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How do I become a Registered Nurse First Assistant (RNFA)?

What is a Registered Nurse First Assistant (RNFA)?

A registered nurse first assistant (RNFA) is a perioperative registered nurse (RN) who functions as the first assistant to the surgeon during surgery (the intraoperative phase). Duties during the intraoperative phase include: using instruments and medical devices, providing surgical site exposure, handling and/or cutting tissue, providing hemostasis, suturing, and wound management. The RNFA role also includes practicing in the preoperative and postoperative areas and fostering patient advocacy and patient safety (AORN, 2014, AORN position Statement on Advanced Practice Registered Nurses in the Perioperative Environment).

What training is required for a Registered Nurse First Assistant (RNFA)?

A Registered Nurse (RN) or an Advanced Practice Nurse (APRN*) must complete an RNFA program that follows the AORN standards for RN First Assistant education programs. You can find the Education Standards and other useful RNFA information on the AORN website.

Who can apply for RNFA training?

Admissions requirements vary by the program that you choose to attend. To see a list of acceptable RNFA programs, click here. Please contact each program for specific admissions requirements.  In general, the following is required to begin RNFA training:

  1. An APRN* can enter RNFA training with no perioperative experience.
  2. An RN must be CNOR-eligible to enroll in an RNFA program, and must earn CNOR before graduation. You can find more information on CNOR on the CCI website. CNOR requires at least two years of experience in perioperative nursing.
  3. As of January 1, 2020 a bachelor’s degree is required for admission to an RNFA program.

How long is the RNFA program?

The scope of RNFA training varies by program. Please see our list of Acceptable RNFA programs, and contact each program for specific information.

In general, an RNFA program will include:

  1. A didactic component that is an equivalent to at least three semester credit hours of study, including student assignments, classroom instruction, and laboratory practicums.
  2. A clinical component that includes at least 120 clinical practice hours in the RNFA role, as well as additional hours of preoperative and postoperative patient care management, working with a board-certified surgeon.

For details: See the AORN’s Educational Standards for RNFA Programs.

*An APRN (Advanced Practice Registered Nurse) is an RN who has earned a graduate-level degree such as a Master’s of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP). APRNs include Nurse Practitioners (NP), Clinical Nurse Specialists (CNS), Nurse Anesthetists (CRNA), and Certified Nurse Midwives (CNM).

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