How to Become a Registered Nurse First Assistant (RNFA)
Registered nurse first assistants (RNFAs) are perioperative nurses who play a significant role in aiding surgeons in the operating room. Read this guide to learn what it takes to join this elite nursing specialty, including schooling, certifications, and salary expectations.
Registered Nurse First Assistant (RNFA) Fast Facts
6% Growth 2022-2032
What is an RNFA?
An RNFA is a perioperative registered nurse who functions as a first assistant during surgical operations. They collaborate with the surgeon and healthcare team members to improve patient outcomes.
The Association of periOperative Registered Nurses (AORN) notes that RNFAs practice intraoperatively at a surgeon's direction while not concurrently functioning as scrub nurses.
RNFAs must earn additional education and credentials that certify their ability to perform in this expanded role. To become an RNFA, you'll take advanced coursework, earn certifications, and undergo an extensive training process.
What Does an RNFA do?
RNFA roles and responsibilities vary depending on their workplace and the surgeons they work with. An RNFA nurse performs preoperative, intraoperative, and postoperative care beyond the scope of an OR nurse. Working at the immediate direction of the surgeon, an RNFA helps develop treatment plans, perform advanced intraoperative tasks, and assist in post-op management.
RNFAs and scrub nurses perform similar tasks, but the real difference is an RNFA's increased abilities in the operating room. Some advanced intraoperative RNFA duties include the following:
- Using instruments and medical devices
- Providing surgical site exposure
- Handling and/or cutting tissue
- Providing hemostasis
- Wound management
Registered Nurse First Assistant (RNFA) Salary
The average annual RNFA salary is $110,000 or $40.22 per hour, as reported by Payscale in August 2023. Similarly, a report by ZipRecruiter in January 2024 found that RNFAs earn $113,214 per year or $54 per hour in the United States.
These reports suggest that RNFAs earn far more than the average for all registered nurses, which is $81,220 annually per the BLS.
Highest-Paying RNFA States
Source: ZipRecruiter, Extracted Feb 1, 2024
Highest Paying RNFA Cities
|Santa Cruz, CA
|St. Helens, OR
Source: ZipRecruiter, Extracted Feb 1, 2024
RNFA Salary Considerations
Some RNFA jobs pay an hourly wage, while others pay an annual salary. Those who work hourly jobs have the opportunity to accrue overtime, which can increase their annual income. Salary workers may be able to negotiate overtime but don't always get it.
Additionally, salary is just one of several factors to consider when deciding on a job. The full compensation package includes non-monetary benefits that may be just as important as the pay itself. The benefits you receive will vary from employer to employer but may include the following:
- Health, dental, and vision insurance
- Retirement plans
- Maternity and paternity leave
- Paid time off and paid holidays
- AORN membership benefits
- Tuition reimbursement
- Attendance at nursing conferences
How to Become an RNFA
The total time it takes to become a registered nurse first assistant ranges from six to nine years. This timeline includes your initial education and registered nursing licensure, two years of relevant experience, an RNFA program, and certification.
The following is a detailed breakdown of what it takes to become an RNFA:
1. Become a Registered Nurse
Becoming an RNFA starts with earning your registered nursing license. You can achieve this milestone by attending an accredited Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) program. Then, you'll sit the National Council Licensure Examination for RNs (NCLEX -RN) to earn your registered nursing license.
Several RNFA programs require a bachelor's degree in any field, making it easier for ADN-RNs with previous degrees to become eligible. Others may need to take additional coursework to earn a bachelor's or attend an RN to BSN program before applying to an RNFA program.
2. Gain Experience & Perioperative Nursing Certifications
On-the-job training programs will get your foot in the door of surgical nursing. From there, you'll build the foundation of knowledge necessary to become an RNFA, earning hands-on experience completing pre-, intra-, and post-surgical tasks.
RNFA programs require at least two years of this vital and relevant nursing experience. It will also qualify you for the Certified Perioperative Nurse (CNOR) exam, which is a required credential for most RNFA schools.
3. Attend an RNFA Program
RNFA schooling builds upon the basic fundamentals and focuses on surgical anatomy, procedures, and techniques. These programs vary in length from one to three years, with different course requirements at each institution. To get into most RNFA programs, you'll need at least:
- An active and unencumbered RN license
- Two years of perioperative nursing experience
- The CNOR designation
Most importantly, you should ensure the program you select is approved by the AORN. You can view a list of approved programs here.
4. Earn RNFA Certifications
You can work as an RNFA without a certification. However, earning one affirms your education and professional achievements and endorses your dedication to patient safety and care. The National Assistant at Surgery Certification (NASC) is the certifying body for RNFAs and offers two credentials.
RNAS-C is a lower-level certification for newer RNFAs. This certification does not require a bachelor's degree but does require at least 120 practice hours, the CNOR designation, and current RN licensure. Learn more about RNAS-C requirements here.
CRNFA is an advanced credential for experienced RNFAs. To become a CRNFA, you need a bachelor's degree, current RN licensure, CNOR designation, and at least 2,000 RNFA practice hours. You can find other certification requirements here.
As a CRNFA, you'll be a more competitive job candidate and have more leverage in salary negotiations. So, while the certification isn't necessary, it's highly valuable and recommended.
Top 10 Registered Nurse First Assistant Programs
Because individual nursing pathways and careers take various forms, the top 10 registered nurse first assistant programs are ranked in no particular order.
- NCLEX pass rate
- Acceptance rate
- AORN approval
- Online availability
- Tracy Everhart, MSN, RN, CNS
- Tyler Faust, MSN, RN
- Kathleen Gaines, MSN, BSN, RN, BA, CBC
Where Can RNFAs Work?
As a registered nurse first assistant, you can work at any surgical facility. These include hospitals, surgery centers, plastic surgery centers, and more. Dental offices, delivery rooms, and postoperative care units also benefit from an RNFA's skillset.
Notably, academic teaching hospitals do not regularly use RNFAs due to the presence of surgical residents and fellows.
RNFA Career Outlook
From 2022 to 2032, the registered nursing field will grow at a rate of 6%, according to the BLS, which is twice the average for all occupations. This figure includes perioperative nurses like RNFAs, showing a promising outlook for this specialty.
Other factors that indicate a growing need for RNFAs include the increasing number of same-day surgery centers and more medical and surgical organizations recognizing RNFA roles. These organizations include the following:
- American College of Surgeons
- 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
- Congress of Neurological Surgeons
- Society for Surgical Oncology
- Society for Vascular Surgery
- Society of American Gastrointestinal Endoscopic Surgeons
- The Society of Thoracic Surgeons
Where to Learn More About Becoming an RNFA
Whether you're just beginning your nursing journey or already have some experience under your belt, becoming an RNFA is within your reach. Browse the following resources to learn more about joining this exciting and vital career field.
- For RNFA Program Information: Association of periOperative Registered Nurses
- For CNOR Certification: Competency and Credentialing Institute
- For RNAS-C and CRNFA Certification: National Assistant at Surgery Certification
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