How Much Do RNFAs Make?

Registered nurse first assistants (RNFAs) work directly with surgeons during operations, applying specialized training to take on more responsibility than scrub nurses and other perioperative nurses. Growing demand for surgical care, along with the rise of outpatient clinics and same-day procedures, has pushed RNFA pay and opportunities up. Here is what RNFAs earn, where they earn the most, and how to raise your pay.

Average Salary for RNFAs

As of August 2022 data from Salary.com, the median RNFA salary in the United States is $104,948, with earnings ranging from $88,090 to $122,855. Payscale put the average closer to $125,000 a year, or about $43.20 an hour, in October 2025.

Like all RN pay, earnings vary by education, certification, employer, and experience. RNFAs in higher cost-of-living states earn more, and those with more years on the job command the top of the range. Because of their broader scope and specialized training, RNFAs typically out-earn other operating room RNs. A general staff nurse, for comparison, averaged $83,503 a year as of Salary.com's October 2025 data.

The Highest-Paying States for RNFAs

The U.S. Bureau of Labor Statistics (BLS) does not break out RNFA pay, but its state estimates for all RNs reflect the ranges RNFAs fall into. As of May 2024, RNs earn a median annual wage of $93,600, from $66,030 at the bottom 10% to more than $135,320 at the top 10%. Since RNFAs enter the field with specialized certification and at least two years of perioperative experience, they can expect to land above that average.

Location drives a lot of the difference. The BLS ranks California, Hawaii, Oregon, Washington, and Massachusetts as the top-paying states for RNs, and California holds the ten highest-paying metro areas in the country, with salaries well above the national average. Pay also tracks cost of living: RNs in Alabama average under $74,970, but living expenses there run far below the top-paying states.

Highest-Paying States

State	Average Salary
California	$148,330
Hawaii	$123,720
Oregon	$120,470
Washington	$115,740
Massachusetts	$112,610

Source: U.S. Bureau of Labor Statistics (May 2024)

Four Ways to Increase Pay as an RNFA

Earning an advanced degree, adding a specialized certification, moving into administration, or changing practice settings all open doors to higher pay.

Pursue Certifications

RNFAs must hold the certified nurse operating room (CNOR) credential to practice. According to the Association of periOperative Registered Nurses, CNORs earn on average $1,700 more per year than other RNs. Beyond the CNOR, the certified registered nurse first assistant (CRNFA) credential is recommended for nurses who assist in surgery and perform pre- and postoperative assessments.

Raise Your Education Level

RNs start with a nursing diploma, an associate degree, or a BSN before entering perioperative roles. The CRNFA certification requires a BSN and two years of perioperative experience. RNFAs who go on to earn a master of science in nursing (MSN) and become advanced practice nurses earn considerably more. Nurse practitioners, who typically hold at least an MSN, earn a median of $129,210 a year, almost $36,000 more than the RN median.

Move into Administrative Roles

RNFAs looking to advance can step into management, running surgical care programs and budgets, training staff, and precepting nursing students. The certified surgical services manager credential prepares perioperative nurses for roles like administrative team leader, director of surgical services, and surgery support coordinator.

Change Practice Settings or Travel

Switching settings or taking temporary travel assignments can boost earnings. Large health systems, hospitals, and surgical centers in major cities tend to pay more. Demand in understaffed and underserved areas has also driven up pay for specialized travel nurses, who often earn above-average salaries plus added benefits.

How RNFA Pay Compares to Other Nurses

Generalist RNs lack the training to assist surgeons in the operating room, so they earn less than RNFAs. Among surgical and operating room nurses, RNFAs carry mandatory certification and extra training beyond basic perioperative experience, which is why they out-earn scrub nurses and circulating nurses. Roles with comparable pay include postanesthesia care unit nurses, certified ambulatory surgery nurses, and advanced practice nurses in high-demand specialties like critical care and gerontology.

What Kind of Salary Growth Can RNFAs Expect?

Pay for all RNs depends on education, certification, and the type and location of employer. RNFA ranges vary by perioperative experience, clinical focus, and degree. Broadly, nursing shortages and retirements, the surgical needs of an aging population, and the growth of outpatient and same-day surgery all drive demand for RNFAs and keep their pay competitive.

Frequently Asked Questions About RNFA Salaries

What does an RNFA do? Duties vary by facility, but RNFAs always practice under a surgeon's supervision. They work with the surgical team, provide care before, during, and after surgery, administer medications, and prepare surgical tools. They also perform procedures such as suturing and wound management and complete postsurgery assessments.

Where do RNFAs work? Most work in hospitals, ambulatory surgical centers, and other outpatient facilities. Some practice in plastic surgery centers, ophthalmology clinics, dental offices, and any setting that performs surgery.

How much do RNFAs make? Because they enter the field with certification and specialized experience, RNFAs earn above the average RN. Salary.com put the range at $84,040 for the lowest 10% to $125,120 for the top 10% as of August 2022.

What does it take to become one? After earning a nursing degree and passing the licensure exam, prospective RNFAs need at least two years of perioperative experience before applying for the CNOR certification, which is required to practice. Some facilities set additional requirements.