issued a distinct position statement on RNFAs, nor has it formally adopted AORN’s Official Statement on the RN First Assistant, which advocates for RNFAs performing functions such as tissue handling and providing exposure during surgery under direct physician supervision (AORN, 2020). However, the BON does reference the importance of specialised training for roles beyond basic registered nursing, suggesting that advanced skills must align with educational preparation and competency standards (Pennsylvania State Board of Nursing, 2023). This implies that while the RNFA role may be permissible, it requires validation through appropriate certification and adherence to delegated tasks as defined by supervising physicians, thus leaving room for interpretation regarding its formal recognition.
Delegated Medical Acts in Nurse and Medical Practice Acts
Both the Pennsylvania Nurse Practice Act and the Medical Practice Act address the concept of delegated medical acts, though with differing emphases. In the Nurse Practice Act, delegated acts are described as tasks performed under the supervision or direction of a licensed physician or other authorised healthcare provider (Pennsylvania State Board of Nursing, 1987). These acts must fall within the nurse’s scope of practice, training, and competency. For RNFAs, this means that functions such as suturing or managing surgical instruments are permissible only if explicitly delegated by a physician and supported by the nurse’s specialised RNFA certification.
Conversely, the Medical Practice Act, governed by the Pennsylvania State Board of Medicine, focuses on ensuring that only licensed physicians perform medical diagnoses and treatments unless specific tasks are delegated to qualified personnel (Pennsylvania State Board of Medicine, 1985). The Act permits delegation to nurses and other healthcare professionals, provided there is adequate supervision and the delegated tasks do not involve independent medical judgement. Therefore, while RNFAs can assist in surgical procedures, their role is strictly supportive and contingent upon direct physician oversight. This dual regulatory framework creates a somewhat restrictive environment for RNFAs, as their practice is heavily dependent on individual physician discretion rather than a clearly defined autonomous scope.
Advanced Nursing Practice Regulations in Pennsylvania
Advanced nursing practice in Pennsylvania is primarily regulated through the certification of Advanced Practice Registered Nurses (APRNs), which include roles such as Nurse Practitioners, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists. The Nurse Practice Act stipulates that APRNs must hold a national certification in their specialty and adhere to collaborative agreements with physicians for certain aspects of practice, including prescriptive authority (Pennsylvania State Board of Nursing, 2023). However, the RNFA role is not explicitly classified as an APRN category under the current regulations, which poses challenges in defining its position within the broader advanced practice framework.
Upon reviewing BON resources and secondary analyses of state nursing laws, it appears that RNFAs are considered a specialised role within registered nursing rather than an advanced practice designation. This categorisation limits their regulatory recognition and potentially restricts the scope of tasks they can perform independently, even with advanced training. Indeed, the lack of specific regulations or position statements from the BON regarding RNFAs highlights a gap in policy that could be addressed to better support perioperative nursing roles.
Alignment of RNFA with the Consensus Model for APRN Regulation
The Consensus Model for APRN Regulation, developed by the National Council of State Boards of Nursing (NCSBN), provides a framework for standardising licensure, accreditation, certification, and education of APRNs across the United States (NCSBN, 2008). The model identifies four APRN roles—Nurse Practitioner, Clinical Nurse Specialist, Certified Registered Nurse Anesthetist, and Certified Nurse-Midwife—and emphasizes the importance of aligning advanced practice with population-based competencies.
Arguably, the RNFA role does not fit neatly into any of the defined APRN categories, as it focuses on perioperative assistance rather than independent diagnosis or treatment. However, the skills and responsibilities of RNFAs, such as assisting in surgery and managing intraoperative care, suggest a level of expertise comparable to advanced practice. A potential alignment could be achieved by integrating RNFAs under the Clinical Nurse Specialist category, with a focus on perioperative care as a specialty. This would require the BON to expand its definition of advanced practice to include roles that, while not fully autonomous, demand significant specialised training and competency.
Alternatively, the Consensus Model’s emphasis on certification could be leveraged to create a distinct pathway for RNFAs, ensuring that their training meets national standards such as those set by AORN. This approach would not only formalise the RNFA role but also enhance patient safety by ensuring consistent educational and practice standards. Ultimately, integrating RNFAs into the Consensus Model framework would address current regulatory ambiguities and provide a clearer career progression for nurses pursuing perioperative specialties.
Conclusion
This essay has explored the regulatory landscape governing the RNFA role in Pennsylvania through an analysis of the Nurse and Medical Practice Acts, alongside BON guidelines and the Consensus Model for APRN Regulation. The findings indicate that while the Nurse Practice Act provides a broad definition of nursing, it lacks specific acknowledgment of the RNFA role, leaving its scope dependent on delegated medical acts and physician supervision as outlined in both Acts. Furthermore, the absence of RNFA designation within advanced practice regulations highlights a policy gap that limits formal recognition of this specialised role. The discussion of the Consensus Model suggests a potential pathway for integration, possibly under an expanded Clinical Nurse Specialist framework or as a certified specialty. Moving forward, it is imperative for the Pennsylvania BON to develop explicit guidelines or position statements on RNFAs to clarify their scope of practice and ensure consistency in training and competency standards. Such steps would not only enhance the professional status of RNFAs but also contribute to improved patient outcomes in perioperative care settings.
References
- Association of periOperative Registered Nurses (AORN). (2020) AORN Position Statement on RN First Assistants. AORN Journal, 111(3), P5-P7.
- National Council of State Boards of Nursing (NCSBN). (2008) Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education. NCSBN.
- Pennsylvania State Board of Medicine. (1985) Medical Practice Act of 1985. Pennsylvania Department of State.
- Pennsylvania State Board of Nursing. (1987) Nurse Practice Act. Pennsylvania Department of State.
- Pennsylvania State Board of Nursing. (2023) Advanced Practice Registered Nurse Regulations. Pennsylvania Department of State.
