Surgical First Assist Operating Room in San Antonio, Texas, United States
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Methodist Hospital

Surgical First Assist Operating Room

San Antonio, TX, United States
Full-time  Days 7-10 Hrs/Wkends Rotate 
Category: Registered Nurse • Job ID: 190185
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Methodist Hospital opened in 1963 as the first hospital in the now internationally acclaimed South Texas Medical Center. From the beginning, we've recognized the unique needs of each of our patients. It's a process that we continue to improve on, creating ways to better serve the community when they need us the most. With 981 beds, Methodist Hospital offers a broad range of specialties including cardiology, cancer care, bone marrow transplants, emergency medicine, neurosciences, maternity care, gynecology and orthopedics.

As the flagship hospital of the Medical Center and of the Methodist Healthcare system of hospitals, we appreciate the support and recognition we receive from the community having been ranked No. 1 in the Express-News Reader's Choice Awards. We also enjoy being the most preferred hospital in San Antonio, as consistently reported by the Consumer Research Corporation. Methodist Hospital has been nationally recognized by Leapfrog’s Hospital Safety Grade A, accredited by the Joint Commission in stroke care, and designated as an accredited Chest Pain Center. For more information, please visit our website at and select Methodist Hospital under Locations.
Here at Methodist Healthcare, our everyday decisions are founded on compassion. Apply today and join a team that is dedicated to serving others in need.


We want to ensure your needs are met. We offer a variety of comprehensive medical, dental, and vision plans along with some unique benefits including


  • Tuition Reimbursement/Assistance Programs
  • Moving, mortgage, and real estate assistance

  • 100% matching 401k based on years of service

  • Identity Theft Protection discounts
  • Auto, Home, and Life Insurance options

  • Adoption Assistance
  • Employee Stock Purchase Program (ESPP)

  • Student Loan Repayment


Key features for OR and CVOR include:

  • Largest robotic program nationwide with six da Vinci Xi HD Surgical Robots
  • Intraoperative Magnetic Resonance Imaging Suite (IMRIS)
  • Largest Deep Brain Stimulation (DBS) program in the country in a non-academic setting
  • Largest neurosurgery and gynecology programs in South Texas
  • Extensive breast reconstructive surgery program to include DIEP flaps and vascularized lymph node transfer
  • Growing head and neck oncology surgical services
  • Level III Trauma Center
  • 22 state of the art OR suites  
  • 4 state of the art CVOR suites, including a hybrid suite
  • Servicing all of South Texas heart transplants
  • ECMO program for adults and pediatrics
  • Busy TAVR program
  • Congenital heart program 
In this role you will:
 The Surgical First Assistant works as a member of the perioperative team under the direction of the surgeon. He/she performs responsibilities of both the Surgical Technologist and the Surgical First Assistant based on department needs and as directed by the unit director or designee. The Surgical First Assistant practices within the scope of the job description and performs clinical and technical skills under surgeon supervision to assist with carrying out a safe operation with optimal patient results. This is done in collaboration with the circulating RN and other perioperative/OB team members.  The Surgical First Assistant is educated and skilled in both the use of surgical instruments on tissues and the handling of instruments; however, the surgical first assistant does not concurrently function as the scrub nurse.
Essential Job Functions:
  • Functions as a surgical first assistant at the direction of and under the appropriate supervision of the attending surgeon; always practices within the limitations of preparation and experience and within the scope allowed by the hospital.
  • Consistently functions at the direction of and under direct supervision (physical presence of the  attending surgeon in the procedure/treatment room) of the attending surgeon. The surgical assistant scope includes:
    1. Providing visualization of the operative site through appropriate placement and securing of retractors with or without padding, packing or sponges; digital manipulation of tissue; suctioning, irrigation or sponging; manipulation of suture materials; proper use of body mechanics to prevent obstruction of the surgeon’s view.
    2. Utilizing appropriate permanent and temporary techniques to assist with hemostasis.  Permanent hemostasis techniques include clamping and/or cauterizing vessels and tissue, tying and/or ligating clamped vessels or tissue, applying hemostatic clips, or placing hemostatic agents. Temporary hemostasis techniques include applying tourniquets and demonstrating awareness of the indications/contraindications for use with knowledge of side effects of extended use; applying vessel loops, non-crushing clamps, or direct digital pressure.
    3. Administering post-operative subcutaneous local anesthetic injection 
    4. Utilizing running or interrupted sutures with absorbable or non-absorbable material of wound layers, including muscle and fascia.
    5. Assisting  with placement of implants
    6. Robotic procedures only: Insertion of subsequent (not initial) trocars. Must have documented training and competency validated (initially within by MHS Medical staff member privileged to perform robotic surgery.  The documentation must include directly supervised trocar insertions on a minimum of 5 patients completed within a 12 month period with good patient outcomes.
    7. Saphenous Vein Harvesting only: May harvest saphenous vein through endoscopic or open technique. Must have documented training and competency validated by a MHS Medical staff member privileged to perform Cardiothoracic surgery.  The documentation must include directly supervised saphenous vein harvests on a minimum of 10 patients completed within a 12 month period with good patient outcomes.

    B.  Under direct or  general perioperative supervision (surgeon/proceduralist presence in the perioperative  area (pre-op department, perioperative suite, PACU, OR/procedure waiting room) and is immediately available), the surgical assistant scope includes closure of body planes and applies wound dressings per the method indicated by the attending physician:

  1. Utilizing sub-cuticular closure technique with or without adhesive skin closure strips
  2. Skin closure with suture, staples and/or spray occlusive material/skin adhesive strips
  3. Securing drainage systems to tissue
  4. Application of immobilizing dressing

3. Consistently assists with maintaining the patient’s expected physiologic responses to surgery including infection prevention (SCIP measures and practices, maintaining effective disinfection practices, instrument processing, and sterilization).


       4. Demonstrates effective communication and works collaboratively with all members of the perioperative team to include active consistent participation in Universal Protocol and timely and accurate sponge and sharp counts to include initiating corrective action as appropriate.

     5. Consistently applies a working knowledge of patient pre-operative deficits, risk for intraoperative injuries, and possible post-operative outcomes to assist in optimal patient outcomes. Demonstrates principles of safe patient positioning for best exposure in collaboration with the surgical team using appropriate positioning equipment to ensure padded pressure points, protection from nerve damage and unimpaired circulation.

     6. Functions in the role of a Surgical Technician as needed by the department; however, does not concurrently perform as the surgical first assistant and surgical technologist. Wears proper surgical attire, opens sterile packs, instruments, and supplies for each procedure, scrubs, gowns, gloves, and drapes according to established aseptic technique and protocols. Monitors sterile field during procedure and takes appropriate measures to insure integrity of  sterile field and maintenance of sterile techniques.  Initiates corrective action for any break in technique.

Education: Must have completed the following:

1. High School Diploma or GED

2. Meets ONE of the following:

A.  Graduate/completion of CAAHEP Surgical First Assistant, Surgical Assistant Program, Medical School Graduate OR an allied health professional with 2250 hours of surgical rotation.

B.  Practiced as a surgical technologist prior to 9/1/2009

2. Experience: New hires as of 3/29/2011- 2 years experience in the perioperative  setting within the last 4 years in either a surgical technologist or surgical first assistant role.


3. Employee completes initial and ongoing training and competencies as defined by service line, facility and department/unit which are specific to the needs of the patient population served (if applicable).

4. Minimum License, Certificates, or Registrations Required:

Must have and maintain ONE of the following:

A.  Surgical Technologist Certification

CST – Certified Surgical Technologist through the National Board for Surgical Technology and Surgical Assisting (NBSTSA) (formally the Liaison Council on Certification for the Surgical Technologist)  OR


  • TS-C- Tech in Surgery, Certified through the National Center for Competency Testing (NCCT)        

                B.  Surgical First Assistant certification  

  1. SA-C – Surgical Assistant, Certified through the American Board of Surgical Assistants (ABSA)
  2. CSA – Certified Surgical Assistant through the National Surgical Assistant Association (NSAA)
  3. CSFA (formally CFA) – Certified Surgical First Assistant through the National Board of Surgical Technology and Surgical Assisting (NBSTSA)

                C.  LSA- Licensed Surgical Assistant through the Texas Medical Board


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