How to Become an RNFA

If you’re a nurse interested in advancing your career in the operating room, you might make a great RN first assistant (RNFA). These perioperative nurses have an expanded role that makes them essential in many surgical suites. Plus, you can become one as an RN or advanced practice nurse (APRN). Let’s unpack what it’s like to work in this role, and how to pursue this career.

It takes a team of professionals to carry out surgeries, from routine procedures to risky and complex operations. RNFAs work among an interdisciplinary group of surgical clinicians, including the following:

• Surgeons
• Anesthesiologists
• Nurse anesthetists (CRNAs)
• Surgical techs
• Operating room nurses
• Surgical residents and fellows
• Surgical assistants
• Scrub nurses
• Circulating nurses

What Is a RN First Assistant and What Do They Do?

This advanced surgical nurse has completed specialized training to assist surgeons during operations. This role emerged relatively recently as the volume of surgeries has risen in the last decades. Responsibilities of RNFAs typically include:

• Preoperative assessments: Performing head-to-toe assessments on patients to evaluate and prepare them for surgery.
• Surgical assistance: Assisting the surgeon during operations by providing exposure, handling tissues, and using instruments.
• Hemostasis: Clamping, tying, or cauterizing blood vessels during surgery to control bleeding.
• Wound closure: Suturing, stapling, or using other methods to close surgical sites.
• Positioning: Helping situate patients on the operating table to ensure proper body mechanics for the team, and patient safety during the procedure.
• Postoperative care: Assisting with patient recovery after surgery, evaluating outcomes, and monitoring for complications.
• Documentation: Keeping accurate and detailed records of the surgical procedure and patient care provided.

RNFAs help surgeries run smoothly, so they’re needed in many clinical areas. In this career, you might work in any of the following settings:

• Hospital operating rooms and surgical suites
• Ambulatory surgery centers
• Trauma centers
• Academic medical centers
• Military and veterans hospitals
• Private surgical practices

What’s the Average RNFA Salary?

Compared to the average annual registered nurse salary ($94,480), you could make more as an RNFA. Nurse first assistants make about $110,000 a year on average. What you earn in this role will depend on your experience, any extra credentials you have, and where you work.

Benefits and Drawbacks of a Career as an RN First Assistant

This role requires a unique blend of strengths, including precision, critical thinking, and the ability to work effectively under pressure. What are some things you might enjoy about this role, and what drawbacks might you expect? See our lists below:

Benefits of being an RN first assistant

• Expanded clinical skills
• Higher income
• More routine schedule
• Working closely with an interdisciplinary team

Drawbacks of being an RN first assistant

• Schedule can be demanding
• On-call hours in some facilities
• Physical demands

How to Become an RN First Assistant: 5 Steps

RNFA requirements include first becoming a registered nurse, then gaining experience and training in the operating room specialty. This path takes at least six years to complete. If you’re already a nurse with operating room experience, you can skip to step three.

Step 1: Complete RN Requirements

Every nursing specialty begins with completing a prelicensure program. To become an RN, you can either enroll in a two-year Associate Degree in Nursing (ADN), or a four-year Bachelor of Science in Nursing (BSN). Most training programs for this role require a BSN, so if you choose the faster path, you’ll likely need to go back to school for additional coursework.

Once you complete nursing school, you’ll need to apply for licensure and pass the National Council Licensure Exam for Registered Nurses (NCLEX-RN). This test is designed to assess your knowledge as an entry-level nurse, with questions on safety, care management, pharmacology, and more. In some states, you may also need to complete background checks, fingerprinting, and vaccination requirements. Learn more about how to become an RN.

Step 2: Gain Experience

Training programs for RNFAs require at least two years of perioperative experience before you can apply. In some locations, you may be able to enter the OR as a new graduate through a residency program. These programs help new nurses transition into professional life, with additional training, preceptor supervision, and skills checks.

But depending on where you live, beginning as a new grad in the OR may not be an option. In this case, try gaining experience in another acute care setting. You may have better chances of finding a role in med-surg, oncology, cardiac nursing, or other inpatient areas. Here, you can gain essential skills and confidence in patient care before transitioning into the operating room.

Another optional step is pursuing an advanced clinical nursing degree to become an APRN. RNFAs with APRN training can perform more procedures and care for patients under a greater scope of practice. Plus, programs waive their two-year practice requirement for APRNs.

Step 3: Attend an RN First Assistant Program

Next, you’ll need to complete RNFA schooling, which includes coursework on surgical emergencies, hemostasis, wound closure, types of surgery, and more. You’ll also complete a preceptorship so you can gain real-world experience in your role. Programs are offered through medical schools and academic institutions, as well as through the National Institute of First Assisting (NIFA).

Additionally, you’ll need to pursue certification to become a Certified Perioperative Nurse (CNOR) if you haven’t done so before beginning your program. Other requirements include Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS). Once you’ve made it through your program, you’re ready to continue your career in the OR as an RN first assistant.

Step 5: Earn RNFA Certification

Once you’ve gained experience, you might want to become a certified registered nurse first assistant (CRNFA). Certifications add authority to your resume and could help open the door to additional opportunities in the OR, leadership, or other areas. They also show your dedication to excellent surgical care. You’ll need at least 2,000 hours of practice as an RN first assistant to apply.

Registered Nurse First Assistant FAQs

How long are RNFA programs?

This will depend on which one you pursue, but certification requires that programs include at least six semester credit hours of formal education, including 120 hours of clinical practice.

RN first assistant vs. CRNA: What’s the difference?

While both professional nursing roles work in the perioperative setting, they have different focuses and scopes. CRNAs administer and adjust anesthesia, monitoring the patient’s response and vitals. They also have more advanced training — the education minimum for CRNAs is a doctoral degree, while RNFAs can work in their role with a bachelor’s degree.

RN first assistant vs. surgical tech: What’s the difference?

Both of these clinicians help the OR run smoothly, but they have different practice scopes and educational backgrounds. RNFAs perform surgical tasks under the supervision of the surgeon, while surgical techs typically focus on technical support, such as instrument setup and sterile field maintenance.

Surgical techs ensure the OR is stocked with supplies, and they may hand instruments to the surgical team during cases. But unlike RNFAs, they don’t go through nursing school and instead complete one to two years of training specific to their role.

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