Registered Nurse First Assistant - OR

This position is eligible for $6/hr RNFA Differential premium pay in addition to hourly base rate.

Job Summary:

Works in collaboration with the surgeon and other health care team members to promote and restore optimal patient outcomes.  Under the general direction of the Operating Room Supervisor; Peri-operative director; or designee, the RNFA remains responsible for the delivery of professional, safe, and quality patient care in the operative room suite.  Functions as the assistant to the operating surgeon during the operative procedure and provides direction of care, under physician supervision, during the perioperative phase to surgical team members.  Collaborating with physicians and multidisciplinary team members; providing physical and psychological support to patients, friends, and families; supervising assigned team members. Nursing care is rendered to all patients in accordance with the Nurse Practice Act, hospital, Nursing Department and regulatory standards.  Responsible for care of patients in the operating room. Participates in 24-hour call coverage. Uses skills in nursing assessment to include recognizing post-anesthesia and post-operative complications.

The job duties listed are essential functions of the position.  For direct patient care roles: Performs and maintains current in essential competencies.

• Has completed and acquired the necessary knowledge, judgment, and skills specific to the expanded role of RNFA clinical practice; Completed necessary RNFA training course and required hours.


• Credentialing process is complete according to hospital policy.


• Supports the surgical team during all types of surgical procedures and intraoperatively practices at the direction of the surgeon


• Assesses the patient information preoperatively and directs team members on specific performance in each case; identifies the patient to ensure that the patient, procedure, and operative site all correspond.


• Follow any instruction provided by the surgeon.


• Create and maintain positive, personal, professional atmosphere around the patient and their family


• Assists staff in ensuring all equipment and supplies for surgical procedures are in the room or readily accessible


• Prepare the operating room for the procedure


• Preoperatively: communicates and collaborates with health care team regarding the patients plan of care


• Intraoperatively: performs surgical first assistant techniques such as:


• Establishes and maintains a surgically clean environment to reduce the potential for infection by applying the principles of asepsis, decontamination, disinfection, sanitation, sterilization, and environmental monitoring.


• Demonstrates a collaborative spirit by exhibiting collegiality and peer support, by mentoring and/or coaching, and by networking.


• Exhibits professional autonomy by accepting responsibility of one’s own actions and upholds professional goals.


• Collaborates with Registered Nurses, Surgical Technologists, and ancillary staff assigned to the OR for their assigned case in partnership with the surgeon.


• Provides leadership and guidance to other staff members in the OR.


• Pursues professional growth and development through active participation in educational opportunities.


• Knowledge of current departmental policies and standards.


• Ability to maintain confidentiality in all patient related information.


• Ability to act effectively in emergent, critical patient care situations.

Education and Training:

• Bachelors degree in Nursing


• Certification in perioperative nursing (CNOR) and maintains CNOR status


• Graduate of an accredited RNFA program


• Compliance with all applicable statuses, regulations, and institutional policies relevant to RNFAs

Licensures and Certifications:

• Current WA State or Multi-State RN license.


• Current American Heart Association BLS upon hire


• ACLS/PALS certification required within 6 months of hire


• CNOR certification


• RNFA certification

Skills and Abilities:

• Strong communication skills 


• Able to deal effectively with patients, family members and surgeons


• Able to work in a team environment while maintaining a highly professional and productive work environment


• Computer and electronic medical record proficiency

Benefits Overview: 

• Paid Time Off 


• Paid Sick Leave


• Medical, Dental, and Vision


• Flexible Health Spending Account and Dependent Care Spending Account


• Retirement - 403(b) with matching contributions 


• Employee Assistance Program


• Tuition Reimbursement


• Life Insurance


• Employee Wellness Program

About TriState Health

Learn more about TriState Health here. 

TriState Health is a not-for-profit, critical access hospital and medical campus, community owned and operated since 1955. As the largest employer in Asotin County, TriState remains committed to our mission of caring for the community and ensuring, “Your Health Is Our First Priority.”

Serving an 8-county region in Washington, Idaho, and Oregon, TriState Health continues to receive awards for excellent service to the community such as “2025 Get with the Guidelines Gold in Rural Stroke” and “1 of 6 Top Recommended Hospitals in Washington State." TriState proudly promotes a 4:1 nurse to patient ratio, with an even lower ratio for critical care patients.

Located in Clarkston, WA, and nestled within the Lewis Clark Valley - a hidden gem found at the confluence of the Snake and Clearwater Rivers and at the mouth of Hells Canyon, America’s deepest river gorge.  With a mild climate and a four-seasons environment, the valley offers a wide variety of year-round family friendly happenings. Spend time boating on the river, hiking, skiing at nearby resorts, savoring delicious wines and cuisines, attending sporting events, and more! Enjoy life at your pace, your way, in the beautiful Lewis Clark Valley.