Understanding The Support And Barriers For RNFA Role In Canadian Healthcare Structure

Explore and examine the understanding and repetitiveness and interest that exist in your health care region and professional group for the RNFA role.

Overview of the RNFA Role

The Registered Nurse First Assistant (RNFA) is a specialized nursing professional providing assistance directly to the surgeon during operation and handling the patients for operative or other hostile procedures. RNFA is a specially qualified nurse for preoperative, intraoperative and postoperative nursing care processes (Rothrock & Alexander, 2014). Although the establishment of RNFA holds its roots in the America, still there is an ongoing resistance to the proper establishment of RNFA role in North American healthcare structure. The RNFA role got its recognition only after 1990s in America. Further, after 2000 all Canadian provinces accepted RNFA role as a part of nursing practice (Goodman & Spry, 2013).

Being a new and critical role for nursing practice, RNFA position has been a matter of contradiction in medical practice for long time. Exploring once personal interest in being prospective RNFA, this study involves a work on understanding the support and barrier for RNFA role in Canadian healthcare structure. The study involves the interview sessions with two individuals, one is practicing RNFA within practice setting and other is Chief of surgery from professional group to understand the RNFA role in a better manner.

Registered Nurse First Assistant is a newly introduced functionality area for Canadian healthcare system with more opportunity as well as a limited establishment. Professionals are now gaining in towards this profession but there is a lacking awareness that restricts their interest as well as the approach towards RNFA profession. Being interested in RNFA profession, this interview session with Chief of Surgery and Practicing RNFA was an attempt to better understand RNFA role gathering knowledge and experience from these professionals. 

Although being a newly introduced profession in Canadian Healthcare system, professionals still hold a positive and supportive perspective towards this profession. The perspectives of Surgery Chief and Practising RNFA are supportive and similar considering RNFA as a useful position for the healthcare setting. However, instead of similar perspective, their viewpoint and approach sound different towards RNFA role. The Surgery Chief is approaching the position from the perspective of management and RNFA approaching it from nurse’s perspective. According to Guglielmi et al. (2015) studies, RNFA profession at the global level is considered as Advanced Practice Nurse profession to overcome the shortage of nursing professional care in the healthcare structure. The Surgery Chief and Practising RNFA also hold a similar perspective considering RNFA as a better assistance compared to the physician assistant for surgical care. Both agree that RNFA practice results in better patient outcomes, well managed and organised surgical assistance. In contrast, both introduced certain barriers that restrict proper RNFA practice in the Canadian healthcare system. In support to this Hains, Strand & Turner (2017) indicated that RNFA and Nurse Anaesthetists role is covered under Advanced Practice Nursing practice that has legal protection and national framework whereas professions like ‘physician assistant’, ‘nurse associate’ and ‘expanded nurse role’ hold no legal protection making RNFA profession a better preference in all conditions.

Exploring Personal Interest in RNFA Role

Being a student willing to get indulged as an RNFA in nursing practice, my personal perspective is a bit confusing due to lack of knowledge and awareness. As per personal viewpoint, RNFA is a new and interested nursing practice having expanded role in the surgical care process. It is something different from the regular nursing care role where one can learn and work as a combination of nurse and surgeon. In a study by Abraham, Whiteman, Coad & Kneafsey (2016) it was mentioned that regular nurse practices in one refined and restricted zone whereas Advanced nursing roles such as RNFA get to learn different work on each new day. RNFA can even come across learning of complicated processes like joint replacement, robotics, endovascular cases etc. This was really interested to know as a level of student deciding prospective career. Therefore, at first place, it was decided by me to get indulged in RNFA practice.

However, while performing interview sessions with Surgery Chief and Practicing RNFA, I confronted different aspects of RNFA role in nursing practice. The interview described a detailed confrontation of RNFA profession explaining both the positive and negative aspect of this profession. There is a resemblance in my personal viewpoint and their (interviewees) viewpoint where RNFA is definitely considered as a promising and necessary nursing practice for future healthcare structure. But, it was also notified in the interviews that the RNFA profession is a new practice in Canadian healthcare setting. According to Demers-Owoka (2017) studies, Ontario region gained awareness about RNFA role in nursing just a decade ago. Amongst all the provinces of Canada, Ontario lack proper awareness about RNFA profession. In the interview also, Surgery Chief also mentioned that there is a lack of qualified RNFA nurses, less educational institute and awareness about RNFA profession are that are barriers restricting RNFA position implementation in existing Canadian healthcare settings. I was completely unaware of this aspect related to RNFA profession. Further, practicing RNFA in their interview mentioned that RNFA pay in Ontario Canada is not that well to attract professionals. The struggle for RNFA qualification is also hard in this region. These aspects hampered my idea of being a prospective RNFA. 

Being a prospective RNFA, the Surgery Chief and Practising RNFA analysed my level of interest for this profession. During the interview, they analysed my interest by putting forward questions like, why am I willing to work as RNFA?, what is my idea about this role? etc. To these questions, I responded that I am looking for nursing professions that hold something innovative and interesting work. In a study by Kopf, Watts, Meyer & Moss (2018) it was mentioned that Advanced Nursing Practices like RNFA holds the future of the nursing profession. This made me develop an interest in the role of RNFA.

Examining Support and Barriers for RNFA Role in Canada

 Further, when the question about pay scale was put forward, the Chief of Surgery was not willing to answer feeling little offended and asked me that why is it necessary to answer such questions in this general interview. To this situation, I calmly responded that he could just provide an idea about pay scale range without properly mentioning anything because this question is a part of the interview structure. However, As per interview rules, if interviewee wants than they can also skip the questions they are not willing to answer. 

According to Ein, Amurawaiye & Ein (2012) studies, America holds roots of establishing RNFA role in nursing practice because since world war RNFA profession existed in the USA. There were nurses who specifically performed the function of surgery assistance during war describing the importance and usefulness of RNFA role in healthcare practice. Since late 1990s this profession started establishing it in the USA but Canadian provinces (North America) are last to implement RNFA position as an established profession in their health system. However, now Canadian healthcare practice demands an established RNFA role. As per viewpoint of Surgery Chief in the interview, ‘RNFA fulfill the knowledge gap that generally exists between surgeon and physician’. Further, Chief added that RNFA is an important role in coming future for healthcare system due to the increasing requirement of manpower in healthcare structure. RNFA role is considered as a sophisticated, technical and logical form of assistant that nurse can offer in surgical practices.

In the interview session, Practicing RNFA notified that RNFA is a promising profession that allows a ‘better version of nursing practice rather than just providing care’. Further, this profession provides more respect and value from patients and their families. Nurses even get an opportunity to learn different skills and teachings from doctors and surgeon in RNFA practice. Demers-Owoka (2017) studied that RNFA role in Ontario is an affiliated group of the nurse by Perioperative Registered Nurses Association of Ontario (ORNAO) describing RNFA as nurses with additional education, advanced technical skills, knowledge and judgemental skills to provide optimal patient outcomes functioning in the surgical zone. RNFA role is the most unique and important amongst Advanced Nursing Practice established in Ontario as per ORNAO. This provides a fulfilling support to implement the RNFA role in Canadian healthcare structure. 

However, apart from supportive viewpoints, the interviewee’s also mentioned some barriers that are working to restrict the establishment if RNFA role in Canadian Healthcare settings. Chief of Surgery mentioned that there is a scarcity of qualified RNFA in Ontario due to lack of updated educational institutes offering good RNFA courses. As RNFA role in new in Canadian healthcare system, it shall take time for organisations to establish effective working RNFA courses. This works as a major barrier to restrict RNFA implementation. Further, Chief of Surgery, as per management viewpoint also mentioned that management finds it difficult to establish RNFA role in current working structure because the changes are very quick and uncertain to accept properly by working structure of healthcare. Further, Practicing RNFA also indicated the same barrier that nurses are not able to attain RNFA qualifications due to lacking proper RNFA courses in educational institutes. Further, RNFA also stated that the pay scale offered for the role of RNFA is not that satisfying in Ontario that changes nurses attitude and interest towards RNFA role in a negative manner. According to Abraham et al. (2016) studies, In Canada there is no proper or specific pay scale band for RNFA role, however, their pay band is similar to a regular RN but the level of labour and effort required from an RNFA is much more than a regular RN. These are some of the barriers restricting proper establishment of RNFA role in Canadian healthcare structure.

Conclusion 

The study describes the importance of RNFA role in the healthcare structure that works to provide a more specified, technical and logical nursing care. The interview session with Chief of Surgery and practicing RNFA of Ontario, Canada indicates that the RNFA role holds an important and unique place in regular medical practice. The requirement, work structure, better patient outcomes and effective assistance for surgeon support the implementation of RNFA role in healthcare, whereas, limited RNFA courses, low pay scale and lacking qualified nurses work as the barriers in properly establishing RNFA role in the healthcare structure. Still, RNFA is a promising profession that holds the future of advanced nursing care practice. 

References

Books

Goodman, T., & Spry, C. (2013). Essentials of perioperative nursing. Jones & Bartlett Publishers.

Rothrock, J. C., & Alexander, S. (2014). Alexander's Surgical Procedures-E-Book. Elsevier Health Sciences.

Journals

Abraham, J., Whiteman, B., Coad, J., & Kneafsey, R. (2016). Development and implementation of non-medical practitioners in acute care. British Journal of Nursing, 25(20), 1129-1134.

Demers-Owoka, J. (2017). STANDARDS COMMITTEE: Journey to Guidelines-Part Three: Our End is Just the Beginning... ORNAC Journal, 35(1), 41.

Ein, S. H., Amurawaiye, E., & Ein, A. (2012). Recycling the retired surgeon surgical assisting--a Canadian's perspective. Bulletin of the American College of Surgeons, 97(4), 27-32.

Guglielmi, C. L., Duffy, W. J., Murphy, E. K., Windle, P. E., Crosson, J., Lara, G., ... & Groah, L. K. (2015). New Strategies to Assert the Value of the Perioperative Nurse. AORN journal, 101(3), 359-369.

Hains, T., Strand, H., & Turner, C. (2017). A selected international appraisal of the role of the Non-Medical Surgical Assistant. ACORN: The Journal of Perioperative Nursing in Australia, 30(2), 37.

Kopf, R. S., Watts, P. I., Meyer, E. S., & Moss, J. A. (2018). A Competency-Based Curriculum for Critical Care Nurse Practitioners’ Transition to Practice. American Journal of Critical Care, 27(5), 398-406.