Summary The Registered Nurse First Assistant OR Circulator is responsible and accountable for all elements of the nursing process when providing and/or supervising direct patient care. The RNFA will follow the VA policies and Directives and will demonstrate professional conduct and team work skills at all times. Responsibilities Registered Nurse First Assistants (RNFAs) are functioning in an expanded perioperative nursing role and reports to the OR Nurse Manager. When performing delegated medical functions, RNFAs are practitioners who are agents of their supervising physician(s)/independent license practitioner(s) who are responsible for the RNFA's actions within the agreed upon scope of practice. The supervising physician(s)/independent license provider is to direct and review the work and practice on a continuous basis to ensure that appropriate directions are given and understood, and appropriate care is rendered. The RNFA must have acquired the necessary knowledge, judgment, and skills specific to the expanded role of RNFA clinical practice. Intra-operatively, the RNFA practices at the direction of the attending surgeon. The RNFA shall not concurrently function as a scrub nurse with responsibility as a surgical first assistant. The RNFA has the duty to verify the standardized procedures in effect before preforming the functions of a surgical first assistant. The full-time RNFA may function in the role of the OR Circulating Nurse, Scrub Nurse or RNFA depending on the need of the Service, however the RNFA can not do more than one of these roles at a time. The RNFA may be assigned process improvement projects and or Quality projects to assist Surgical services as the surgical workload allows. Specific practice settings include the perioperative arena. The practice of each RNFA is based on knowledge, experience, and research and has a direct impact on patient outcomes in the assigned area and for the facility. When directed by the attending surgeon, the RNFA's intra-operative functions include but are not limited to: Positioning the patient, preparing, and draping the surgical site Administrating local anesthetic Providing exposure and retraction Providing hemostasis utilizing electrosurgical cautery (ESU), suture ligation, hemostatic agents, and argon beam - Use and handling of surgical instrumentation Tissue handling, dissection, suturing, and stapling Making the skin incision or stab wound for laparoscopic surgery or drains and placement of trocar (based on State Board of Nursing) for laparoscopic access Robotics insertion and removal of instrumentation Securing drains Closure of wounds and changing dressing, including wound vac therapy Apply and remove casts and splints Harvest vein and arteries for bypass conduit Cleansing surgical area, including superficial, subcutaneous, muscle and fascia, bone and abdominal and pelvic cavities Removal of surgical drains under the direction of the attending surgeon (Chest tubes, knee drains) Additional RNFA behaviors in the perioperative arena include, but are not limited to: Preoperative patient management in collaboration with other health care providers, such as: Performing focused preoperative nursing assessments and Communicating and collaborating with other health care providers regarding the patient plan of care Postoperative patient management in collaboration with other health care providers in the immediate postoperative period and beyond, such as: Participating in postoperative rounds Assisting with patient discharge planning and identifying appropriate community resources. VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases, potential for performance awards Paid Time Off: 50 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year) Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement) Licensure: 1 full and unrestricted license from any US State or territory Work Schedule: Monday - Friday, 7:00am to 3:30pm, with occasional flexibility in scheduling dependent on the Service's needs for RNFA assistance. (Call requirement during week and weekends, Holiday Call coverage) Telework: Not available Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not authorized Permanent Change of Station (PCS): Not authorized Pay Schedule: N09M Requirements Conditions of Employment U.S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA. Selective Service Registration is required for males born after 12/31/1959. You may be required to serve a probationary period. Subject to background/security investigation. Selected applicants will be required to complete an online onboarding process. Must pass pre-employment physical examination. Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). Participation in the Coronavirus Disease 2019 (COVID-19) vaccination program is a requirement for all Veterans Health Administration Health Care Personnel (HCP) - See "Additional Information" below for details. Qualifications Basic Requirements: English Language Proficiency. In accordance with 38 U.S.C. 7403(f), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English. Graduate of a school of professional nursing approved by the appropriate accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE); OR Individuals attending a master's level bridge program in nursing who have completed coursework equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program. Upon achievement of a State license, the individual may be appointed on temporary basis and later converted to a permanent appointment upon successful completion and graduation from the bridge program. (Reference VA Handbook 5005, Appendix G6); OR In cases of graduates of foreign schools of professional nursing, possession of a current, full, active, and unrestricted registration will meet the requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse who has completed an associated degree/entry level Nursing education program. Credit for foreign nursing education higher that associate degree/entry level requires a formal degree equivalency validation from a recognized equivalency evaluation accepted by VA such as International Consultants of Delaware (ICD). Current, full, active, and unrestricted registration as a graduate professional nurse in a State, Territory or Commonwealth (i.e., Puerto Rico) of the United States, or the District of Columbia. Graduate Nurse Technician (GNT) Exception: Candidates who otherwise meet the basic education requirements, but do not possess the required licensure, may be appointed at the entry step of the grade and level applicable to the completed nursing education as a GNT on a 120-day temporary appointment while actively pursuing licensure (may be extended up to two years on a case-by-case-basis.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification. Grade Determinations: The following Scope, Education and Dimension criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade. The Dimension requirements (Practice, Veteran/Patient Driven Care, Leadership, Professional Development and Evidence-Based Practice/Research) are detailed for each grade and level within the online assessment. Grade/Level Scope Education Nurse I, Level I Delivers fundamental, knowledge-based care to assigned clients while developing technical competencies. An Associate Degree (ADN) or Diploma in Nursing, with no additional professional nursing required. Nurse I, Level II Demonstrates integration of biopsychosocial concepts, cognitive skills and technically competent practice in providing care to clients with basic or complex. An ADN or Diploma in Nursing AND 1 year of specialized nursing experience equivalent to Nurse I, Level 1 ;OR a Bachelor of Science in Nursing (BSN) with no additional professional nursing experience required. Nurse I, Level III Demonstrates proficiency in practice based on conscious and deliberate planning. Self-directed in goal setting for managing complex client situations. An ADN or Diploma in Nursing AND 2 years of professional nursing experience in which one year is equivalent to Nurse I, Level 2; OR a BSN and 1 year of professional nursing experience equivalent to the Nurse I, Level 2; OR a Master's degree in nursing (MSN) and no additional professional nursing experience; OR a Master's degree in a *related field with a BSN and no additional professional nursing experience. Nurse II Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others. A BSN with 2 years of professional nursing equivalent to Nurse I, Level 3; OR an MSN with one year of specialized nursing experience equivalent to Nurse I, Level 3; OR a Master's degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse I, Level 3; OR a Doctoral degree in Nursing with no professional nursing experience; OR a Doctoral degree in a *related field with a BSN with no additional professional nursing experience. Nurse III Executes position responsibilities that demonstrate leadership, experience and creative approaches to management of complex client care beyond the immediate practice setting. MSN and 2 years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Master's degree in *related field with BSN and two years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Doctoral degree in Nursing with and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Doctoral degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III. *Note: Foreign education programs/degrees are not creditable as related degrees. Preferred Experience: First Assist experience preferred Previous OR experience & extensive experience in surgical care required (2 years) BSN, MSN preferred Meets all requirements of KBN for RNFA Experience in complex, high acuity surgical areas, robotics, orthopedics, and other surgical specialties preferred Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/. Physical Requirements: It is VA policy to ensure that all selected applicants and employed personnel are physically, mentally and emotionally fit to perform the duties of the position to which assigned. A pre-placement physical examination is required for all fulltime, part-time and intermittent employees identified by VA Directive and Handbook 5019. The pre-placement physical examination shall be completed prior to appointment to determine the physical and mental fitness for candidates for appointment in VA. The examination will be concerned with the mental and physical ability of the applicant to satisfactorily perform the duties of the proposed assignment and will include requisite laboratory and other screening as required by Federal regulatory agencies. This position requires visual acuity, keen hearing, clear distinctive speech, and manual dexterity. This position requires potentially long periods of continued walking, standing, stooping, sitting, bending, pulling, and pushing. This position requires that you are able to lift at least 50 lbs. Transferring patients and objects may be required. The incumbent may be exposed to infected patients and contaminated materials and may be required to don protective clothing in isolation situations or operative/invasive procedures. The incumbent may occasionally be exposed to patients who are combative secondary to delirium, dementia, or psychiatric disorders. The incumbent must be a mature, flexible, sensible individual capable of working effectively in stressful situations, able to shift priorities based on organizational needs. Must complete annual Employee Health requirements, such as annual Influenza vaccination, TB screening or testing, as a condition of employment. Education Additional Information This job opportunity announcement may be used to fill additional vacancies. This position is in the Excepted Service and does not confer competitive status. VA encourages persons with disabilities to apply. The health-related positions in VA are covered by Title 38, and are not covered by the Schedule A excepted appointment authority. Pursuant to VHA Directive 1193.01, VHA health care personnel (HCP) are required to be fully vaccinated against COVID-19 subject to such accommodations as required by law (i.e., medical, religious or pregnancy). VHA HCPs do not include remote workers who only infrequently enter VHA locations. If selected, you will be required to be fully vaccinated against COVID-19 and submit documentation of proof of vaccination before your start date. The agency will provide additional information regarding what information or documentation will be needed and how you can request a legally required accommodation from this requirement using the reasonable accommodation process. If you are unable to apply online or need an alternate method to submit documents, please reach out to the Agency Contact listed in this Job Opportunity Announcement. Under the Fair Chance to Compete Act, the Department of Veterans Affairs prohibits requesting an applicant's criminal history prior to accepting a tentative job offer. For more information about the Act and the complaint process, visit Human Resources and Administration/Operations, Security, and Preparedness (HRA/OSP) at The Fair Chance Act.