A Registered Nurse First Assistant (RNFA) is a perioperative nurse who practices in an expanded role within the surgical environment. This role requires extensive training to perform direct, hands-on tasks that streamline the surgical process. The RNFA ensures patient care and contributes to positive surgical outcomes.
Defining the Registered Nurse First Assistant Role
The Registered Nurse First Assistant is a licensed Registered Nurse who has completed a formal, post-basic nursing education program to function as a first assistant during surgical procedures. The RNFA practices within the sterile field, working under the direct supervision of the operating surgeon. This advanced designation signifies the nurse has acquired the specific knowledge, clinical judgment, and technical skills necessary for surgical assisting.
The RNFA collaborates with the surgical team to achieve the best results for the patient throughout the pre-operative, intra-operative, and post-operative phases of care. The role is an expansion of the perioperative nursing scope, but it remains grounded in professional nursing practice. The RNFA uses specialized training to perform delegated functions distinct from the traditional roles of other operating room staff.
Specific Responsibilities in the Operating Room
The RNFA’s duties begin before the first incision. They assist with patient preparation, including proper positioning on the operating table for safety and optimal surgical exposure. They also review the patient’s medical history and participate in the final surgical plan development.
During the intra-operative phase, the RNFA performs hands-on tasks that directly facilitate the surgeon’s work. This includes providing constant surgical site exposure by retracting tissue and utilizing instruments to manipulate structures. The RNFA also performs hemostasis, which involves clamping, tying, or using electrosurgical tools to control bleeding and maintain a clear field of view for the surgeon.
The RNFA manages tissue and surgical wounds, including handling, cutting, and shaping tissue as directed by the surgeon. A primary function is performing the final wound closure, involving suturing and applying staples to close the incision layers and the skin. Post-operatively, they may apply surgical dressings and assist with patient transfer while ensuring wound integrity.
Educational and Experience Requirements
The foundation for the RNFA role is a current, unrestricted Registered Nurse (RN) license. AORN standards require that all candidates for an RNFA program hold a Bachelor of Science in Nursing (BSN) degree or a higher degree. This education ensures a comprehensive understanding of nursing theory, research, and patient care management.
Before applying to a formal RNFA program, nurses must gain substantial experience in the operating room setting. Most programs require applicants to have a minimum of two years of perioperative nursing experience. This experience is typically confirmed by holding the Certified Nurse Operating Room (CNOR) credential, which requires at least 2,000 hours of surgical nursing practice.
Following the prerequisite experience, the nurse must complete a formal RN First Assistant program that meets AORN standards. These accredited programs include a strong didactic component covering surgical anatomy and techniques, along with a supervised clinical component. Clinical training requires a minimum of 120 hours of direct practice in the RNFA role under the mentorship of a qualified surgeon.
Achieving RNFA Certification
After completing an accredited RNFA education program, the final step is achieving national certification, which validates advanced competency. The primary credentialing body is the National Assistant at Surgery Certification (NASC), which offers the Registered Nurse Assistant at Surgery-Certified (RNAS-C) credential. Certification is obtained by passing a comprehensive examination that tests the RNFA’s knowledge and judgment in all phases of perioperative care.
Certification must be maintained through a renewal process that typically occurs every five years. To renew the credential, RNFAs must demonstrate ongoing commitment to professional development. This involves completing a specified number of continuing education hours and providing evidence of continued clinical practice in the first assistant role.
Distinguishing the RNFA from Other Perioperative Roles
The RNFA occupies a unique position within the operating room team, differentiated by the authority to perform invasive, hands-on tasks at the surgical site. Other perioperative nurses, such as the Circulating Nurse and the Scrub Nurse, focus on managing the environment and instruments rather than directly assisting the surgeon’s technique. The Circulating Nurse manages patient care outside the sterile field, oversees documentation, ensures proper equipment is available, and coordinates the flow of the room.
The Scrub Nurse works within the sterile field, managing the instruments and supplies used during the operation. While the Scrub Nurse hands instruments to the surgeon, their scope of practice does not include performing surgical techniques like suturing, tissue manipulation, or providing hemostasis. The RNFA is the only registered nurse with the advanced training and credentialing to perform these technical, intra-operative functions alongside the surgeon.
Career Outlook and Work Settings
The career outlook for Registered Nurse First Assistants remains positive, with a sustained demand for their specialized skills in surgical environments. The growth in surgical procedures, particularly in outpatient settings, contributes to this ongoing need. This advanced role frequently correlates with higher compensation, with RNFAs earning a salary that exceeds the average for general registered nurses.
RNFAs find employment in a variety of healthcare settings where surgical procedures are performed. These include large hospital operating rooms, trauma centers, and academic medical centers that handle complex cases. Many RNFAs also work in ambulatory surgery centers and private surgical practices. Professional growth often involves specializing in a particular surgical area or moving into leadership roles, such as surgical education or departmental coordination.