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.

Our Mission: Your Health Is Our First Priority!

Our Vision: Empowered Employees. Compassionate Care. Patients First. Community Always.

Our Values:

Quality. Through teamwork, we strive to continuously improve our quality of care and service.
Compassion. We are the caretakers of our community and we treat each patient, partner, and team member with a tender touch and an unparalleled level of care.
Respect. We create a culture of respect by engaging professional staff who demonstrates respect for each other, our patients, and their families.
Collaboration. We seek healthy partnerships – both within and outside our walls – to build teams that deliver the highest quality of care.
Innovation. We embrace and integrate new ideas and technology to improve our community’s health and wellness.

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Communicate change in condition, or signs and symptoms of decline to appropriate provider (e.g., NP, PCP, Hospice Physician). Support the continuity of care by recognizing and supporting home health, palliative and hospice referrals as appropriate and recognizing and supporting transitions in levels of care. Document timely clinical records on all patients including screening/assessment findings, physician orders, progress notes, and care plans. Maintain effective working relationships with IDG, and involve team when patient's care plan warrants team participation to achieve desired outcome. Participate in on-call and patient support activities as applicable, conducting on-call services in a clinically competent and responsive manner. Core Competencies Clinical excellence and sound judgment Patient-centered communication and empathy Interdisciplinary collaboration Accountability and regulatory compliance Adaptability and critical thinking Timeliness of patient visits and documentation Accuracy and completeness of clinical records Patient and caregiver satisfaction Compliance with regulatory and policy standards Participation in team collaboration and IDG activities About You To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Education: Registered Nurse Experience: A minimum of one (1) year experience as an RN, either in acute care hospital, oncology, long-term care, hospice or home health. School internships and clinical hours may be considered as experience in individual cases. Hospice or palliative care experience preferred Licenses, Certifications and/or Registration: Current license to practice nursing in the state of requested employment CPR Certification Current automobile insurance and valid driver’s license Specialized Knowledge and Skills: Knowledge of terminally ill patients and their families along with understanding of hospice; ability to apply knowledge of the special needs of hospice patient and families; knowledge of roles of all disciplines providing hospice services; excellent patient assessment skills; knowledge of community resources; good oral and written communication skills; documentation and program management; knowledge of general nursing practice; thorough knowledge of managed care principles, regulatory guidelines (i.e., Medicare, Medicaid, ACHC, and human resource management principles). Working Conditions: Patient’s homes and/or institutional setting and automobile. Potential exposure to infections, communicable diseases, odors, blood, excreta and hazardous materials. Personal Traits, Qualities and Aptitudes: Sensitivity to the impact of life and death issues faced by individuals with terminal illness; tact in dealing with these patients and their families; ability to support others at a time of crisis. Must be able to demonstrate flexibility by performing a variety of tasks, often changing from one to another of a different nature without loss of efficiency or composure. Communicate effectively with people of all socioeconomic backgrounds. Responsible functioning in the work place, maturity, cooperation, flexibility, tact in dealing with co-workers and all members of the hospice team. Equipment/Tools/Work-Aids: Must be able to effectively operate nursing assessment tools, computers, facsimile equipment, copier and cell phone/beeper. Must have and maintain transportation to be used for work. Compensation may vary within the salary range provided based on several factors including but not limited to a candidate’s location, experience, education, skills, licensure, certifications and department equity. Gentiva provides associates with a comprehensive benefits and total rewards package, of which base pay is just one piece. Salary Range – $80,000.00 - $89,000.00 We Offer Benefits for All Associates (Full-Time, Part-Time & Per Diem): Competitive Pay 401(k) with Company Match Career Advancement Opportunities National & Local Recognition Programs Teammate Assistance Fund Additional Full-Time Benefits: Medical, Dental, Vision Insurance Mileage Reimbursement or Fleet Vehicle Program Generous Paid Time Off + 7 Paid Holidays Wellness Programs (Telemedicine, Diabetes Management, Joint & Spine Concierge Care) Education Support & Tuition Assistance (ASN to BSN, BSN to MSN) Free Continuing Education Units (CEUs) Company-paid Life & Long-Term Disability Insurance Voluntary Benefits (Pet, Critical Illness, Accident, LTC) Ready to Join a Team That Cares? Apply now to become part of our Hospice Nursing team and help make every moment count for our patients and their loved ones. Legalese This is a safety-sensitive position Employee must meet minimum requirements to be eligible for benefits Where applicable, employee must meet state specific requirements We are proud to be an EEO employer We maintain a drug-free workplace ReqID: 2026-140828 Category: Registered Nurses Position Type: Full-Time Company: Gentiva Hospice