What Is An RNFA?

A registered nurse first assistant (RNFA) is an RN or advanced practice RN who works in an expanded role as a surgical first assistant. You assist the surgeon directly during the operation, working as part of the surgical team.

Plan on 6 to 8 years to reach this role. RN job growth sits at 5% from 2024 to 2034, and RNFAs often earn a six figure salary. They can practice in all 50 states. Teaching hospitals usually fill the role with surgical residents and fellows, so most RNFA jobs are in community and outpatient settings.

If you like working in surgery, here is what RNFAs do, where they work, and how to become one.

What Does an RNFA Do?

An RNFA collaborates with the surgeon for the best patient outcome, drawing on added training in surgical technique, judgment, and assessment. You work across all three phases of surgery: preoperative, intraoperative, and postoperative. That means collecting patient data, monitoring blood loss, protecting against contamination, and assessing wound healing.

During the procedure you coordinate perioperative care while cutting, dissecting, or suturing under the surgeon's direction. The goal is to keep the surgeon efficient and shorten time in surgery.

Core responsibilities include assessing the patient before, during, and after surgery; building perioperative and discharge care plans; monitoring wound exposure; using instruments to control bleeding and suture; and handling postoperative dressing changes and suture removal.

The work is high stress, fast paced, and physically demanding. It rewards strong communication and attention to detail.

Where Do RNFAs Work?

RNFAs work where patients are in or recovering from surgery. Most states do not allow an RNFA to also function as a scrub nurse in the operating room. Expect long hours on your feet, often standing in one spot beside the surgeon, which strains the lower back and legs.

In surgery centers, which schedule outpatient procedures with no overnight stays, RNFAs often take on an expanded role: preoperative education for the patient and family, intraoperative assistance, and postoperative discharge teaching.

Inside the operating room, an RNFA provides surgical site exposure, handles or cuts tissue, sutures, and manages hemostasis and wound closure. They may also prep the surgical tools and supplies.

In postoperative care units, RNFAs educate patients and families on wound care and postsurgical recovery, and run assessments to catch complications early.

How to Become an RNFA

Start by graduating from an accredited nursing program and passing the NCLEX-RN, which every state requires for licensure. Remaining license requirements vary by state board of nursing.

You need at least a BSN to be eligible for an RNFA program. Nurses with an ADN can complete an RN-to-BSN program, online or in person. APRNs with perioperative experience can also enter an RNFA program, offered through nursing schools or the National Institute of First Assisting.

To qualify, you need a current unrestricted RN license, two years of perioperative experience, and the Certified Nurse Operating Room (CNOR) credential. Some programs let you earn the CNOR during the program. The Association of periOperative Registered Nurses (AORN) must approve the program. After completing it, you sit for the certification exam from the National Assistant at Surgery Certification board. Pass it and you can use the CRNFA designation.

How Much Do RNFAs Make?

Per November 2025 Payscale data, the average base salary for a small sample of RNFAs is $125,000 a year, or about $43.20 an hour. Roughly 94% of respondents were female.

Pay rises with advanced education such as an APRN credential, additional surgical certifications, and years of experience. Changing practice setting or location can also move your number.

Frequently Asked Questions About RNFAs

How long does it take? A BSN takes up to four years. Add two years of perioperative experience before an RNFA program, plus time to study for the certification exam, and you are looking at up to seven years total.

How is an RNFA different from a perioperative nurse? A perioperative nurse helps with paperwork, monitors the patient before and after surgery, and maintains instruments. An RNFA does those things too, but also works side by side with the surgeon, assists with incisions and suturing, and helps control bleeding.

Can an RNFA operate independently? No. An RNFA assists with dissection and suturing only under the surgeon's supervision.

Is the role recognized everywhere? Yes. All 50 states recognize the RNFA within the RN scope of practice. An RNFA can be BSN prepared or an APRN.