RN Circulator Laws and Language
Hospital: State Board of Nursing Statement:
Kentucky Board of Nursing opinion letter dated February 7, 2003 in response to a request for an opinion on the role of the registered nurse in performance of circulatory duties in a hospital operating room.
“Only qualified registered nurses who possess the cognitive knowledge, competent skills and expertise in perioperative nursing care shall function as a supervision, head nurse and/or circulating nurse in the operating room, delivery room and any area where surgical and obstetrical procedures are planned.”
ASC: Kentucky Administrative Regulations
Cabinet for Health Services Department for Public Health
Chapter 20. Health Services and Facilities:
90 KAR 20:106: Operation and services; ambulatory surgical center
Section 4. Surgical Services.
(4) A registered nurse shall be available to circulate at all times. The operating rooms shall be supervised by a registered nurse.
Registered Nurse First Assistants (RNFAs)
Kentucky Revised Statutes, Title XXV, Chapter 304, Subtitle 17A, 304.17A-146
Notwithstanding any provision of law, a health plan issued or renewed on or after July 15, 2000, that provides coverage for surgical first assisting benefits or services shall be construed as providing coverage for a registered nurse first assistant who performs services that are within the scope of practice of the registered nurse first assistant.
CHAPTER 216B. LICENSURE AND REGULATION OF HEALTH FACILITIES AND SERVICES. 216B.015. Definitions for chapter
Except as otherwise provided, for purposes of this chapter, the following definitions shall apply:
(24) "Registered nurse first assistant" means one who:
(a) Holds a current active registered nurse licensure;
(b) Is certified in perioperative nursing; and
(c) Has successfully completed and holds a degree or certificate from a recognized program, which shall consist of:
Kentucky Board of Nursing, Advisory Opinion Statement, Approved 10/84, Rev’d 2/05.
After study of the issues and concerns regarding both the role and scope of practice of registered nurses who act as first assistants to the physician during surgical procedures, the Kentucky Board of Nursing issued the following opinions:
1) It is within the scope of registered nursing practice for a registered nurse who possesses substantial, specialized knowledge and technical skill to act as an RN first assistant to the physician who is immediately available and onsite during surgical procedures.
2) In no event should the RN first assistant be expected to replace or assume the responsibilities of the physician performing the surgical procedure, but may accept appropriate responsibility if the physician becomes incapacitated by protecting the surgical wound, maintaining homeostasis, and maintaining sterility of the operative field until the replacement physician accepts responsibility for procedures completion.
3) Registered nurses who perform first assistant acts should:
A. Possess an in-depth knowledge of perioperative and intraoperative nursing practice;
B. Be knowledgeable of the potential complications and adverse reactions, which may result from such acts;
C. Possess the knowledge and skill to recognize adverse reactions and to take appropriate action as directed by the physician;
D. Perform acts which are in accordance with: 1) the established written agency policies and procedures, 2) the definition of "registered nursing practice" as stated in KRS 314.011(6), 3) evidence-based practice, and 4) the scope of practice of RN First Assistants as established by Association of Operating Room Nurses.
Further, it was the advisory opinion of the Board that handling and/or tissue cutting for performance of small skin lesion excision and punch biopsy are within the scope of registered nursing practice for the registered nurse who possesses substantial, specialized knowledge and current clinical competency in the performance of the procedures. The procedures should be preformed under the supervision of a physician who is onsite and immediately available to the nurse.