N.J. Admin. Code § 13:35-4.1

Current through Register Vol. 56, No. 8, April 15, 2024

Section 13:35-4.1 - Major surgery; qualified first assistant

(a) A major surgical procedure is one with a substantial hazard to the life, health or welfare of the patient. By way of example, but not limitation, major surgical procedures include:

1. A procedure performed where the anatomic locality, the condition, the difficulty or the length of time required to operate would constitute a direct hazard to the life of the patient; and

2. A procedure in which an opening is made into any of the three major body cavities (abdomen, chest or head), if the facility's credentials committee, in conjunction with the chair or chief of the relevant department or division, has delineated the procedure as one requiring a qualified first assistant.

(b) A major surgical procedure shall be performed by a duly qualified surgeon with a duly qualified assisting physician who may be a duly qualified resident in or rotating through a training program approved by the Accreditation Council on Graduate Medical Education or the American Osteopathic Association.

(c) In addition to those individuals listed in (b) above who may act as qualified first assistants, in a health care facility licensed by the Department of Health and Senior Services, a duly qualified registered nurse first assistant (RNFA), a duly qualified physician assistant or a licensed podiatric physician may so act. A duly qualified certified nurse midwife (CNM) may also act as a qualified first assistant in the performance of cesarean sections. For purposes of this subsection, a licensed CNM shall be deemed to be "duly qualified" provided that the CNM has taken and passed a 30-hour didactic training course that includes anatomy, physiology, surgical technique (including wound closure), and direct observation of cesarean sections. Following the completion of the course, a CNM shall serve and be supervised as a second assistant on 10 cesarean sections and complete a supervised preceptorship as a first assistant in 20 cesarean sections.

(d) A duly qualified surgeon, duly qualified assistant physician, duly qualified resident, duly qualified registered nurse first assistant, duly qualified physician assistant, or duly qualified certified nurse midwife (CNM) shall be determined by the hospital credentials committee in conjunction with the chairman or chief of the appropriate committee in conjunction with the chairman or chief of the appropriate department or division consistent with the requirements of law or applicable rule.

(e) Licensees shall comply with the rules as promulgated by the medical staff at the health care facility and shall cooperate to assure compliance with the rules of the Board as well as any rules of the Department of Health and Senior Services which licenses the facility.

(f) In all instances in which a registered nurse first assistant, a physician assistant, or duly qualified certified nurse midwife (CNM) may act as first assistant pursuant to (c) above, the operating surgeon shall have discretion to determine whether to utilize such an individual as a first assistant, despite the fact that they are permitted to so act pursuant to this rule.

(g) In the event of incapacity or unavailability of the operating surgeon during a major surgical procedure, the functions of a first assistant who is not a physician shall be limited to maintaining the status of the patient while a substitute operating surgeon is summoned, except in matters of dire emergency. "Dire emergency" shall include only those circumstances posing a significant risk of imminent death or serious bodily injury to the patient, such as uncontrolled bleeding.

N.J. Admin. Code § 13:35-4.1

Amended by R.1989 d.532, effective 10/16/1989.
See: 21 New Jersey Register 2226(b), 21 New Jersey Register 3307(a).
Deleted reference to specific statute.
Amended by R.1994 d.522, effective 10/17/1994.
See: 26 New Jersey Register 2526(a), 26 New Jersey Register 4195(a).
Amended by R.1995 d.503, effective 9/5/1995.
See: 27 New Jersey Register 1744(a), 27 New Jersey Register 3365(a).
Amended by R.1999 d.356, effective 10/18/1999.
See: 31 New Jersey Register 1742(a), 31 New Jersey Register 3117(a).
In (a)1, substituted "on the premises of the health care facility" for "in the operating suite" at the end; and rewrote (e).
Amended by R.2000 d.66, effective 2/22/2000.
See: 31 New Jersey Register 252(a), 32 New Jersey Register 710(a).
In (c), added the second through fourth sentences; and in (d) and (f), inserted references to duly qualified certified nurse midwives.
Amended by R.2005 d.120, effective 4/18/2005.
See: 36 New Jersey Register 4633(a), 37 New Jersey Register 1203(a).
Rewrote (a); in (c), inserted "or a licensed podiatric physician" preceding "may so act" in the first sentence.