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Registered Nurse First Assistant (RNFA) Career Guide


A Registered Nurse First Assistant, or RNFA, is a perioperative registered nurse that assists surgeons during their procedures.

An RNFA, according to the Association of periOperative Registered Nurses (AORN), is defined as:

  • collaborates with the surgeon and other members of the healthcare team to obtain the best possible results for patients;

  • has gained the requisite information, judgment, and abilities for RNFA clinical practice's enhanced position;

  • intraoperatively, under the surgeon's supervision; and

  • does not work as a scrub person at the same time

The aforementioned definition is the gold standard by which RNFAs operate, allowing them to practice outside of their typical scope of practice. To be a First Assistant, you must complete advanced curriculum, extra certifications, and orientation.


Tasks and Responsibilities

The RNFA's duty will differ depending on the surgical facility as well as the physician. Due to the presence of surgical residents and fellows, many academic teaching institutions do not employ RNFAs on a regular basis. A First Assistant can undertake responsibilities throughout preoperative, intraoperative, and postoperative care after getting credentialing. These nurses can aid in the development of treatment regimens in collaboration with the main surgeons, as well as postoperative management. While nurses may typically accomplish identical activities, their genuine talents in the operating room are what set them apart.

  • Instruments and medical gadgets are used.

  • Providing exposure to the surgical site

  • Tissue handling and/or cutting

  • Maintaining hemostasis

  • Suturing

  • Management of wounds



The typical RNFA compensation is $98,000 per year, according to Unfortunately, due to the specialized nature of this area, pay information is scarce. Salary numbers are provided by the US Bureau of Labor Statistics for all registered nurses together, rather than for specific specialty. The median average yearly wage in May 2020 was $75,330.

Highest Paying States for Nurses

Most health-care systems pay nurses on an hourly basis, whereas others, such as nurses at a free-standing surgical facility, are paid a fixed yearly income. Hourly employees can receive overtime compensation, however salaried staff would have to debate it with the hiring committee.

In general, compensation is related to the cost of living in a particular location. For example, regardless of expertise, nurses in Oklahoma earn much less than their colleagues on the west coast. Despite the fact that they have the same job title, the cost of living in California is substantially higher, resulting in higher salary.

Earning potential grows with increased education and experience, as it does with other careers in the nursing sector. Nurses are usually given a raise every year.

Full-time and part-time RNFAs get equal perks regardless of their employment environment. While real advantages differ by institution, the following are the most common:

  • Health insurance

  • Retirement Options

  • Family Leave of Absence

  • Maternity Leave

  • Dental Insurance

  • Vision Insurance

  • Discounts

  • AORN membership benefits

  • Tuition Reimbursement

  • Attendance at nursing conferences


How to Become a Registered Nurse First Assistant

Step 1: To become an RNFA, a nurse must first have extensive perioperative experience, since this advanced training builds on the foundations and emphasizes surgical anatomy, procedures, and methods. In terms of credit hours required to work as an RNFA, courses differ across the country. Prerequisites differ by institution, but commonly include:

  • Active RN license

  • At least two years of perioperative nursing experience

  • Certified Nurse Operating Room (CNOR) designation, offered by the Competency and Credentialing Institute (CCI)

The AORN must approve the program, regardless of which one is picked. A list of authorized programs may be found here. Individuals should aim toward certification after successfully completing the RNFA courses. It's critical to understand the distinction between an RNFA and a CRNFA.

Step 2: A nurse must have a CNOR certification, a valid and unencumbered RN license, a bachelor's degree, and 2,000 hours of experience working as an RNFA to become a certified RNFA.


10 Best RNFA Programs

In-State Program Tuition: $1,500 Out-of-State Program Tuition: $2,250

Online: Hybrid

Program Length: 2 semesters

The RNFA program at Delaware County Community College is located in the township of Marple, just outside of Philadelphia. The two needed courses are spread across two semesters in this six-credit program that blends online and in-person instruction. A five-day visit to school is required for the first semester course, and the remainder is performed online. The second semester course is an independent internship that the student can finish wherever they desire. Nurses can complete their internship faster and graduate after it is completed.

Program Tuition: Up to $5171.25

NIFA, a Colorado-based nonprofit dedicated only to first-aid education, offers one of the more complete RNFA programs. NIFA, the nation's biggest RNFA program, teaches nurses fundamental RNFA skills and standards in three- and five-day programs. After that, nurses must undergo an internship to complete the degree. Any graduates who believe they haven't grasped the material can retake the course for free. Although the curriculum can take up to two years to complete, most students complete it in 5-8 months.

In-State Program Tuition: $2,478

Out-of-State Program Tuition: $4,968 AND $1,650 due to St. Elizabeth Healthcare

St. Elizabeth Healthcare is a local leader in medical services, located in Edgewood, Kentucky. The RNFA curriculum at the healthcare facility, which is conducted in collaboration with Northern Kentucky University, starts with a five-day hands-on experience in Northern Kentucky. Following that, students undergo a minimum of 130-hour clinical internship. Students get six NKU college credits and a certificate of accomplishment upon completion of the program. A large number of students complete this program in just one semester.

Program Tuition: $4,019

Gulf Coast State College, in Panama City, Florida, is designed primarily for registered nurses who wish to enter the surgical department quickly. Gulf Coast's curriculum, like other RNFA programs, combines online and on-campus coursework and takes two semesters to complete. Students can finish their clinicals in their hometown or obtain on-site clinical experience in Florida. This program's graduates have a 100% RNFA job placement rate.

Program Cost: $4,000

The University of Rochester's RNFA program, designed for APRNS or certified operating room nurses (CNOR), has certain stringent entry criteria. The institution, on the other hand, allows students to complete the curriculum in their own way. For starters, students take online courses that work around the schedules of nurses. The nurses then go to an in-person lab day. Finally, students must complete a 50-hour internship in the state where their RN license is issued. Most nurses study part-time over the program's two semesters.

In-State Program Tuition: $4,195.50

Out-of-State Program Tuition: $4,429.50

The University of Tennessee's RNFA program, which is open to both RNs and APRNs, consists of three courses spread out over a year. Except for a 40-hour on-campus workshop during the first course, which is completed between the fall and spring semesters, the first two courses are entirely online. The third course needs 180 hours of clinical practice in perioperative medicine. Students do their internships in their home state or at the University of Tennessee's Memphis campus, as is the case with most programs.

Program Tuition: $4,650

The RNFA program at the University of Massachusetts is run in partnership with UMass Chan Medical School and is available to BSN-prepared RNs with a CNOR, advanced practice nurses, and students enrolled in an advanced practice graduate program. There are two courses that are necessary. The first course employs a hybrid approach, with three live courses in Worcester, Massachusetts on Saturdays. The second course is effectively an internship that requires students to complete 270 hours of precepted practice, allowing nurses to obtain clinical experience. While most students may complete this program in two semesters, some students may require more time for their internship.

Program Tuition: $5,904

The University of Alabama at Birmingham, unlike other RNFA programs, provides its RNFA option as an MSN speciality; nevertheless, BSN-prepared nurses must hold their CNOR at the time of application. Three courses are required for the RNFA specialization, one of which is solely clinical experience. This program is only available in the autumn semester.

Program Tuition: $5,500

Current RNs and APRNs can enroll in the RNFA program at the University of California, Los Angeles. The curriculum begins with a UCLA-led six-day, 52-hour course. The following step is for students to complete a 120-hour independent preceptorship. Students must, however, arrange their own preceptorships, which UCLA establishes during the program's first course. Any APRN with less than two years of operating room experience can enroll in a one-day workshop to prepare for the RNFA.

In-State Program Cost: $1,314

Out-of-State TuitionTuition: $2,304

St. Charles Community College in Cottleville, Missouri, begins its six-credit RNFA program with six days of on-campus study. Following that, students must do a three-credit internship to get clinical experience. This internship must last at least 120 hours, however students can do it anywhere they like. It's worth noting that St. Charles Community College only admits BSN graduates.



The need for RNFAs will continue to rise as a growing number of same-day surgical clinics operate across the country. Furthermore, a growing number of medical and surgical organizations recognize the RNFA's position and significance. The following are a handful of these organizations:

  • American College of Surgeons

  • American Academy of Ophthalmology

  • American Academy of Orthopaedic Surgeons

  • American Academy of Otolaryngology–Head and Neck Surgery

  • American Association of Neurological Surgeons

  • American Pediatric Surgical Association

  • American Society of Colon and Rectal Surgeons

  • American Society of Plastic Surgeons

  • American Society of Transplant Surgeons

  • American Urological Association

  • Congress of Neurological Surgeons

  • Society for Surgical Oncology

  • Society for Vascular Surgery

  • Society of American Gastrointestinal Endoscopic Surgeons

  • The American College of Obstetricians and Gynecologists

  • The Society of Thoracic Surgeons

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