The Registered Nurse First Assistant (RNFA) is a highly valuable perioperative nurse who works closely with the entire surgical team. Having completed advanced training, education, and certification, the RNFA practices as an assistant under the surgeon’s direction. For nurses fascinated by the intraoperative process and the ability to have a major impact on patients’ surgical outcomes, being an RNFA may be an excellent career choice. In this guide, readers can discover what an RNFA is, and how to become a RNFA, including details about certifications, education, and what it’s like to work in this advanced nursing role.
How Long to Become
Clinical Nurse – Operating Room (CNOR)RNFA
With the exception of RNFAs practicing prior to January 1, 2020
What is an RNFA?
The Registered Nurse First Assistant is a highly trained perioperative registered nurse (RN) or advanced practice registered nurse (APRN) with the expertise to be the first assistant to the surgeon during procedures.
The RNFA can play a vital role in the preoperative, intraoperative, and postoperative phases of the surgical process.
RNFAs can go beyond the standard scope of RN practice, due to the advanced training and certification involved in preparing for this high-level perioperative position.
According to an important position statement by the Association of periOperative Nurses (AORN), the RNFA “works in collaboration with the surgeon and other healthcare team members to achieve optimal patient outcomes; has acquired the necessary knowledge, judgment, and skills specific to the expanded role of RNFA clinical practice, [and] intraoperatively practices at the direction of the surgeon.”The scope of duties for an RNFA may include:
- Preparing patients for surgery
- Administering medications
- Monitoring vital signs
- Handling and using surgical devices
- Draping surgical site and maintaining sterile field
- Performing incisions
- Suturing incisions
- Taking part in post-op rounds
- Caring for surgical wounds
- Achieving hemostasis through the controlling of incisional bleeding
- Educating patients and their families
- Postoperative incision assessment and care
Some hospitals do not have RNFAs, preferring to have two surgeons in the operating room. However, the RNFA can be a key perioperative team member in many acute care hospitals.
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Steps to Becoming an RFNA
For those nurses who wonder how to become an RNFA, the process is intensive. Ambitious nurses focused on gaining expertise can achieve certification.. For CRNFA credentials, both the National Assistant at Surgery Certification (NASC) and the Association of periOperative Registered Nurses (AORN) lay out their own requirements. Under NASC, the RN requirements are:
- Working a minimum 2,000 hours as an RNFA
- Earning a bachelor’s degree (or higher) in any field
- Holding current CNOR certification
- Maintaining an unrestricted RN license
- Completing a program that meets AORN standards
In addition to the above, NASC requirements for APRNs involve completing a certified APRN program before applying.
Under AORN, there are separate requirements for RNs and APRNs:
Requirements for RNs
- A BSN degree (with the exception of RNFAs practicing prior to January 1, 2020, who are allowed to have an ADN degree)
- Current unrestricted RN licensure
- Passing the NCLEX and becoming licensed as an RN
- Achieving basic life support (BLS) certification, bearing in mind that some employers require RNFAs to be certified in advanced cardiac life support (ACLS)
- Earning CNOR (Clinical Nurse – Operating Room) certification
- Completion of an accredited RNFA program that meets AORN standards
- A minimum of 2,000 hours of documented practice as an RNFA
Requirements for APRNs
- Earning APRN certification by an accredited program;
- Holding current, unrestricted RN licensure
- Completing an accredited RNFA program that meets AORN standards education
- Obtaining a minimum of 2,000 documented hours of practice as an RNFA
Earn an ADN or BSN Degree From an Accredited Program
Community colleges often offer an associate degree in nursing (ADN) program. This entry-level nursing degree is two years long, although it may take longer without first completing prerequisite courses. Note: as of January 1, 2020, nurses earning an ADN must complete a BSN degree program in order to apply for certification and practice as an RNFA.
A bachelor of science in nursing (BSN) is a 4-year degree program.
Nurses with an ADN can enroll in an RN-to-BSN program. These degree tracks are between 9-24 months, with many programs geared towards the working nurse.
Those with a bachelor’s in a non-nursing field can complete an accelerated BSN program, an entry-level degree track where previous credits can transfer. Accelerated programs are an intensive course of study over 11-18 months.
Pass the NCLEX Exam to Receive RN Licensure
All ADN and BSN students must pass the National Council Licensure Examination (NCLEX) to earn their nursing practice license. Most recently graduated nurses take the exam within one month of graduation.
The NCLEX-RN exam is for ADN and BSN graduates, while the NCLEX-PN exam is for those who have graduated from a practical nurse certificate program. Approximately 79.9% of first-time candidates passed the NCLEX-RN in 2022.
Gain Experience in Surgical Nursing
Many employers may require a nurse interested in a perioperative position to have at least 1-2 years of experience in med-surg or other acute care settings.
Some nurses may find a position in the OR directly out of school, and a small number of new graduates will find a position in a new graduate perioperative residency program.Nurses with several years of acute care experience can dedicate themselves to finding a job in the perioperative setting.
Become a Certified Nurse, Operating Room (CNOR) or APRN
RNFA prerequisites require perioperative experience as either a CNOR or APRN.
RNs with an unrestricted license and at least two years of experience in a perioperative setting may take the national certification exam from The Competency & Credentialing Institute (CCI) to become a CNOR.
RNs who choose to earn their MSN can become APRNs. Most MSN programs take around two years to complete. APRNs need to complete an assessment from a program instructor. The assessment includes competency in preoperative and postoperative care.
Complete an Association of Perioperative Registered Nurses (AORN) Approved RNFA Program
RNs can validate their knowledge and experience by earning specialty board certification as an RNFA.
RNs must first complete an AORN approved RNFA program. Nurses have two years to complete the program but many APRNs graduate in as early as 5-8 months.
All RNFAs must be registered nurses with a BSN (with the exception of those certified prior to January 1, 2020). According to the 2013 AORN Standards for RN First Assistant Education Programs, all candidates for RNFA certification must complete six semester credits of post-RN education. These credits must be accredited university-awarded at the undergraduate or graduate level.
These programs must include:
- Didactic education (with specific requirements outlined in detail by the AORN)
- Clinical training of at least three credit hours (with specific requirements outlined in detail by the AORN)
ADN programs are common at community college. This degree fulfills the minimum eligibility to sit for the NCLEX and earn RN licensure. Completing an ADN takes around two years, although completing prerequisites can lengthen the process for some students.
High school diploma or GED certificate with 2.5 GPA; completed application with transcripts; 2.5 college GPA (if previous college experience); HESI Exam Exam (scored subtests: math, reading comprehension, vocabulary and general knowledge, grammar).
Clinical assignments, nursing care, pathophysiology, physical assessment, psychosocial assessment
Nursing assessment, critical thinking, nursing process, hands-on patient care, psycho-emotional and psychosocial assessment
A BSN degree is an important step towards becoming an RNFA. A traditional BSN program consists of English, math, and other general education courses; prerequisites (e.g.: microbiology, anatomy and physiology), and 2-3 years of lecture-based education and clinical hands-on training. A BSN is often considered the minimum degree required to pursue a master’s degree in nursing.
Many hospital employers require all nurse candidates to hold a BSN, so earning this degree is a smart career move for most nurses interested in the acute care setting.
2.5-3.0 GPA; college and high school transcripts; completed application, often with personal essay; successfully completed prerequisites; SAT or ACT scores; CV or resume
Clinical assignments, nursing care, pathophysiology, physical assessment, management and supervision, delegation, community health, population health, evaluation of scientific research
Nursing assessment, critical thinking, nursing process, hands-on patient care, psycho-emotional and psychosocial assessment, management and supervision, delegation, community health assessment, evaluation of research
A master’s degree in nursing expands nurses’ career potential. The MSN is the minimum requirement to become an APRN, and suits nurses seeking increased specialization, autonomy, and clinical responsibility.
BSN degree, unless enrolled in an RN-to-MSN bridge program
Advanced pharmacology and pathophysiology; legal and ethical issues in nursing; theory and research; advanced physical assessment; diverse populations; practicum or capstone experience 2-3 years Depending on the educational track, may include advanced physical assessment, management of nurses and direct reports, research, advanced pharmacology, diagnosis and treatment of common disease processes
Time to Complete
Depending on the educational track, may include advanced physical assessment, management of nurses and direct reports, research, advanced pharmacology, diagnosis and treatment of common disease processes
There are several reliable resources to help nurses find an appropriate and approved RNFA program.
According to the NASC list of acceptable RNFA programs, no program is affiliated with NASC, and each will have its own eligibility requirements.
NASC lists programs in Alabama, California, Colorado, Florida, Kentucky, Massachusetts, Missouri, New York, North Carolina, Ohio, Pennsylvania, and Tennessee.
Each candidate applying for CRNFA certification through NASC must submit a copy of a certificate of completion of an acceptable RNFA program.
AORN links the accepted programs in their RNFA resources, and provides an RNFA program checklist, and the AORN position statement on RNFAs.
RNFA Licensure and Certification
Both RNs and APRNs can serve as RNFAs, depending on the requirements of the employing institution. An active RN license is required to practice as an RNFA. Maintaining RN licensure is based on the continuing education (CE) requirements of the state where a nurse lives and works. Successful completion of 30 hours of CE every two years is common in many states. According to the previously mentioned RNFA position statement by the AORN, qualifications for serving as an RNFA include:
- Certification as a perioperative nurse (CNOR)
- Completion of an RNFA program that meets the “AORN standards for RN first assistant education programs”
- Compliance with institutional and state regulations, statutes, and policies
- BSN degree, with the exception of RNFAs practicing prior to January 1, 2020
- Completion of AORN requirements of six hours of post-RN RNFA education provided by an accredited school of nursing. This includes three credits of didactic and three credits of clinical RNFA training as outlined by the AORN
Sitting for the CNOR (Certified Nurse – Operating Room) exam and earning the CNOR credential is achieved by fulfilling the following requirements:
- Having an unrestricted RN license
- Currently working full time or part time in perioperative clinical practice, education, or research
- Completing a minimum of two years and 2,400 hours in perioperative nursing practice, with at least 1,200 hours in the intraoperative setting
Certification as an RNFA is required for clinical practice.
Working as an RNFA
Following the completion of education, training, and certification, successfully finding a position as an RNFA will be dependent on many factors:
- Quality of resume/CV and cover letter
- Years of experience
- Professional recommendations
- Evaluation of the RNFA job market in the nurse’s specific geographic area
- Networking and job-hunting skills
- Interview and negotiation skills
Since RNFAs are intraoperative nursing professionals, employment will be found in acute care hospital facilities.
Frequently Asked Questions About Becoming an RNFA
How many years does it take to become an RNFA?
In order to become an RNFA, you must earn a BSN, complete a minimum of two years and 2,400 hours in perioperative nursing practice in order to become CNOR certified, and receive six credits of post-RN accredited RNFA training. This process may take between 6-7 years.
What is the quickest way to become an RNFA?
The quickest way to become an RNFA is outlined in the previous response.
How hard is it to become an RNFA?
Becoming an RNFA is a challenging process involving a basic BSN program followed by the accumulation of considerable perioperative experience and several certifications (CNOR and RNFA). This process is intensive yet doable for the ambitious nurse with keen interest in achieving the RNFA credential.
Do RFNAs get paid well?
According to January 2023 Salary.com data, RNFAs earn a competitive median salary of around $100,000 per year. Wages may vary per state.
Page last reviewed January 26, 2023