RNFA Education Requirements: A Comprehensive Guide
An RNFA, or Registered Nurse First Assistant, is a highly skilled and experienced perioperative registered nurse who plays a crucial role in surgical operations. Functioning as the first assistant to the surgeon, the RNFA provides comprehensive care to patients throughout the preoperative, intraoperative, and postoperative phases. This expanded role necessitates additional education and credentials to certify their competence and expertise.
What is an RNFA? Defining the Role
The Association of PeriOperative Registered Nurses (AORN) defines the RNFA as a perioperative registered nurse who works in collaboration with the surgeon and health care team members to achieve optimal patient outcomes. RNFAs are experienced perioperative RNs or APRNs who assist in surgery after advanced training and certification. An RNFA nurse performs preoperative, intraoperative, and postoperative care beyond the scope of an OR nurse. RNFAs and scrub nurses perform similar tasks, but the real difference is an RNFA's increased abilities in the operating room.
Specific duties for an RNFA may include:
- Preparing patients for surgery
- Handling and using surgical devices
- Draping surgical site and maintaining the sterile field
- Performing and suturing incisions
- Taking part in postoperative patient care
- Achieving hemostasis through the controlling of incisional bleeding
- Educating patients and their families
- Postoperative incision assessment and care
- Using instruments and medical devices
- Providing surgical site exposure
- Handling and/or cutting tissue
- Providing hemostasis
- Suturing
- Wound management.
RNFA roles and responsibilities vary depending on their workplace and the surgeons they work with.
Steps to Becoming an RNFA
Becoming an RNFA is a challenging process involving a basic BSN program followed by the accumulation of considerable perioperative experience and several certifications. This process is intensive yet achievable for ambitious nurses with a keen interest in the field. The total time it takes to become a registered nurse first assistant ranges from six to nine years.
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Here's a breakdown of the steps involved:
Earning Your Registered Nursing License: Becoming an RNFA starts with earning your registered nursing license. Community colleges commonly offer associate degrees in nursing (ADN). This entry-level nursing degree typically requires two years of full-time enrollment, although it may take longer without first completing prerequisite courses. A bachelor of science in nursing (BSN) is a four-year degree. Nurses with ADNs can enroll in RN-to-BSN programs. These degree tracks last 9-24 months, and many programs are geared toward working nurses. Candidates with bachelor’s degrees in non-nursing fields can complete accelerated BSN programs. This entry-level degree track offers transfer-friendly policies for enrollees to bring past credits. Accelerated programs use an intensive course of study over 11-18 months.
ADN Degree: ADN programs are common at community colleges. This degree fulfills the minimum eligibility to sit for the NCLEX and earn RN licensure. Completing an ADN takes around two years, although prerequisites can lengthen the process for some students. As of Jan. 1, 2020, nurses pursuing ADNs must complete BSN programs to apply for certification and practice as RNFAs.
- Admission Requirements: High school diploma or GED certificate with 2.5 GPA; completed application with transcripts; 2.5 college GPA (if previous college experience); HESI Exam (scored subtests: math, reading comprehension, vocabulary and general knowledge, grammar)
- Program Curriculum: Clinical assignments, nursing care, pathophysiology, physical assessment, psychosocial assessment
- Time to Complete: 2 years
- Skills Learned: Nursing assessment, critical thinking, nursing process, hands-on patient care, psycho-emotional and psychosocial assessment
BSN Degree: Earning a BSN degree is an important step toward becoming an RNFA. A traditional BSN program covers English, math, and other general education courses plus microbiology, anatomy, and physiology, and 2-3 years of lecture-based education and clinical hands-on training. A BSN is often considered the minimum degree required to pursue a master’s degree in nursing. Many hospital employers require all nurse candidates to hold BSNs, so earning this degree is a smart career move for most nurses interested in working in acute care settings.
- Admission Requirements: 2.5-3.0 GPA; college and high school transcripts; completed application, often with personal essay; successfully completed prerequisites; SAT or ACT scores; CV or resume
- Program Curriculum: Clinical assignments, nursing care, pathophysiology, physical assessment, management and supervision, delegation, community health, population health, evaluation of scientific research
- Time to Complete: 4 years for a traditional program, less for RN-to-BSN or accelerated BSN programs
- Skills Learned: Nursing assessment, critical thinking, nursing process, hands-on patient care, psycho-emotional and psychosocial assessment, management and supervision, delegation, community health assessment, evaluation of research
Passing the NCLEX-RN: All ADN and BSN students must pass the National Council Licensure Examination (NCLEX-RN) to earn their nursing licensure. Recent graduates can take the exam within one month of graduation. The NCLEX-RN exam applies to ADN and BSN graduates, while the NCLEX-PN exam is for those who have graduated from practical nurse certificate programs. Approximately 80% of first-time candidates passed the NCLEX-RN in 2024 so far.
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Gaining Perioperative Nursing Experience: On-the-job training programs will get your foot in the door of surgical nursing. RNFA programs require at least two years of this vital and relevant nursing experience. Many employers may require candidates to have at least 1-2 years of experience in medical-surgical environments or other acute care settings. This requirement applies because of the high-stakes nature of the OR and the critical-thinking skills required to succeed. However, some hospitals offer new graduate residency programs for the OR. To become an RNFA, you must gain operating room experience and become certified as a CNOR or become an APRN.
Completing 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. Most importantly, you should ensure the program you select is approved by the AORN. According to the AORN Standards for RN First Assistant Education Programs, all candidates for RNFA certification must also complete six credits of post-RN education.
- These programs must include:
- Didactic education (with specific requirements outlined in detail by the AORN)
- Clinical training of at least three credit hours (with specific requirements outlined in detail by the AORN)
- These programs must include:
Earning CNOR Certification: An RN with an unrestricted license and at least two years of experience in a perioperative setting can take the national certification exam to become a CNOR. Sitting for the CNOR exam and earning the CNOR credential is achieved by fulfilling the following requirements:
- Unrestricted RN license
- Currently working full-time or part-time in perioperative clinical practice, education, or research
- Completing a minimum of two years and 2,400 hours in perioperative nursing practice, with at least 1,200 hours in the intraoperative setting
Consider APRN Certification: RNs who choose to earn MSNs can become APRNs. Most MSN programs take around two years to complete. Each APRN needs to complete an assessment covering competency in preoperative and postoperative care from a program instructor. A master of science in nursing (MSN) expands nurses’ career potential. The MSN is the minimum requirement to become an APRN and suits nurses seeking increased specialization, autonomy, and/or clinical responsibility.
- Admission Requirements: BSN degree, unless enrolled in an RN-to-MSN bridge program
- Program Curriculum: Advanced pharmacology and pathophysiology; legal and ethical issues in nursing; theory and research; advanced physical assessment; diverse populations; practicum or capstone experience
- Time to Complete: 2-3 years
- Skills Learned: Advanced physical assessment, management of nurses and direct reports, research, advanced pharmacology, diagnosis, treatment of common diseases
RNFA Certification (Optional but Recommended): 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. Finally, RNs can validate their knowledge and experience by earning specialty board certification as RNFAs. To do so, they must first complete an AORN-approved RNFA program. Nurses have two years to complete the program, but many APRNs graduate as early as 5-8 months.
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- RNAS-C: 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.
- CRNFA: 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. As a CRNFA, you'll be a more competitive job candidate and have more leverage in salary negotiations.
RNFA Program Options
There are several reliable resources to help nurses find approved RNFA programs. According to the NASC list of acceptable RNFA programs, no program is directly affiliated with NASC, and each will have its own eligibility requirements. NASC lists programs in Alabama, California, Colorado, Florida, Illinois, Kentucky, Massachusetts, Michigan, Missouri, New York, North Carolina, Pennsylvania, and Tennessee. Each candidate applying for CRNFA certification through NASC must submit a copy of a certificate of completion from an acceptable RNFA program. AORN links the accepted programs in its RNFA resources. *NIFA is a licensed provider approved by the California Board of Registered Nursing. The following RNFA programs have met specific criteria and are acceptable programs for CRNFA or RNAS-C eligibility. These programs are in compliance with AORN recommendations for RNFA programs. None of the programs listed are affiliated with NASC, so they may have separate eligibility requirements for enrollment. Links have been provided where available. This is a list of current RNFA programs meeting the criteria and does not include historical programs. St. St. Program Director: Nicole L. Director Perioperative Programs: Jacqueline R.
Here are some examples of RNFA programs:
- Delaware County Community College: Delaware County Community College's RNFA program is based in the township of Marple, located just outside of Philadelphia. This six-credit program combines online and in-person education, splitting the two required courses over two semesters. The first-semester course requires a five-day visit to campus, and the rest is completed online. The second-semester course is an independent internship completed wherever the student wants.
- NIFA (National Institute of First Assisting): One of the more comprehensive RNFA programs is offered by NIFA, a Colorado-based organization that focuses solely on first assisting education. Currently, the largest RNFA program in the nation, NIFA uses three- and five-day workshops to teach nurses basic RNFA skills and requirements. Nurses then complete an internship to finish the program. Any graduates who feel they haven't mastered the subject matter can take the program again at no cost.
- St. Elizabeth Healthcare (in conjunction with Northern Kentucky University): Located in Edgewood, Kentucky, St. Elizabeth Healthcare is a local leader in medical services. The healthcare center's RNFA program, offered in conjunction with Northern Kentucky University, begins with a five-day face-to-face experience in Northern Kentucky. Next, students begin a clinical internship worth at least 130 hours. Upon finishing the program, students earn six college credits from NKU and a certificate of completion.
- Gulf Coast State College: Gulf Coast State College, located in Panama City, Florida, is intended specifically for RNs who want a fast track to the surgical department. Like most RNFA programs, Gulf Coast's program blends online learning with on-campus education and takes roughly two semesters to complete. Students can choose to either complete their clinicals in their hometown or gain clinical experience on-site in Florida.
- University of Rochester: Created for APRNS or certified operating room nurses (CNOR), the University of Rochester's RNFA program sets relatively strict admission requirements. However, the university offers flexibility in how students complete the program. First, students complete courses from a distance, and courses fit around nurses' schedules. Next, nurses attend an in-person lab day. Finally, students complete a 50-hour internship in the state where they hold their RN license.
- University of Tennessee: Created for both RNs and APRNs, the University of Tennessee's RNFA program requires three courses completed over a year. The first two courses, completed during the fall and spring semesters, are both online, except for a 40-hour on-campus workshop during the first course. The third course requires 180 clinical hours in perioperative practicum.
- University of Massachusetts: The University of Massachusetts' RNFA program is in collaboration with UMass Chan Medical School and is open to BSN-prepared RNs with a CNOR, advanced practice nurses, or students who are currently in an advanced practice graduate program. There are two required courses. The first course uses a hybrid format, teaching three live classes in person on Saturdays in Worcester, Massachusetts. The second course is essentially an internship requiring students to complete 270 precepted hours, allowing nurses to gain clinical experience.
- University of Alabama at Birmingham: Unlike other RNFA programs, the University of Alabama at Birmingham offers its RNFA option as an MSN subspecialty; however, BSN-prepared nurses must have their CNOR at the time of application. The RNFA subspecialty requires three courses, one of which consists only of clinical experience.
- University of California Los Angeles (UCLA): The University of California Los Angeles offers an RNFA program for current RNs and APRNs. The program begins with a six-day, 52-hour course completed at UCLA. Next, students must complete a 120-hour independent preceptorship. However, students must set up their own preceptorships, and UCLA sets preceptorship requirements during the program's first course.
- St. Charles Community College: Located in Cottleville, Missouri, St. Charles Community College begins its six-credit RNFA program with six days of on-campus study. Next, students complete a three-credit internship program to gain clinical experience. This internship must consist of at least 120 hours, though students can complete it wherever they want.
RNFA Licensure and Certification
RNs and APRNs can serve as RNFAs, depending on the requirements of the employing institution. An active RN license is required to practice as an RNFA. Maintaining RN licensure is based on the continuing education (CE) requirements of the state where a nurse lives and works. Successful completion of 30 CE hours every two years is common in many states. According to the AORN’s RNFA position statement, qualifications for serving as an RNFA include:
CNOR certification
Completion of an RNFA program that meets the “AORN standards for RN first assistant education programs”
Compliance with institutional and state regulations, statutes, and policies
BSN degree, with the exception of RNFAs practicing before Jan. 1, 2020
Completion of AORN requirements of six hours of post-RN RNFA education provided by an accredited school of nursing. This requirement includes three credits of didactic and three credits of clinical RNFA training as outlined by the AORNSitting for the CNOR exam and earning the CNOR credential is achieved by fulfilling the following requirements:
- Unrestricted RN license
- Currently working full-time or part-time in perioperative clinical practice, education, or research
- Completing a minimum of two years and 2,400 hours in perioperative nursing practice, with at least 1,200 hours in the intraoperative setting
- Certification as an RNFA is required for clinical practice.
Career Outlook and Salary
As a registered nurse first assistant, you can work at any surgical facility. These include hospitals, surgery centers, plastic surgery centers, and more. According to the BLS, there's a predicted 5% (faster than average) growth rate for RNs over the next decade. 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.
The average annual RNFA salary is $125,000 per year, as reported by Payscale in 2025. 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. 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. According to September 2025 Payscale data, surgical assistants had the highest salaries among common RNFA positions, averaging about $138,292 per year.
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